Journal of Forensic Medicine & Toxicology
The Journal of Forensic Medicine & Toxicology (JFMT) is a peer-reviewed, hybrid, bi-annual journal with a broad international perspective. The journal is dedicated to all branches of Forensic Medicine, Legal Medicine, Toxicology and allied sciences for the administration of justice. Specifically, the Journal encourages research articles that explore principles of forensic practice in contact with judicial system, practice of toxicology; and articles related to medical litigation, medical law and medico-legal issues arising out of day-to-day practice. The journal is an official publication of Medicolegal Society (regd.). The journal was initiated in year 1984 and passing through 40th year of its publication in 2023.
Understanding Suicidal Death Patterns in Northeastern India: Demographic Predictors, State Level Influences, Emerging Self-Infliction Methods, and Policy Recommendations
ObjectiveThis study examines suicide patterns in the Northeastern states of India, often referred to as the Seven Sisters. The aim is to assess whether demographic factors such as gender, marital status, and income group can explain suicide trends, and to explore broader systemic influences. The findings are intended to support forensic medicine professionals, policymakers, and public health authorities in their work.MethodPanel data from the National Crime Records Bureau (2014–2022) were analyzed using a Linear Mixed Model (LMM). This method evaluates both the direct role of demographic variables and the hidden, state-specific influences that may affect suicide rates, such as culture, economy, policies, and social conditions.FindingsThe analysis reveals that demographic factors alone (male/female, married/unmarried, rich/ poor) are not strong predictors of suicide rates. Instead, large-scale, state-level conditions play a more decisive role. Each state shows unique patterns shaped by its own social and systemic environment.ConclusionThese findings emphasize the importance of considering state-specific factors in forensic investigations of suicide. Forensic pathologists and medico legal experts may benefit from this perspective when conducting psychological autopsies, interpreting case patterns, and providing expert opinions. The study also underlines the need for region-specific suicide prevention strategies that can inform both forensic practice and public health policy.
Suicide Patterns, Northeastern India, Demographic Variables, Medico-legal, Forensic Psychology, Psychological Autopsy, NCRB (National Crime Records Bureau), Linear Mixed Model (LMM), Public Health Policy.
Acute Lung Injury in Fatal Paraquat Poisoning: A Case Report
Paraquat is a highly toxic herbicide associated with significant morbidity and mortality following ingestion, primarily due to its profound pulmonary toxicity. Acute lung injury (ALI) and progressive pulmonary fibrosis represent the hall mark pathological features, often leading to respiratory failure and death. We report a case of fatal paraquat poisoning in a young adult who presented with gastrointestinal symptoms and rapidly deteriorated despite supportive management. Laboratory investigations revealed multi-organ involvement, and imaging demonstrated diffuse pulmonary infiltrates consistent with ALI. Despite intensive care, the patient developed severe hypoxemia and succumbed within days of ingestion. This case underscores the challenges in managing paraquat poisoning, as no specific antidote exists and therapeutic strategies remain largely supportive. Early recognition, aggressive decontamination, and novel treatment modalities may improve outcomes; however, prognosis remains poor in cases with significant exposure. Clinicians must maintain high suspicion and counsel regarding the lethal potential of paraquat ingestion.
Paraquat; Poisoning; Toxicology; Acute Lung Injury
Unforeseen occupational injury from textile foil printing machine: A case report exploring injury mechanism and forensic analysis
Despite significant efforts to enhance workplace safety, occupational injuries constitute a substantial proportion of the overall injury burden globally. The textile industry is a prominent global industrial sector that utilises a variety of machinery to transform fibres into cloth. This article reports an unusual case in which an injury was caused by a textile hot foil printing machine, a device that is generally regarded as safe. A 40-year-old man suffered severe injury to his upper limb while attempting to introduce fabric into the foil printing machine during the machine’s initial operation time. The injuries are characterised by a combination of abrasion, laceration, crush injury, fracture, and avulsion. The patient was treated surgically, and there was a significant physical and economic burden. Establishing the occurrence and mechanism of injury is essential for raising safety awareness and reducing the likelihood of dangerous injuries among stakeholders. In conclusion, this case report highlights the potential hazards associated with textile hot foil printing machines, despite their apparent level of safety. Heightened awareness, protective measures, and comprehensive training are pivotal to prevent such occupational hazards any industrial settings.
