Indian Journal of Forensic Medicine and Pathology

Forensic medicine plays a critical role in medico-legal investigations, particularly in determining the cause, manner, and time since death (TSD). In recent years, transformative research driven by interdisciplinary innovation and technological advancements has significantly enhanced forensic capabilities. Molecular autopsy, post-mortem imaging, and genomic profiling are revolutionizing cause-of-death analysis, while digital forensics, injury biomechanics, and AI-based assessments are improving accuracy in identifying the manner of death. Meanwhile, emerging tools such as microbial forensics, RNA degradation studies, and then atomicrobiomics offer new potential for precise TSD estimation. Despite these advancements, implementation in India faces challenges due to infrastructural, educational, and policy constraints. This editorial emphasizes the need for ethical integration of transformative research into practice and urges investment in forensic research infrastructure and training to meet the evolving demands of justice delivery in India and beyond.

Background: Breast cancer is a formidable health issue, necessitating continuous research for improved prognostic and therapeutic strategies. Cycloxygenase-2 (COX-2) is linked to aggressive breast cancers, characterized by high-grade tumors, large size, lymph node involvement, HER-2 overexpression, and ER negativity. Ki-67, which is used to measure cell growth, is predictive of chemotherapy response in ER and PR-negative breast cancers. High Ki-67 is associated with elevated recurrence rate and poorer prognosis. This study evaluated COX-2 and Ki-67 expression in breast carcinoma and their correlation with clinicopathological features. Elevated Ki-67 is linked to higher recurrence and poorer prognosis. Methods: This retrospective cross-sectional study included 70 cases of invasive breast carcinoma diagnosed between August 2022 and July 2024. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue sample for COX-2 and Ki-67. COX-2 expression was scored based on quantity and intensity, while Ki-67 was scored using St. Gallen Consensus thresholds. ssociations were analyzed using Pearson’s Chi-square or Fisher’s exact test, with p<0.05 considered significant. Results: The study revealed significant associations between high expression levels of COX-2, Ki-67 with aggressive tumor characteristics, including larger tumor size, advanced stage, lymphovascular invasion (LVI), perinodal spread and ER/PR negativity (P -<0.001). Though no significant association was found with age, SBR(Scarff-Bloom-Richardson) grade, N stage, perineural invasion(PNI) and Her2 status. Conclusion: High COX-2 and Ki-67 expression correlate with aggressive breast cancer features, supporting their role as prognostic markers and potential therapeutic targets, particularly in hormone receptor-negative and triple-negative subtypes

Backgrounds: The occurrence of sudden cardiac death (SCD) has been continuously rising globally. Identification of modifiable risk factors may help reduce the incidence of sudden cardiac death. Aims: This study aimed to evaluate the incidence, associated risk factors, myocardial ischemic changes, and the specific arterial involvement in individuals who died due to a cardiac event. Material and method: The study was conducted at the Department of Forensic Medicine, Shri M. P. Shah Govt. Medical College, Jamnagar, from January 2023 to December 2023. A total of 110 cases of sudden death were included in the study. The heart was examined in these cases for both gross and myocardial analysis. Results: Left anterior descending artery (27.27%) was the most common site of stenosis, followed by left main artery (13.63%). The main feature was softening (8.18%) of myocardium, followed by hyperemia (4.54%) and myocardial fibrosis (3.63%) in the cases showing gross changes of ischemia. Conclusion: Sudden death caused by acute myocardial infarction mainly affects middle-aged individuals, with an increasing trend in younger people. The most common artery affected by stenosis was the left anterior descending artery, with most cases showing grade-3 or grade-4 stenosis. The left lateral wall is the most common site of infarction. Hypertension, Diabetes, nicotine consumption and drinking habits are the major risk factors. Nicotine and drinking habits can accelerate the development of coronary artery stenosis.

Introduction: Head injuries, especially those resulting from road traffic accidents (RTAs), are a significant public health concern in India, particularly among the young population. This autopsy-based study aimed to evaluate the demographic profile, causative factors, survival times, and the pattern of skull fractures in fatal head injury cases reported in a tertiary care hospital in Western India. Results: A total of 350 autopsied cases of fatal head injuries were analyzed over one year. The majority were males (84.29%), with the most affected age group being 21–30 years (24%). Accidental head injuries accounted for 90.57% of cases, and RTAs were the leading cause (67.14%). Two-wheeler occupants represented the most common victim group, with 82% of them not wearing helmets. Headon collisions were the most frequent RTA type. Most deaths (over 60%) occurred within 12 hours of injury. Skull base and vault fractures were significantly more common among non-helmeted riders. Discussion: The findings indicate a strong association between lack of helmet use and fatal skull fractures. Young adult males are at greater risk due to increased exposure to outdoor and vehicular activities. Delays in emergency response and limited trauma care infrastructure contribute to early mortality following head injury. Conclusion: This study underscores the urgent need for strict helmet laws, public awareness campaigns, improved pre-hospital care, and well-equipped trauma centers to reduce the incidence and severity of fatal head injuries in India.

