Indian Journal of Forensic Medicine and Pathology

Introduction: A fall from considerable height followed by landing on a surface can lead to multiple injuries which can be sustained during the fall or after landing on the ground. The injuries sustained after a fall from height can vary from an abrasion or contusions to more severe injuries like fractures, head injury, injury to the visceral organs or even death. This study was conducted to interpret the injuries caused due to fall from a considerable height and their medicolegal interpretation in cases brought for autopsy to a Tertiary Care Hospital of Northern India. Aims and Objectives: To study the pattern of distribution of external and internal injuries in autopsy cases of deaths caused by a fall from height and to analyze their demographic characteristics. Methodology: This cross-sectional study was conducted over a period of one and a half years from 1st January’ 2020 to 30th December’ 2020 in the Department of Forensic Medicine, Indira Gandhi Medical College, Shimla. Results: During our study period, 125 (26%) cases were of fall, out of which, most of the cases were in the age group of 51-60 years (22.4%), 110 (88%) were males. The commonest region sustaining the primary impact was Head in 98 (78.4%) cases. The intracranial findings were present in 105 cases. The internal thoracic injury was present in 57 cases. The spinal fractures were found in 33 cases. The abdominal visceral injuries were found in 18 cases. 55 (44%) cases suffered fall from a height of 10-20 feet. Conclusion: This study highlights that falls remain a significant cause of mortality, accounting for 26% of the total autopsy cases examined during the study period. The most affected demographic was middle-aged adults, particularly those between 51–60 years, with a notable male predominance (88%). the study underscores the urgent need for preventive strategies, especially in rural and occupational settings, as well as improvements in pre-hospital care and trauma management to reduce fall-related fatalities.

Introduction: Electricity is an essential resource in modern society. However, its ubiquitous presence also presents inherent risks to human life. Although electrocution deaths account for a small proportion of overall fatalities, which can be preventable, which represents a significant public health concern due to accidental exposure, equipment malfunction, and failure to use proper safety precautions. Objective: To analyze the demographic profile, seasonal variation, occupation, and forensic characteristics of electrocution deaths in Northwest Delhi, India, over five years. Methods: A retrospective review was conducted on 105 autopsy-confirmed electrocution death cases from the Department of Forensic Medicine at Dr. Babasaheb Ambedkar Medical College, Rohini, Delhi (2018–2022). Results: Electrocution fatalities accounted for approximately 1.2% of all autopsy cases. Males predominated (95 cases, 90.5%), with the most affected age group being 21–30 years (40 cases, 38.1%), followed by 11–20 years (26 cases, 24.8%) and 31–40 years (21 cases, 20.0%). Cases peaked during the monsoon season (June– September; 73 cases, 69.5%), with the highest incidence observed between 12:00 PM and 5:00 PM (41 cases, 39.0%). The labor class represented the most common occupational group (24 cases, 22.9%), and the most common source of electrocution was the exposed electric wires and faulty electrical boards (18 cases, 17.1%). Upper extremity involvement was most frequent (73 cases, 69.5%), with entry wounds identified in 92 cases (87.6%) and both entry and exit wounds observed in 7 cases (6.7%). Conclusion: The study indicates that electrocution deaths in the Northwest region of Delhi are predominantly due to accidents and occur most often in young males, particularly during the monsoon season and afternoon hours. So, several preventative strategies including improved electrical safety education, regular maintenance of electrical installations, and heightened public awareness are essential to reduce these fatalities.

Background: Bloodstains are commonly encountered biological evidence at the crime scenes. Bloodstain pattern analysis provides crucial information about height of fall, angle and force of impact assisting in crime scene reconstruction. Objective: The present study was conducted to evaluate the influence of surface characteristics and height of drop of fall of blood drop on various porous and nonporous surfaces on bloodstain pattern analysis for forensic purpose. Methodology: In the present study, simulated blood was prepared using red water color and corn flour homogenized with distilled water to attain the consistency and appearance of real blood avoiding ethical implications associated in using real blood. The experiment was conducted to examine the bloodstain patterns formed on various porous (paper, cardboard and soil) and non-porous (glass, metal and tile) surfaces when simulated blood was dropped passively from various heights with a constant impact angle of 90º. The experiment was carried out in triplicate. The bloodstains were analyzed for the shape, size and distribution. Results: The results showed an increase in size of the stain with increase in height of fall across all surfaces. Depending on point of impact, soil showed different bloodstain patterns while paper and cardboard due to their absorbent nature displayed larger stains with prominent satellite stains and spikes on the edges of the central stain. Non-porous surfaces displayed more uniform smaller stains with no spikes on the edges and few secondary stains. Conclusion: Simulated blood can be used as an effective, ethical and safer substitute to real blood for employing in training, research and forensic experimentations.