Foil printing machine; Machine injury; Occupational accident; Health and safety; Hand injury
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Suicidal Death Due to Double-Barreled Shotgun Wound with Muzzle Imprint: An Interesting Case Report
This report presents an unusual case of firearm-related death in a 40-year-old male. Autopsy examination revealed bloodstained clothing and a split laceration measuring 15 × 2.5 cm x bone deep over the chin, consistent with a firearm entry wound. The wound had irregular margins, cherry-red discoloration of underlying tissues, and a comminuted mandibular fracture. Multiple teeth were broken, and fractures were noted in the nasal bone. The oral cavity also showed cherry-red discoloration. Blackening of the skin, non-removable on wiping and without singeing of surrounding hair, was noted along the upper edge of the lacerated wound. A semicircular muzzle imprint was present 1.9 cm to the right, with its lower margin adjoining the wound. The entry wound was located 152 cm above the heel. Scalp examination revealed ecchymosis, with multiple fractures of varying dimensions on the outer and inner tables of the skull. The dura was torn in several places. Numerous pellets were found dispersed in the cranial cavity, after striking the base of the skull, along with a plastic wad in the left parietal region of the brain. Both subarachnoid and subdural hemorrhages were present all over the brain at places. Internal organs appeared pale on cut section. Based on the autopsy findings and circumstantial evidence, the cause of death was determined to be craniocerebral trauma due to a firearm injury. The pattern and characteristics of the injuries were consistent with a contact-range shot and supported the conclusion of a suicidal manner of death.
The Challenge of Diagnosis: Cardiac Tamponade Identified at Autopsy.
There has been a rise in the incidence of sudden death among individuals in middle age. Predominantly, cardiovascular diseases have seen to be the most leading cause behind such deaths. Despite being a relatively uncommon presentation, cardiac tamponade presents as one of the rare yet fatal complications. This condition manifests when the pericardial cavity becomes filled with either blood or blood clots, compromising the heart’s normal contractile function. Typically, patients experiencing cardiac tamponade are often reported to have succumbed to sudden death, with history of chest pain. The definitive diagnosis of cardiac tamponade usually occurs during post-mortem examinations during Autopsy. We consider the case of a 45-year-old man who was found unconscious at his residence and was pronounced dead upon arrival at the hospital. Subsequent autopsy findings unveiled the presence of both blood and blood clots within the pericardial cavity, in conjunction with a rupture in the left ventricle and occlusion of the right coronary artery. Histopathological examination further confirmed the root cause of this fatal event as an acute myocardial infarction.
Cardiac Tamponade; Myocardial infarction (MI); Sudden natural death
Patterns of Histopathological Changes in Kidney in Phosphorus Poisoning- An Autopsy Finding
Background Yellow phosphorus is a toxic, nonmetallic inorganic substance used in various sectors, such as fireworks, firecrackers, rodenticides, ammunition, match industries and fertilizers. We report a case of phosphorus poisoning with histopathological changes in the kidney. Case description An 18 years old male died from the consumption of rat poison (contains yellow phosphorous). On postmortem examination, yellowish discoloration was seen all over the body. Internal examination showed edematous brain. Yellowish discoloration with hemorrhagic areas was seen in the cerebellum along with yellowish discoloration of both liver and kidney. On histopathological examination of kidney, the proximal tubular epithelial cells were predominantly affected by diffuse cytoplasmic vacuolation. Glomerular epithelial cells showed cloudy swelling. No significant interstitial inflammation/tubulitis was seen.
Yellow phosphorous; poisoning; histopathology; proximal tubular epithelial cells; glomeruli.
War with Wicked Wounds- Rightful interpretation of intricate injuries and meticulous autopsy preventing both wrongful convictions and miscarriage of justice.
Differentiating between antemortem and postmortem injuries is of paramount importance for medical and legal rea sons. Wrong interpretation of injuries and subsequently the wrong cause of death would lead to a miscarriage of justice. Ideally in a fresh intact body the position and gross findings may indicate the cause and time of injury. Decomposition and dismemberment of a body will make difficult for subsequent identification. However, careful examination at autopsy helps in knowing the injury (antemortem or post-mortem) even in a decomposed or dismembered body. Here we report a case of a decomposed and dismembered body, where a diligent autopsy examination helped in correctly ascertaining the nature of injuries, the manner of death and thus aiding in apt execution of justice.
