Indian Journal of Forensic Medicine and Pathology

A planned complex suicide is the complex action mechanism, formerly planned to protect the victim of suicide from failure. A 22-year-old female body was brought by the relative to the hospital with cut injury in the both forearms. Autopsy findings revealed cut injury in both forearms with ligature mark around the neck. Death scene investigation, Forensic science lab reports and different observations confirmed, it is a case of planned complex suicide. To the best of our knowledge combination of methods used in this case is unique and has not been reported. The sequence of events in this case was difficult to determine as both the methods used, viz. cut wrist and hanging were sufficient to cause death individually. Also the sequence of event made it more difficult to determine.

Venomous and poisonous animals are a major cause of global morbidity and mortality with cardiovascular and renal toxicity as common presentation. Renal functional impairment as a result of their toxicity is manifested in form of specific histopathological changes. Regardless of vast mentioning of renal toxicity in literature previously, only few studies are currently available with an integrated approach. This paper mentions about various such animals with nephrotoxic potential describing the toxic principles in their venom and inflicted changes in renal pathology.

Background and objectives: Scorpion sting is a frequent, life-threatening medical emergency in children. They constitute a significant public health problem in many underdeveloped countries, including India. This study was done to study the epidemiological factors responsible for high prevalence of scorpion sting in our community. Methodology: This is an observational study of 35 cases of scorpion sting, admitted at our institute. An epidemiological study was done to determine the factors predisposing to prevalence of scorpion sting in the community. Results: Scorpion sting is a common, pediatric emergency in our area. Rural male children, from lower socioeconomic groups, aged between 1–3 years (28%) and 3–10 years, (57%) were most commonly affected. Maximum admissions in May, June. Conclusion: Scorpion sting is a serious, potentially fatal emergency in our area. Cardiovascular manifestations are most common and life-threatening. Scorpion stings constitute a "occupational hazard" for children employed as agricultural laborers. The epidemiological factors affecting the severity of scorpion envenomation are studies in the present study. The various factors are season summer being 49% cases, rural area common being 64%, scorpion sting common in lower socioeconomic strata residing in kaccha house. Sting found more in night time and 44% were in outdoor. Sixty eight percent scorpion stings were on exposed part of body.

Introduction: Cervical cancer screening using Pap smear is the cornerstone of any cancer control program. The study aimed to know the burden of various cervical lesions which were assessed by conventional Pap smear study. Methodology: We included 500 referred symptomatic patients in the study. The history, deatiled clinical examination, per speculum examination and a vaginal examination were performed for all women. Pap smear was used to screen all women for cervical cancer. Results: Mean age of the study population was 44 years and the most common complaint was whitish discharge per vaginam (54%). Classifying patients according to the Bethesda System 2001 Guidelines, we observed 61% (n = 303) cases to be Negative for Intraepithelial Lesion or Malignancy (NILM), 36% (n = 182) as Atypical Squamous Cells (ASC), 2% (n = 10) as Atypical Endocervical Cells (AEC) and 1% (n = 05) as unsatisfactory. Of the 303 cases of NILM, non-specific inflammatory changes were seen in 63%, reactive cellular changes in 21%, atrophic changes in 10%, candidiasis in 3%, Gardnerella vaginalis in 2% and inflammation with Trichomonas in 1%. Of the 182 ASC, 30% had low-grade squamous intrapeithelial lesion, 26% atypical squamous cells of underdetermined significance, 24% with high-grade squamous intraepithelial lesion and 21% with squamous cell carcinoma. Of the 10 AEC cases, 1 case had adenocarcinoma. Conclusions: Pap smear is less invasive, cost-effective and simple procedure which can be used to detect dysplasia in the cervix.

Introduction: An accurate assessment of c-erbB2 expression in invasive breast cancer (IBC) has become crucial to precisely recognize the candidates to be treated with Trastuzumab. Presently, fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) are most commonly employed methods for evaluating c-erbB2 status. Recent literature has documented a strong correlation between the two c-erbB2 diagnostic analyzes. However, discordance between both the assays has been rarely reported. Therefore, we aimed to compare and correlate FISH and IHC results for c-erbB2 expression in Indian breast cancer patients. Material and methods: A total of 388 formalin fixed, paraffin embedded blocks of invasive breast cancer were retrospectively evaluated for c-erbB2 status by IHC (DAKO) and FISH (PathVysion dual-probe system) and results were compared. Results: 92.5% cases with IHC 3+ score showed significant concordance with the FISH results; while c-erbB2 gene amplification was noted in 48.3% of IHC 2+ cases. A large number of referral cases in the study group and variation in pre-analytical and analytical factors have attributed in escalating the number of indeterminate cases expressing c-erbB2 gene amplification. Additionally, an inverse correlation was revealed between ER/ PR expression and c-erbB2 status. Conclusion: The results of the current study established a high degree of concordance between IHC and FISH in Indian breast cancer patients with 3+ immunoreactivity. However, reflex testing by FISH is recommended for IHC equivocal cases in order to avoid false results related to technical and interpretation errors, usually encountered while performing an immunohistochemical assessment.