Background: Head and neck Squamous cell carcinoma (HNSCC) is a highly rapidly spreading invasive malignant tumour of the epithelium and in the entire world, it is the sixth most common malignant neoplasm. EGFR protein is crucial for several processes that impact tumor genesis, growth, differentiation, suppression of apoptosis and metastatic development. Increased expression of EGFR is linked to poor clinical outcomes and resistance to radiation therapy. Aim: Evaluation of expression of EGFR is done in HNSCC and it is correlated with various parameters like histological grade, staining intensity, percentage of tumor cells stained and its prognostic significance is determined. Materials and methods: Total number of 80 cases were studied and statistically p value is determined. Results: Females holds the majority of 51cases (63.75%) and males were 29 cases (36.25%). Age group 41 to 50 years has highest occurrence which is followed by 51 to 60 years. 63.75% of patients have positive smoking history. 71.25% have history of tobacco use. Most common site of tumor is oral cavity (95%). Majority of the cases were conventional Squamous Cell Carcinoma (95%) and verrucous carcinoma comprising (5%) cases. Most of the patients had grade I tumors (53.75%). 51.25% of cases have strong intensity in staining. Greater than 50% of cells are stained by EGFR in 56 cases and p value is statistically significant. Conclusion: High EGFR expression is a helpful diagnostic and prognostic immunohistochemical marker especially in advanced cancers. EGFR targeted therapy along with radiotherapy, chemotherapy can be used for locally advanced, metastatic and recurrent Head and Neck squamous cell carcinomas

Background: Medico-legal autopsy is often warranted in cases of sudden and unexpected deaths. In the present study period, 2,267 such autopsies were carried out, with 222 cases (9.79%) identified as sudden and unexplained deaths. The analysis considered all natural deaths occurring within 24 hours from the onset of symptoms, as per the WHO definition. Aim: The primary aim of this study is to examine the sociodemographic characteristics associated with sudden natural deaths. Objectives: To study the predominant age group involved, gender predominance, and to know about the socioeconomic groups in sudden death cases. Material: This prospective study was carried out in the Department of Forensic Medicine, Government Medical College, Mumbai, spanning a two-year duration from January 2020 to December 2022. Results: A total of 2,267 cases were brought for medicolegal autopsy to the mortuary, of which 222 were identified as sudden natural deaths, accounting for 9.79% of the total. All autopsy cases where the cause of death was certified as natural, along with those brought dead to the casualty without any evidence of unnatural cause, were included in the study. The distribution of these cases across various sociodemographic variables was examined, and all data were analysed using appropriate statistical methods with SPSS software. Conclusion: Sudden deaths can occur at any age, but the most common age group is 51-70 years, and it is more common in the Hindu religion and among the people of the lower middle class; therefore, raising awareness of associated risk factors and promoting early intervention may help mitigate the occurrence of such deaths.

Background: Lip print is a common type of evidence found in a forensic context. The determination of the sex from an in-situ lip print is a critical job. Aim and Objectives: The present study aimed to investigate the sexual dimorphism present in lip groove patterns and Cupid’s bow morphology for sex determination. Materials and Methods: The bilateral lip prints were obtained from 100 healthy youths, including 49 males (23.82±8.52) and 51 females (22.25±7.49) from North 24 Pargana District, West Bengal. All the prints were analyzed to quantify total grooves, vertical, cross, and fork-type grooves on both upper and lower lips. Results: Males exhibited a significantly (p<0.05) higher count of vertical grooves on the lower lip, whereas females showed a significantly (p<0.05) higher count on the upper lip. However, the Cross-type grooves were significantly (p<0.05) dominant in both lips of the studied females. Total groove count across both lips was also significantly (p<0.05) higher in females. However, the fork-type grooves in the lower lip showed a significantly higher (p<0.05) count in males. Apart from those, Cupid’s bow morphology showed distinct patterns among the males and females, V-type structures significantly (p<0.05) predominated in the upper lips of males, while W-type structures were significantly (p<0.05) frequent in females. However, the lower lip showed significant (p<0.05) sexual dimorphism, with round structures significantly (p<0.05) prevalent in males and flat structures in females. Conclusion: Therefore, lip print analysis can be used as a reliable indicator for individual and gender identification in a Forensic context

Introduction: Sex determination based on skeletal features plays a crucial role in forensic identification. There is sparse data on the metric cranial and mandibular criteria for Indians. This study aimed to establish population-specific standards for sex determination in the crania and mandibles of adults using logistic regression analysis. Materials and methods: The sample consisted of 300 participants (150 males, 150 females; age range: 18-30 yrs) of Indian origin. Fifteen standard cranial and 10 mandibular measurements were recorded on radiographic images and processed using a computer-aided drafting program (Adobe Photoshop 7 CS3 extended). To ascertain the usefulness of these parameters in sex prediction, a logistic regression analysis was performed. Results: All cranial parameters, except the upper facial height (G-ANS) and orbital measurements, showed sexual dimorphism. All mandibular parameters, except the mandibular angle, showed sexual dimorphism. The cranial measurements had a sex assessment accuracy of 86%, and the mandibular measurements had an accuracy of 82.7%. The combination of these parameters significantly improved the accuracy to 89.7%. Conclusion: This study on crania and mandibles of the Indian population clearly indicates that they have satisfactory potential for sex determination in adult Indians in forensic contexts. The width measurements, that is, bizygomatic breadth for the crania and bigonial breadth for the mandibles, were the most discriminatory.