Wound interpretation, Antemortem, Postmortem, Judiciary
Filicide: A Case Series Study of eight cases on Medicolegal Profile and Circumstances
Background: Filicide, the murder of a child by a parent is a complex phenomenon. It has various characteristics and causes. Even though rare, the outcome of filicide is more pronounced and long lasting compared to other types of murders. Maternal and paternal filicides are deaths of children when the killer/perpetrator is the mother and father of the victim. Material and Methods: This article presents 8 cases of filicide where the parents killed the children. These cases were studied from the postmortem records during the past five years, i.e., from 2020-2024. Results: Most of the cases were maternal filicides. The age of the victims ranged from newborns to adolescents. Mothers usually prefer soft methods of homicide whereas fathers prefer hard methods of homicide. Conclusion: A better understanding and knowledge of potentially fatal paternal/ familial dynamics, methods espoused for filicide could facilitate the identification of risk and enable effective intervention strategies. This case series highlights pattern of filicides in Kadapa region in order to enlighten the health professionals, clinicians and the general population about the importance of early identification of possible risk factors and filicidal tendencies
Filicide; Mental disturbance; Spousal revenge; Awareness
Predicting Acute Myocardial Infarction in Patients with Critical Coronary Artery Narrowing: A Systematic Review and Meta-Analysis
Background: Acute myocardial infarction (AMI) remains a global health burden. Early identification of individuals at high risk, particularly those with ≥70% coronary artery stenosis, can facilitate preventive strategies. This systematic review and meta-analysis aimed to evaluate the risk of AMI among patients with critical coronary artery narrowing. Methods: A comprehensive literature search of PubMed, Scopus, Embase, and Cochrane Library was conducted for stud ies published from January 2000 to December 2023. Eligible studies included adults (≥18 years) with angiographically confirmed ≥70% stenosis in at least one major coronary artery and reported AMI incidence. Data were extracted and pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and risk of bias was evaluated with the Newcastle-Ottawa Scale and the Cochrane RoB tool. PROSPERO Registration: CRD420251075342. Results: Eighteen studies (n=22,456 participants) were included. The pooled relative risk (RR) of developing AMI in patients with ≥70% stenosis was 3.45 (95% CI: 2.88–4.13), with moderate heterogeneity (I² = 48%). Subgroup analysis showed higher risk among patients with multi-vessel disease and diabetics. Funnel plot and Egger’s test (p=0.22) showed no significant publication bias. Conclusion: Patients with critical coronary stenosis are at substantially elevated risk for subsequent AMI. These findings emphasize the need for vigilant monitoring, risk stratification, and aggressive therapeutic in terventions in this high-risk cohort. Future studies should focus on novel biomarkers and predictive models to enhance early detection.
Acute myocardial infarction, coronary stenosis, critical narrowing, prediction, meta-analysis.
Medical Certification of Cause of Death (MCCD) for Brought Dead Cases in India- A legal perspective.
The Medical Certification of Cause of Death (MCCD) is a critical document serving legal, statistical, and public health purposes by recording the medically certified cause of death. However, certifying deaths becomes particularly challeng ing when individuals are “brought in dead” (BID) or declared “dead on arrival” (DOA) at hospitals. In such cases, the absence of prior medical history and unclear circumstances make it inappropriate for primary practitioners to issue MCCD without further evaluation. Certifying such deaths carries legal and ethical implications, especially in suspected unnatural deaths, where police inquests and post-mortem examinations under BNSS Section 194 are required. As per the Registration of Births and Deaths Act, 1969 [Section 10(2) & (3)], only registered medical practitioners who attended the patient during terminal illness are authorized to issue death certificates. As per National Medical Commission guide lines (Professional Conduct, Etiquette and Ethics Regulations, 2002) personal examination of the body before certifi cation is mandatory. Despite its importance, MCCD coverage and quality in India remain inadequate, averaging only 20%. Common deficiencies include incomplete, incorrect, or illegible entries. Strengthening hospital protocols, involving forensic experts, and providing regular training to medical staff are essential tools to improve accuracy. Additionally, establishing audit committees to review MCCD documentation can enhance accountability. Improving awareness and adherence to existing guidelines will enable MCCD to function more effectively as a tool for justice, health surveillance, and public policy.
MCCD; Cause of Death; Brought dead; Registration of Deaths.
Unveiling Invisible Clues: The Evolving Landscape of Clinical Microbiology in Forensic and Toxicological Studies
The integration of clinical microbiology into forensic medicine and toxicology has revolutionized investigative method ologies, enhancing the precision of criminal investigations. This review examines the role and impact of clinical micro biology in forensic contexts, focusing on its applications, technological advancements, challenges, ethical considerations, and future prospects. Forensic microbiology has proven invaluable in various forensic investigations, such as identifying pathogens in unex pected deaths, analysing soil microbiomes to infer crime scene geolocations, and utilizing the human microbiome for individual identification. Advances in next-generation sequencing, artificial intelligence, and machine learning have significantly enhanced the capabilities of forensic microbiology, enabling faster and more precise analyses. These tech nologies facilitate a deeper understanding of microbial evidence, contributing to more accurate forensic conclusions. However, the field faces challenges, including the need for standardized methodologies and protocols, rapid pathogen identification, and handling complex microbial ecosystems. Ethical considerations, particularly regarding the privacy of microbiome data and its legal interpretation, are also pivotal. Future research directions emphasize developing rapid on-site testing methods, expanding microbial databases, and establishing robust ethical frameworks for microbiology’s use in forensic science. These advancements are anticipated to further refine forensic microbiological methods, ensuring their responsible and effective application in legal investiga tions. In summary, the integration of clinical microbiology into forensic medicine and toxicology marks a significant ad vancement in forensic science. It offers enhanced capabilities in crime scene analysis and pathogen identification, while posing challenges that require careful consideration and ongoing research. The continued evolution of this field prom ises to significantly contribute to the efficacy and integrity of forensic investigations.