Introduction: The teeth are one of the durable parts of our body which can withstand more assaults than any other part of the body and there exists a relation between tooth crown length and body height. The study aims to determine the possible correlation between tooth dimensions and stature estimation using Carrea’s index. Materials and methods: The study group comprised about 67 subjects above 18 years. Alginate impressions were made for mandibular arch and height was assessed. The mesiodistal widths of mandibular anterior teeth were measured and substituted in the formula given by Carrea to obtain the minimum and the maximum estimated height of a person. Results: On comparison of the Carrea’s index in right side, females showed 9.3% successful prediction, on left side 8.3% showed successful prediction in males than in females. The height was accurately predicted when average values of left and right side were considered. Females showed 55.8% accuracy and males showed 37.5% which was statistically significant. Discussion: Teeth could be used as a reliable source for stature estimation especially in those forensic cases where other body parts are not available. In the present study the average values from right and left side were considered for both genders to predict the height of the individual. Our findings could be explained on the basis that perfect bilateral symmetry seldom exists on right and left side arches which could be due to congenital or environmental factors or both. The Carrea´s index for stature estimation is a convenient, simple and inexpensive method, and can provide valuable information to the forensic investigation.

Background: Autopsy study of liver aids in the knowledge of pathology by revealing lesions that were asymptomatic during life. Due to enormous functional reserve, many liver lesions are silent till late in the course of disease. Hence histopathological study of all liver specimens is necessary. Material and methods: The present study included 260 liver specimens from medicolegal autopsies received over a period of two years from August 2014 to July 2016. Thorough gross examination was done followed by microscopy. Result: The most common lesion was steatosis, accounting for 78 (30%) out of 260 liver specimens. There were 43 (16.5%) cases of congestion, 20 (7.8%) cases of hepatitis and 17 (6.5%) cases of steatohepatitis. Ten (4%) cases of cirrhosis were noted. Other lesions included microabscesses 7 (2.6%), granulomas 6 (2.3%), and one case (0.3%) each of bile duct hamartoma, sickle cell anemia, disseminated intravascular coagulation, extramedullary hematopoiesis, disseminated cryptococcosis and microfilarial infection. Conclusion: The present study showed that fatty change was the most common lesion encountered in liver specimens from medicolegal cases, followed by congestion and hepatitis. Hence histopathology of every liver specimen is must.

Keywords: Medicolegal autopsy; Fatty change; Cirrhosis.

The therapeutic perception of access to medicines and health care in government hospital of Union Territory of Jammu and Kashmir (UToJ&K) is an empirical study of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar in right based approach underpinned in Patents (Amendment) Act, 1970, Patents (Amendment) Act, 1999, Patents (Amendment) Act, 2002 and Patents (Amendment) Act, 2005, Essential Commodities Act, 1955 and Drug Price Control Order, 1995. On the other hand consumer law perspective are rooted in Consumer Protection Act, 1986, J&K Consumer Protection Act, 1987 and Consumer Protection Act, 2019. The broad parameters are access to medicines, health care system, health delivery services, patient satisfaction and utility and doctor – patient relationship. It is estimated that substantial section of population in Union Territories of Jammu and Kashmir is health deficient and medicine starved due to unavoidable contingency, spiraling cost shifting and inordinate health care infrastructures. The therapeutic perception needs a closer analysis of attendance and care of patients, diagonostic methods of treatment and access to medicine in the context of medico-legal profiling of SKIMS, Srinagar.

Introduction: Granulomatous mastitis (GM) is a rare, chronic inflammatory condition of obscure etiology, varied clinical and pathological features. Methods: This was a restrospective, three-year analysis, of the clinical and histological parameters of diagnosed cases of GM. Results: An analysis of age at presentation revealed the mean age as 35.3 yr. Clinical data was available for 26 patients and the mean lesional size was 5.3 x 4.3 cm. The most common presenting complaint was as a lump, with diffuse swelling and nipple discharge next in frequency. Clinical diagnosis varied widely from benign to malignant. Treatment administered included incision and curettage, lumpectomy and simple mastectomy. Thirty-eight cases reviewed showed granulomas in all the cases. Caseous necrosis was absent. Special stains for tubercular bacilli and fungi had been done in 26 cases and were negative. Follow-up ranged from 3–5.5 years. Recurrence was documented in 57.6% of patients. Conclusion: GM, generally, is a disease of young women that is of particular significance since it can easily be mistaken for malignancy. Histopathological diagnosis is confirmatory.