Introduction: Road Traffic Accidents (RTAs) are a major cause of unnatural deaths, especially in developing countries. It is necessary to consider the limitation of human body for designing safety equipment necessary to safeguard human life. This study aims to analyse the pattern of injuries and the survival period of victims amongst the other objectives to increase the awareness about fatal injuries resulting from road traffic accidents. Methodology: This prospective cross-sectional study analysed 242 fatal RTA cases autopsied at HIMS Teaching Hospital, Hassan, between January 2023 and June 2024. Results: The majority of victims were males (87.6%) in the 41–50-year age group (21.5%), with two-wheeler drivers being most common victims (41.7%). Maximum victims died (48.8%) before any first aid was made available. A combined Sub dural hemorrhage and Sub arachnoid hemorrhage (88.5%) was most frequently noticed pattern of intracranial hemorrhages. Head injuries sustained (61.6%) was the leading cause of death. Conclusion: The age group of victims commonly affected suggests the socioeconomic status of the place, and their need for using two wheelers for commuting during evening time. This highlights the need for improved trauma care, lack of awareness about the need for using helmets. Targeted preventive strategies, public awareness campaigns and strategies for stricter enforcement of law are recommended.

Background: Suicide presents an increasingly significant challenge to the health of the Indian population, and patterns of methods and modes of self-harm are changing. During the past few years, the southern states have continued registering one of the highest suicide rates. The growing prevalence of methods that are fatal and the advent of family related suicides are an indication of changing social, psychological and economical strains. Such patterns are crucial in creating responsive and preventive approaches to mental health. Objectives: The objective of the study is to find out the trends of suicide in five south Indian states and predict the future trends in order to enable regional planning. It also touches on demographic trends and discrepancies set by gender on the cause basis. Methods: Official NCRB data on suicide over ten years were combined and evaluated. Long-term developments and predictions of the future rates were made with forecasting methods. Regional and gender-related trends were evaluated on the basis of the causes reported and demography available. Results: The results of analysis show that suicide rates continue to increase in the majority of the states in the region. Disparities were noted in the contributing factors between the male and female populations and economic stressors were more common among males and interpersonal or domestic factors were common among women. Conclusion: The results indicate that the need early intervention, area-specific mental health care and area-specific awareness efforts should be an essential aspect of attempting to prevent the predicted increase in the suicides in South India.

Background: Violent asphyxial deaths constitute a major proportion of medicolegal fatalities in India, with hanging and drowning being the most common mechanisms. Regional epidemiological data are essential for forensic interpretation and prevention strategies. Aim: To study the pattern and characteristics of violent asphyxial deaths in the Belagavi region with respect to demographic, environmental, and socio-economic factors, and to evaluate the effects of neck constriction in different forms of asphyxia. Materials and Methods: A prospective autopsy-based study was conducted over 18 months (November 2012–April 2014) at the Department of Forensic Medicine and Toxicology, Belagavi Institute of Medical Sciences, Karnataka. Out of 1,176 medico-legal autopsies, 175 cases of violent asphyxial deaths were included. Data regarding age, sex, marital status, residence, season, motive, manner of death, and type of asphyxia were collected from police records, circumstantial history, and detailed postmortem examination. Statistical analysis was performed using descriptive statistics and chi-square test. Results: Violent asphyxia constituted 14.88% of all autopsies. Hanging (62.28%) was the most common type, followed by drowning (28.57%). Suicidal deaths predominated (78.86%). Males were more commonly affected (73.71%), with the highest incidence in the 21–30 year age group. Married individuals and rural residents constituted the majority. A significant seasonal variation was observed, with maximum cases during summer. Hyoid bone fracture was noted in 20% of cases. Conclusion: Hanging and drowning remain the predominant modes of violent asphyxial deaths, mainly suicidal in nature, affecting young adult males from rural and socio-economically stressed backgrounds.

Background: Prune belly syndrome (PBS) is a congenital and rare condition which presents a partial or complete triad of deficiencies or absence of muscles of abdomen, abnormalities in the genital organs like cryptorchidism and abnormalities of the urinary tract. This condition is usually not compatible with life. Case presentation: A 26-year-old female, fourth gravida with 1 alive and well child and 2 abortions, a known case of hypothyroidism, delivered a stillborn baby at 19 weeks of gestation. On autopsy there was lax, “prune belly” like abdominal wall, low set ears with club foot, hypoplastic lungs, crytorchidism, blind cloacal sac, urachal sac, hypoplastic left kidney, hydroureter, urethral and anal atresia. A case of prune belly syndrome with urorectal malformation sequence was diagnosed. Conclusion: Anomaly scan should be advised wherever a routine obstetric scan shows abnormality of the lungs or urinary system to rule out prune belly syndrome.