Forensic Microbiology; Clinical Microbiology; Forensic Medicine; Artificial Intelligence; Ethics
Trends in Estimation of Post-Mortem Interval Using Instrumental Analysis
The importance of estimating time since death has been acknowledged for centuries. One of the key elements in crime investigation lies in the reckoning of post-mortem interval(PMI). It’s evident why an accurate post-mortem interval estimation is needed in all criminal cases. There is ample literature regarding the techniques for estimating postmortem interval, but these techniques must be as precise, reliable, and scientific as possible. Conventional methods for determining PMI are fixed on physical, metabolic, autolysis, histochemistry, and physicochemical processes. These parameters are employed in the initial period of postmortem, and over time its reliability decreases. Recent research attempts the improvement of post-mortem interval estimation by more predictable and quantifiable parameters. This study presents the current headway in estimating time since death. Chemical changes in biological samples, Spectroscopical analysis for detection of biochemical changes, thanatomicrobiome analysis, predictable protein degradation process in human muscles, and dating of skeletal remains -improved the postmortem interval estimates. Further research is needed in these many parameters, the field still has a long way to go in terms of finding the exclusive formula for accurate post mortem interval estimation. This is a review that emphasizes several recent methods for precisely estimating post mortem intervals by instrumental analysis.
Medico-Legal Examination; Post-Mortem Interval; Autolysis; Thanatomicrobiome; Spectroscopy.
Towards Standardizing Medicolegal Practices In India: Challenges and Solutions
In India, Medicolegal cases require meticulous examination and evidence collection to support legal investigations, yet the absence of a standardized national medicolegal code leads to inconsistent practices. Currently, only a few states and institutions have developed their own codes, leaving many healthcare facilities, particularly in resource-limited settings, reliant on outdated or ad-hoc protocols. This variability complicates workflows, especially for junior consultants, medical graduates working in district hospitals performing medicolegal duties and foreign-trained medical graduates unfamiliar with Indian procedures, risking suboptimal evidence collection and documentation. A national medicolegal code is pro posed to standardize protocols for examination, sample preservation, and stakeholder responsibilities, ensuring unifor mity and clarity. Such a code would align with updated criminal laws, address logistical challenges like evidence storage, and incorporate guidelines for diverse medicolegal scenarios, including sexual violence, autopsies, and disaster victim identification. Despite challenges in enforceability due to state jurisdiction over law and order, voluntary adoption by states, endorsed by the Union government, could streamline practices, ultimately improving medicolegal service quality and aiding the justice delivery system across India. This review article discusses several practical difficulties in medicole gal practice, challenges in creating a national medicolegal code, and proposes recommendations to move forward.
Evidence, India, Medico-Legal Case, National Medicolegal Code and Manual (MLMC)
A Comparative autopsy-based study of presence of fluid in paranasal sinuses in deaths due to drowning and other asphyxial deaths in North Kerala
Background: Drowning is regarded as the primary cause of fatalities in aquatic environments and the third most prevalent form of accidental death globally, with the largest incidence rates occurring in underdeveloped nations. Accurate forensic diagnosis of drowning poses a problem because of the generic characteristics of post-mortem findings derived from traditional autopsy techniques. This study examines the importance of fluid in the paranasal sinuses in drowning incidents and aims to differentiate drowning from non-drowning instances. Methods: This was an observational descriptive comparative study done in fifty cases of drowning fatalities and fifty cases of other asphyxial fatalities who underwent medicolegal autopsy at the Department of Forensic Medicine, Government Medical College, Kannur. The paranasal sinuses were inspected for fluid during the medicolegal autopsy. Results: The study group consisted primarily of males (62.7%) with an average age of 46.90±16.34 years. Nearly half of them were in their fourth and fifth decades of life. In this study, 46 (92%) of the 50 drowning cases exhibited fluid in the paranasal sinuses (frontal, maxillary and sphenoid sinuses). None of the 50 instanc es of other asphyxial deaths showed fluid in the paranasal sinuses. The findings endorse the efficacy of para nasal sinus fluid analysis as a significant diagnostic tool in instances where drowning is suspected yet cannot be conclusively verified by conventional methods. Conclusion: This study demonstrated that the presence of fluid in the paranasal sinuses serves as a diagnostic indi cator of drowning-related death, corroborating other research. The physiological comprehension of fluid accumu lation in the paranasal sinuses of drowning victims and its forensic ramifications illustrate the importance of this diagnostic technique in medico-legal enquiries. The detection of fluid in these sinuses offers insights into the phys iopathology of drowning and serves as a crucial instrument for distinguishing between drowning and non-drown ing incidents, thus facilitating the precise identification of the cause of death and assisting in criminal enquiries.