Background: Metric and non-metric analysis of the human dentition have played an important role in human biological research and have formed a central focus in the field of dental anthropology for over a century. This study intends assess the degree of sexual dimorphism in permanent anterior teeth in south Indian origin student population. Aim: The purpose of this study is to analyze the mesiodistal crown width of permanent anterior teeth and assess the degree of sexual dimorphism in permanent anterior teeth in south Indian origin student population. Materials and methods: Materials for this cross-sectional study consisted of 210 students belonging to various parts of South India (Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, and; union territories of Lakshadweep and Pondicherry) comprising of 100 males and 110 females in the age group of 18–25 years studying at A. J. Institute of Medical Sciences and Research Centre, Mangalore, Karnataka who are willing to participate in the study. Methods for the study consisted of measuring the maxillary and mandibular incisor and canine widths of these students using a digital caliper with a resolution of 0.01mm with the provision to fix it in position to the desired position so as to avoid any errors in recording the exact measurements of canines. Results: 100 males and 110 female students in the age group of 18–25 years, from various parts of South India were examined to predict the sex from the mesiodistal widths of permanent anterior teeth for both the arches. The mean mesiodistal width of mandibular central incisor was greater in males (Right: 5.55 ± 0.39 mm; Left: 5.59 ± 0.38 mm) than females (Right: 5.43 ± 0.34 mm; Left: 5.44 ± 0.34 mm). The mean Mesiodistal width of maxillary central incisor was greater in males (Right: 8.60 ± 0.52 mm; Left: 8.60 ± 0.58 mm) than females (Right: 8.29 ± 0.52 mm; Left: 8.24 ± 0.67 mm). The mean Mesiodistal width of mandibular lateral incisor was greater in males (Right: 6.07 ± 0.45 mm; Left: 6.10 ± 0.38 mm) than females (Right: 5.83 ± 0.41 mm; Left:

Objectives: The study was contemplated to ascertain the trends of dermatoglyphic pattern in individuals with different ABO and Rh blood groups and to evaluate the relationship between the pattern of fingerprints and blood groups. Methodology: The study was carried out in the Department of Forensic Medicine at Government Medical College of southern Haryana. Medical students of the age group 18–24 years knowing their blood group and considering their accessibility to the department of Forensic Medicine were randomly selected for the study. Plain and rolled fingerprints for all digits of both hands were taken with ink pad on non-glazed paper. Results: The study revealed that loop was most frequently seen fingerprint followed by whorl, arch and composite. B positive is the most common blood group, and loops pattern of the fingerprint is predominant in all blood groups and Rh-positive and negative subjects, followed by whorls. Conclusion: Each fingerprint is unique; hence, it can be effectively used for corroborative identification of an individual in mass disasters as well as in other forensic applications. More studies with larger sample size should be conducted to enhance the reliability of correlation of dactylographic pattern with sex and blood group.

Introduction: Hashimoto’s/Lymphocytic thyroiditis is a common autoimmune disorder which has female preponderance. Autoimmune thyroiditis is considered as a complex interaction and interplay between various genetic and non-genetic factors. Molecular basis of Hashimoto’s thyroiditis is not known. Fine needle aspiration cytology being first line of investigation for thyroid lesions is helpful in diagnosing these lesions as well. However, few potential pitfalls in cytology may lead to cytohistologic discordance. Materials and methods: This is a retrospective study of one year where all histologic proven cases of Hashimoto’s/ Lymphocytic thyroiditis with their corresponding fine needle aspiration cytology slides from pathology database were studied. All FNACs were analyzed in depth and reviewed for cytohistologic correlation. The reasons of cytohistologic discrepancies and discordant cases were analyzed. The genetics of autoimmune thyroiditis was also reviewed from literature. Results: Out of total 38 cases of HT/LT analyzed in this study, 89% were females and 11% were males. Mean and median age was found to be 44.4 years and 44 years respectively. Correlation of cytology and histology showed that 50% FNACs’ correlated with their respective histologic diagnosis. Major causes of the discrepancies and discordance are reporting on suboptimal smears, cystic fluid samples, and giving over emphasis on a single cytologic feature in rare cell clusters. Conclusion: Autoimmune thyroiditis is frequently encountered lesion. Fine needle aspiration cytology is useful in deciding the management of thyroid lesions. In order to restrict the discrepancies and cytodiagnostic errors, one must adhere to the adequacy criterion along with primary fixation, quality of the smear and cellularity. Cytopathologists should be aware of the possible pitfalls and differentiating clues when overlapping features between different lesions are encountered. Also an integrated multidisciplinary approach can be used to minimize potential pitfalls. Many a time the condition can be diagnosed after death as seen in case of few sudden deaths. The unexpectedly brought in thyroid dysfunction is expected in such cases. So the forensic pathologist must keep this entity in mind while dealing with cases of sudden death.