Background: The Medical Certificate of Cause of Death is not just a legal formality but the backbone of accurate public health surveillance and policy, yet error rates as high as 50–60% threaten the integrity of national health data and decisionmaking. Addressing persistent gaps in knowledge and practice among medical ndergraduates is crucial to ensure reliable mortality statistics and effective healthcare planning for the nation’s future. Objectives: To evaluate medical undergraduates’ knowledge, awareness, and practical competence regarding the purpose, legal significance, correct completion, guidelines, and common errors of the Medical Certificate of Cause of Death, and to identify gaps in these areas. Materials and Methods: This cross-sectional study was conducted among third year, final year, and Compulsory Rotatory Medical Internship (CRMI) students, at Chettinad Hospital and Research Institute using a structured, self-administered online questionnaire to assess knowledge and awareness regarding the Medical Certificate of Cause of Death. Data were analyzed with SPSS version 29, and ethical approval was obtained from the Institutional Ethics Committee. Results: While all surveyed medical undergraduates correctly identified the expansion and legal importance of the MCCD, significant knowledge gaps persisted only about 80% knew when not to issue an MCCD, and just 70–80% consistently applied the correct sequencing of causes of death, especially in complex cases. These findings highlight persistent deficiencies in both the practical and legal aspects of MCCD completion among future certifiers. Conclusion: Precise and diligent death certification forms the bedrock of reliable health data and effective public health policy. Strengthening this competency among medical professionals is essential to uphold the integrity of healthcare systems and ensure informed decision-making at every level.

Background: Lungs are incidentally involved in nearly all terminal death events and are frequently studied during postmortem examination. Histopathological lung examination helps us to understand disease processes and detect incidental findings and study their association with different variables. Aims & objectives: a. To evaluate the pulmonary histopathological features in adult and pediatric medico-legal autopsies. b. To determine the frequencies of the various causes of death and study their association with age and gender. Methods: Lung specimens of all medico-legal autopsies received between January 2018 to December 2023 at a tertiary care centre were retrospectively studied for gross morphological findings. Further, the specimens were fixed and representative sections were submitted, processed and stained with H & E routinely to study histomorphological findings. Final diagnosis was given after correlating gross and histomorphological findings. Results: Among 270 autopsy cases, the most common cause of death in adults was cardiac pathology (28.9%), followed by primary pulmonary pathology (20.4%). Common pulmonary findings in cardiac deaths included edema and chronic venous congestion, while interstitial pneumonitis (10.2%), edema, and bronchopneumonia were predominant in primary pulmonary causes. In children, deaths were mainly due to accidental emergencies (32%), respiratory failure (24%), and aspiration (12%), with pulmonary findings such as edema, congestion, aspiration pneumonitis, and pneumonia. Histopathologically, aspiration (20% vs. 1.63%), pneumonia (32% vs. 17.14%), interstitial pneumonitis (24% vs. 10.2%), and hemorrhage/infarct (20% vs. 11.02%) were more frequent in children than adults; emphysema, granulomas, and thrombi were absent in children. Age-wise, coronary artery disease was prevalent in middle-aged adults, RTA and poisoning in younger adults, and malignancy in the 30–50 age group, with findings statistically significant (p < 0.05). Incidental discoveries included pulmonary saddle embolus and primary pulmonary carcinoma. Conclusion: This study validates the routine histopathological examination of lungs in all paediatric and adult autopsies as it yields a treasure trove of information including unexpected and incidental findings which significantly contribute to the cause of death. The study also highlights the role of pulmonary pathology in the paediatric population.

Accidental cut throat injuries are common usually in home or workplace. However, accidental cut throat injuries leading to death have been of rare occurrence in forensic literature. In present case, five years old male who was carrying empty ceramic cups, used for serving tea, accidentally slipped, leading to fall of ceramic cups causing its breakage, followed by fall of child over broken pieces of cup causing cut throat injury. He succumbed to death after around 22 hours of incidence, due to aspiration of blood subsequent to cut throat injury. We hereby report the case in view of its rarity in forensic literature, as well as to document the unknown and potentially preventable hazard from ceramic objects in pediatric population.

Context: The role of Forensic Expert plays a vital role in the examination and preparing wound certificate of every Medico-Legal cases.1 Many times, the victims get the initial treatment in the Private hospital or the casualty, then comes for the medico-legal examination after 3 to 5 days.2 In such cases the problem arises as how to comment upon the contact surface/ weapon when the healing has already started, and margins have become regular. In stitched wounds, many a times the surgeon wound have cleaned the margins, and this further adds the complication to comment upon the weapon. The approximation of the margins depends upon the surgeon’s skills, area of injury, the size of needle used.3 The edges or tailing cannot be made out from the stitched wound most of the times. Many times, the police also seek help from the Medico-legal expert to decide on which IPC section is involved. It relies on the report of Medico-legal expert whether the wound is simple/Grievous caused by non-Dangerous weapon or Dangerous weapon.4 Aims: Through this case series we tried to study the stitched wound of different duration about their margins and edges, and how reliable it is to comment upon the contact surface/ weapon in the stitched wound. Material & Method: Descriptive Observational type of study done at Department of Forensic Medicine, MBS Hospital associated with Governmental Medical College, Kota (Rajasthan), on 10 cases of Stitched wound. Results & Conclusion: we have observed that it is difficult to comment upon the weapon from the Stitched wound and the solution is CFMU.

Imagine someone enjoying a meal, perhaps a bit too much to drink, when suddenly they go silent, stand up, and then inexplicably collapse. This is the classic presentation of a cafe coronary, a condition where a piece of food completely obstructs the airway by lodging in the laryngopharynx and larynx. Unlike typical choking, there are often no dramatic struggles. The person might turn blue, cough violently for a moment, and then die relatively quietly. While it can be mistaken for a sudden heart attack, the true cause of death is generally attributed to reflex vagal inhibition of the heart, not a cardiac event. Autopsy often reveals a sizable, poorly masticated food bolus lodged in the larynx. A crucial detail is the absence of typical choking signs, which can be attributed to the deadening effect of high blood alcohol content on the gag reflex.