drowning; autopsy; paranasal sinuses; Svechnikov’s sign
Anthropometric Correlation of Hand Length with Height in adults aged 20-23 years and Derivation of Regression Formulae for Height Estimation – A Cross-Sectional Study in Raebareli
Background: Identification plays a crucial role in forensic and medico-legal investigations. In situations where only body fragments such as hands or feet are available, height estimation becomes challenging. While previous studies have explored stature estimation using long bones, limited research has focused on hand length, particularly in non-Caucasian populations. This study aims to establish the correlation between hand length and height and derive regression equations for stature estimation in the Raebareli population. Material and Methods: A cross-sectional study was conducted at a tertiary health care centre, involving 200 adult participants (100 males, 100 females) aged 20 to 23 years. Hand length and height were measured following standardized anthropometric protocols. Statistical analyses, including Pearson’s correlation and linear regression, were performed using Jamovi version 2.6.44. Results and discussion: The findings revealed a strong positive correlation between hand length and height for both sexes, with all correlations being statistically significant (p < 0.001). For males, the correlation coefficients for left- and right-hand length were r = 0.619 and r = 0.612, respectively. For females, these values were slightly higher at r = 0.627 and r = 0.640, respectively. Linear regression equations were derived separately for males and females, showing that hand length serves as a reliable predictor of height. Conclusion: This study confirms that hand length exhibits a strong and significant correlation with height in both males and females. The regression models developed provide an effective method for stature estimation, partic ularly in forensic cases where only hand fragments are available. These findings are especially relevant for the population of Raebareli and similar ethnic groups, offering valuable anthropometric and forensic applications.
Hand length; Height estimation; Anthropometry; Forensic identification; Regression analysis; Rae bareli population
Behind the flames: a retrospective study of burn injury cases in a tertiary care centre, Nizamabad
Background: Burns are a global public health problem, accounting for an estimated 180,000 deaths annually.1 The majority of these occur in low- and middle-income countries and almost two thirds occur in the WHO African and South-East Asia Regions. Non-fatal burns are a leading cause of morbidity, including prolonged hospitalization, disfigurement and disability, often with resulting stigma and rejection. According to the Na tional Burns Programme, 91,000 of these deaths are women; a figure higher than that for maternal mortality. Women of child bearing age are on average three times more likely than men to die of burn injuries. Females have slightly higher rates of death from burns compared to males. This contrasts with the usual injury pat tern, where rates of injury for the various injury mechanisms tend to be higher in males than females.2 Along with adult women, children are particularly vulnerable to burns. Burns are the fifth most common cause of non-fatal childhood injuries.3 Methods: Retrospective study involving 53 cases of burn injuries were included in this study over a period of 3 years. Results: Out of 53 cases, 37 individuals were females depicting female preponderance.
Burn injuries; Socio-economic group; gender distribution; Total Body Surface Area
Future Perspectives of Super Speciality Courses in Forensic Medicine & Toxicology in India – A way Forward
Forensic Medicine and Toxicology (FMT) in India is undergoing a paradigm shift, with growing recognition of the need for super-speciality training to address the rising complexity of medico-legal challenges. Advances in Forensic Toxicology, Forensic Pathology, Forensic Radiology, Molecular Diagnostics, and Toxico-genomics, alongside judicial demand for precise scientific evidence, highlight the limitations of existing postgraduate curricula. This editorial article explores the future perspectives of super-speciality courses in FMT in India, examining the need, driving factors, chal lenges, local and global opportunities. Current developments in premier institutions, including AIIMS and the National Forensic Sciences University, are paving the way for structured super-speciality training, though gaps in infrastructure, faculty expertise, and regulatory frameworks persist. International benchmarks demonstrate the potential for integrat ing advanced technologies such as artificial intelligence and digital Forensics into medico-legal practices. Initiation of super-speciality programs may further add value to the subject, strengthen its scope and recognise position of India as a global leader in Forensic field. The future of super specialty courses in Forensic Medicine in India looks promising, with several developments indicating growth and recognition of the field.
Forensic Medicine; India; Pathology; Radiology; Super-speciality courses; Toxicology
Correlation of Height and Maximum Overhead Reach Among Adult Individuals
To analyze the correlation between height and maximum overhead reach among individuals having a height between 150-182 cm. This cross-sectional observational study was conducted on 320 cases with an equal \ proportion of both sexes i.e.,160 males as well as 160 females in the Forensic Medicine Department, UCMS & Guru Teg Bahadur Hospital. A formula for linear regression was devised to calculate an individual’s maximal overhead reach from standing height. This formula was tested on a sample of living and deceased individuals from the population of North India aged 21-30 years. In addition to helping to rule out any foul play, this overhead reach estimate will be helpful in determining if the apparent suicide victim had been capable of reaching the point of suspension
Height; Overhead Reach; Cadaver; Forensic
Haemorrhage in Middle Ear and Mastoid Air Cells (Temporal bone) in Drowning cases- an Autopsy based Cross-sectional study
Drowning is a form of asphyxia caused by fluid aspiration into air-passages. Hemorrhage in the middle ear, a narrow air filled space, is a recognized result of drowning. The study aims to determine the prevalence of middle ear and mastoid air cell hemorrhage in deaths due to drowning, helping to understand their significance. A cross-sectional autopsy-based study was conducted at B. J. Medical College, Civil Hospital, Ahmedabad, involving 100 cases with alleged drowning histories. Data was collected from medico-legal autopsies and narrated by police and relatives.Middle ear hemorrhage was seen in 65% of cases, out of which it was bilateral in 27% of cases, only right side in 22% of cases, and only left side in 16% of cases. Hemorrhage in mastoid air cells was seen in 57% of cases, out of which it was bilateral in 14% of cases, only the right side in 22% of cases, and only the left side in 21% of cases. Middle ear hemorrhage in drowning cases aids forensic pathologists in determining cause of death, distinguishing drowning from other causes and providing insights into water asphyxiation mechanisms.