Keywords: Autoimmune; Cyto-histologic discordance; Fine needle aspiration cytology; Genetics; Hashimoto’s thyroiditis

Introduction: Ovarian tumors are a group of diverse neoplasms with a varied clinical, morphological and histological feature. The varied anatomy, histogenesis and its peculiar physiology including the cyclical changes from puberty to menopause give rise to number of cell types, each of which may give rise to tumors. Materials and methods: A 3-year retrospective study of histologically proven ovarian neoplasms where the tumors were classified according to World Health Organization (WHO) 2014 classification and their clinical and histopathologic parameters were analyzed. Results: Of all 138 ovarian tumors studied, 94 (68.12%) were benign, 13 (9.42%) borderline and 31 (22.5%) were malignant in nature. Benign tumors chiefly presented with abdominal pain with median age of 39. Mature cystic teratoma was found to be the most common benign tumor. Borderline tumors presented at a median age of 37. Borderline serous and mucinous tumors (30.76%) were the most common borderline tumors. Malignant tumors presented frequently with abdominal mass and at median age of 48. According to WHO classification of tumors based on cell of origin, surface epithelial tumor were the most common ovarian neoplasms, accounting for 63.04% cases, followed by germ cell tumor (24%) and sex-cord stromal tumors (8.7%). Conclusion: Surface epithelial tumors were the most common histopathological subtype of ovarian tumors. Benign and borderline tumors were predominantly found in reproductive age, whereas malignant tumors were seen in perimenopausal and postmenopausal women. Since the prognosis, therapeutic strategies including multidisciplinary approach depend primarily on the histopathologic diagnosis, an accurate pathological evaluation and classification is of prime importance. The multidisciplinary approach employed has its own medico legal implications.

Keywords: Neoplasm; Epithelial Cancer; Ovarian

Background: The Protection of Children from Sexual Offences (POCSO) Act was enacted in 2012 with a view to curbing the menace of sexual assault, sexual harassment and pornography on children. The present study gives a profile of cases registered under the Act and subsequently brought to the Forensic Medicine Department for the purpose of medicolegal age estimation. Material and methods: Research was conducted in the Department of Forensic Medicine, NEIGRIHMS, Shillong. Data was extracted from records maintained in the office and analyzed using statistical software SPSS version 11 by descriptive analysis. All cases brought for age estimation under the POCSO Act, 2012 for the period May 2013 to June 2018 were included. Results: Medical examinations were performed in compliance to police requisitions from four districts of the state of Meghalaya. A total of 26 (twenty-six) individuals were brought for age estimation during the study period. Among those examined, 81% were victims and 19% accused in sexual offences. The majority of victims were female children in the 6–15 age group. Conclusion: These findings should draw the attention of doctors and healthcare workers to the problem of sexual crime against children and prompt them to work together with law enforcement and social organizations in securing justice for the vulnerable.

Introdution: Autopsy is recognized as a necessary part of medicine to establish final diagnosis, and relate the cause of death to the associated pathologies and the interaction between the two. Aim: To study and highlight the histopathological changes in lungs seen in autopsy cases. Methods: A cross-sectional study was done in the department of Pathology in a tertiary care hospital in Bangalore. A total of 100 lung specimens received from the department of forensic medicine for clinical autopsy over 3 years (January 2016 to January 2019) were studied. After noting the patient details and autopsy findings, the specimens were examined grossly and based on the gross findings, representative bits were given for histopathological examination. The histopathological findings were noted and results were statistically analyzed. Results: Amongst the 100 lungs studied, the commonest lesion was Congestion and/ Pulmonary edema (64%), followed by non-tuberculous pneumonia (15%), chronic bronchitis (5%), emphysema (4%), tuberculous pneumonia (4%), autolytic changes (2%), pulmonary embolism (2%), lung abscess (1%) and an immature lung (1%). Conclusion: This study highlights the various lesions in lungs from patients with history of varied causes of death and the lung lesions contributing directly or indirectly to the cause of death.