Asphyxia; Autopsy; Drowning; Hemorrhage; Mastoid air cell; Middle ear.
Clinico-Epidemiological Profile of Burn Patients Admitted to a Tertiary Care Hospital of Rural North India
Introduction: Burn injuries represent a significant & often devastating public health concern in India. The burden of burns is notably higher among women & children due to domestic accidents, including cylinder/stove burns and scalds. Aims & objectives: To establish a detailed clinico-epidemiological profile of burn patients admitted to a tertiary care hos pital, including demographics, burn severity, causes and treatment outcomes. Materials & Methods: This retrospective study was conducted over a one-year period, at Uttar Pradesh University of Medical Sciences in Saifai, Etawah, UP, India. The data retrieval process involved the examination of medical records and documents contained within the patient’s hospital records. Results: Total 323 patients were analyzed. Out of them, 56.9% were male and 43.1% were female. Most were under 10 years (94), followed by 21-30 years (69). Flame burns were the most common (48.3%), followed by scalds (27.6%), electrical burns (23.8%), and chemical burns (0.3%). Winter saw the highest incidence (40.8%). Accidental burns accounted for 77.1%, with 19.8% of patients dying, mainly due to septicemia (13.3%). Mortality increased with burn severity: 3.6% died with less than 30% TBSA, 36.2% with 31-60% TBSA, and 65.7% with over 60% TBSA. Most burns affected the right upper limb (64.4%). Conclusion: A developing country like India requires an extensive public education program to raise awareness about the various causes of burns and effective prevention methods. Additionally, there is a need for burn care hospitals that are both accessible and affordable to the general population.
Demographic characteristics; Epidemiology; Burn patients; Rural north India.
Assessing Sexual Dimorphism of the Sternum: A Forensic Evaluation of the Sternal Index and Hyrtl’s Law
Background: Sex estimation plays a critical role in forensic investigations, particularly in cases involving incomplete skeletal remains. While the pelvis and skull are the most sexually dimorphic bones, alternative markers such as the ster num are gaining attention. This study investigates the utility of sternal measurements and the sternal index in determin ing sex and evaluates the applicability of Hyrtl’s Law in forensic contexts. Materials and Methods: A total of 132 cadavers (92 males, 40 females) were examined for sternal morphometry. Parameters measured included total sternal length, manubrium length, and mesosternum length. The sternal index was calculated and analyzed for sexual dimorphism. Additionally, the applicability of Hyrtl’s Law—stating that the manu brium is shorter than the mesosternum—was assessed in both sexes. Results: Males exhibited significantly greater sternal lengths compared to females. The mean sternal index was signifi cantly higher in females, indicating a potential marker for sexual dimorphism. However, notable overlap in sternal index values was observed—98.9% in males and 90% in females—limiting its reliability as a standalone indicator. Hyrtl’s Law was applicable in 71.73% of male cadavers but only in 40% of female cadavers, suggesting limited utility in female sex estimation. Conclusion: The sternum demonstrates measurable sexual dimorphism and may aid in sex estimation when key skeletal elements are unavailable. Although the sternal index and Hyrtl’s Law show potential, their application is constrained by significant overlap between sexes. Further research with larger and more diverse populations is recommended to enhance their forensic reliability.
Sternal Index; Sexual Dimorphism; Forensic Anthropology; Hyrtl’s Law; Sternal Measurements; Cadaveric Study
Clinical and autopsy findings in Paraquat poisoning: A two year retrospective study
Paraquat (PQ) is a highly toxic herbicide which causes cellular damage by production of superoxide radicals or other reactive oxygen species (ROS) and nitrite radicals. Agricultural health hazards of PQ are seen among the handlers due to its direct effect. However, most fatal toxicity is seen following ingestion; which is mostly done for self-harm. The target organ of PQ toxicity is lungs and kidney causing very rapid death following extensive pulmonary fibrosis and kidney damage. It also causes local effect on oral cavity by extensive erosion of oral mucosa and tongue. There is no specific treatment due to lack of antidot. In our study, we have seen 57 cases of PQ poisoning brought to our tertiary care centre in southern part of India. Out of these cases, 21 patients were brought directly by family members and remaining were referred from outside. All of the patients received conservative treatment and there was good clinical outcome with 15 deaths. Autopsy was conducted in all deaths in our mortuary. The autopsy findings also highlighted extensive pulmonary damage in all cases.
Herbicide; Reactive oxygen species; Pulmonary fibrosis; Antidote
Sex Determination by Morphometric Analysis of the Mental Foramen and Mandibular Ramus from Digital Panoramic Radiography: An Institutional Study
This study aimed to perform morphometric analysis of the mental foramen and mandibular ramus on digital panoramic images and find a highly significant parameter in determining an individual’s sex. A total of 150 digital panoramic images of 75 males and 75 females, aged between 20 and 50 years, were carefully selected based on inclusion criteria from the Dental Screening program data at the Radiology Department of the National Forensic Sciences University in Gujarat. Morphometric analysis of the mental foramen and mandibular ramus was performed, and measurements were taken on the right and left sides of all the O.P.G. images. Measurements of distances from the superior border of the mental foramen to the lower border of the mandible height (SBM-LBM), inferior border of the mental foramen to the lower border of the mandible height (IBM-LBM), condylar height, projective ramus height (P.R.H.) and coronoid height were taken. The obtained data were subjected to statistical analysis, and regression function analysis was used to estimate the efficiency of each variable in sex determination. Our study revealed a highly significant relationship in SBM-LBM, IBM LBM distance, and projective ramus height on both the right and left sides. The left side values were higher than the right side in both males and females. SBM-LBM, IBM-LBM, and ramus height values were higher among males than females. SBM-LBM, IBM-LBM, and projective ramus height showed significant sexual dimorphism.
Digital radiography; mandibular ramus; mental foramen; sex determination
Analysis of Motives and Factors Connected to Suicidal Deaths in Bikaner Region of Rajasthan- An Autopsy Based Study.
Self-injurious behaviours are amongst the most alarming of all human behaviours and leading cause of death worldwide. The word suicide originated from a latin word Suicidium (to kill oneself). The essential ingredients of suicide include unnatural death with desire from within and reason for ending life. In 2017, Indian Parliament decriminalised suicide. A one-year cross sectional study was conducted from February 2023 to January 2024 in the Department of Forensic Medicine, SPMC, Bikaner. 150 cases with history of suicide subjected to medicolegal autopsy were included in study on a purposive sampling basis. Information was gathered from autopsy related documents, proforma, history of relatives of the deceased, suicide notes, hospital records, concerned investigating agencies and laboratory reports. Number of suicides committed by males were more as compared to females with a ratio of 2:1, maximum in the age group of 21-30 year. Hanging was the most common pattern followed by poisoning. Some cases have previous history of suicide attempt and only few left suicide notes explaining the reason behind their action. Extreme of summer season i.e. months of May, June and July showed more cases and evening time was preferred by most cases. Marital issues were the most common motive behind committing suicide.
Suicide, cross sectional study, methods, motive.
Identifying the barriers for the decline of Eye donation among the post-mortem cases in SCBMCH, Cuttack.
Globally blindness is a public health problem. Corneal blindness is the third leading cause of blindness worldwide after cataract and glaucoma. Corneal transplantation is the most frequently performed type of transplant worldwide. Cadaver donors are the only source of donor corneas. The need therefore is to educate the masses about eye donation in an effort to increase the procurement of corneas by eliminating the prevailing misbeliefs and misconceptions. The study was done to identify the hindrances and misconceptions and steps to overcome them. The study was done on 1030 participants who were the next of the kin of the deceased autopsied in the central mortuary of SCB MCH, Cuttack, Odisha. Only about a third of the total study population had heard about corneal donation, and still lesser had some knowledge regarding it. Among the willing, the males outnumbered the females; and the urban population was keener to donate corneas. The Sikh population were more willing than the Hindus and Muslims. Majority of the willing considered corneal donation as noble act. The rural population was more familiar on corneal donation. Print media was the major source of information and least was from news media. Conclusion: Disfigurement was the most common misconception, whereas ignorance was the most common hindrance in corneal donation. Educating the children on organ donation from school level can develop the long-term counselling and constant sensitization benefits when they grow up as an adult.
Corneal Blindness; Corneal transplant; Corneal donation; Disfigurement.
Analysis of Childhood and Adolescent Deaths: An Autopsy-Based Study at Central India region, Indore
Background: Globally, over 5.2 million children under five years perished in 2019, primarily from preventable causes, with road traffic injuries ranking second among 5–14-year-olds in India in 2000. Injury and violence account for nearly 950,000 annual deaths in those under 18, with unintentional events comprising 90 percent. This study characterizes demographic, epidemiological, and medicolegal features of pediatric and adolescent fatalities in Indore. Material and Methods: In this prospective, one-year investigation (October 2022–September 2023) at Mahatma Gandhi Memorial Medical College, all medico-legal autopsies for individuals ≤18 years were reviewed. Data—drawn from police reports, family interviews, and autopsy findings—were recorded on structured proformas. Cases were stratified by age: infants (≤1 year), toddlers (2–3 years), preschool (4–6 years), school aged (7–12 years), and adolescents (13–18 years). Analyses encompassed age, sex, manner, and mode of death. Results: Of 2,423 autopsies, 120 (4.95 percent) involved ≤18 years. Adolescents predominated (64.2 percent), followed by preschoolers (10.8 percent), school-aged (9.2 percent), toddlers (8.3 percent), and infants (7.5 percent). Males outnumbered females (M: F = 1.5:1), especially in older age groups. Unintentional deaths accounted for 62.5 percent, suicides 26.7 percent, homicides 3.3 percent, natural 2.5 percent, and undetermined 5 percent. Road traffic accidents were the leading mechanism (28.3 percent), followed by poisoning (15.8 percent), asphyxia (13.3 percent), falls (11.7 percent), burns (8.3 percent), and electrocution (4.2 percent). Conclusion: In this Central Indian cohort, adolescents—particularly males—bear the highest burden of fatal injuries. Road traffic collisions and intentional self-harm are predominant. Prevention strategies should emphasize strict traffic enforcement, parental supervision during play, and accessible mental health resources.
Pediatric mortality, adolescent autopsy, accidental death, suicide, road traffic injuries, Central India
The effect of Chamomile Tea on Oral Mucositis among patients Undergoing Chemotherapy: Randomized Control Trail
Background: The side effect oral mucositis from chemotherapy harms patients who receive high-dose treatment because it affects 9 out of 10 individuals. The current oral medication palifermin needs extra funding to treat patients especially in less developed healthcare settings.Aim of study: This study aimed to test if chamomile tea can lower the harm oral mucositis causes from chemotherapy.Material and Method: Babylon oncology center in Iraq ran an official experiment with 75 patients split into two groups during medicinal studies. Card method was used to assign patients randomly into different groups. During two weeks’ participants in the chamomile group needed to apply chamomile tea rinses to their mouths three times a day but only standard medical care applied to the control group. WHO Mucositis Scale was used to measure oral mucositis severity in patients both at the start, day 7, and day 14.Results: The chamomile treatment sig nificantly reduced oral mucositis pain for patients but worsened symptoms for control patients (p < 0.001). Out of the 20 participants, 75% had no more mucositis by day 14. oral mucositis severity related closely to cancer stage, length of chemotherapy treatment and patient oral hygiene practices as tested with p values under 0.05. Standard oral care protocols for chemotherapy patients should include chamomile tea integration particularly in resource-limited healthcare facilities because it effectively decreases OM severity
Karnataka’s Bold Step to Classify Sudden Deaths as Notifiable: A National Imperative in the setting benchmark.
In a significant public health development, the Karnataka government has proposed making sudden out-of-hospital deaths, particularly in individuals under 45, a notifiable condition. This initiative, driven by expert committee recom mendations, also mandates autopsies in such cases and the creation of a centralized registry. By aligning with interna tional best practices and emphasizing data-driven strategies, this model addresses India’s long-standing gaps in mortality surveillance. While ethical and logistical challenges persist, Karnataka’s policy can serve as a national blueprint for reforming death investigation and improving cardiovascular health outcomes.
Effective and Professional Handling of Medico Legal Cases in a Busy Tertiary Care Hospital Emergency Medicine Department and Solutions to Address Challenges
Medico-legal cases (MLCs) form a critical part of emergency medicine practice, requiring meticulous documentation, legal compliance, and seamless coordination between healthcare providers and law enforcement agencies. Handling medico legal cases in the Emergency Medicine department of a busy tertiary care hospital is associated with lot of chal lenges that can affect the quality of patient care and the integrity and quality of legal processes. This article examines the key aspects of effective and professional MLC management, highlighting best practices for accurate documentation, ethi cal considerations, and timely legal reporting. Common challenges, such as inadequate staff training, lack of standardized protocols, and communication gaps, are discussed. Practical solutions, including staff training, digital documentation, and streamlined communication strategies, are proposed to enhance medico-legal case handling. By implementing these strategies, emergency departments can optimize medico-legal case handling, ensuring legal integrity, patient rights pro tection, and improved emergency care services. This article serves as a guide for healthcare professionals to handle MLC complexities with confidence and professionalism
Haemothorax in the Context of HELLP Syndrome: Unravelling the Etiological Dilemma - A Rare Case Report
Background: Haemothorax denotes the pathological accumulation of blood in the pleural cavity, distinguished by the presence of pleural fluid exhibiting a haematocrit that surpasses 50% of the peripheral haematocrit. Although predominantly associated with traumatic origins, instances of spontaneous haemothorax are not without precedents. Spontaneous haemothorax encompasses a multitude of causative factors and may manifest as a complication arising during pregnancy and parturition. Spontaneous haemothorax during pregnancy can arise from diverse factors, including diaphragmatic ectopic pregnancy, gestational trophoblastic disease, peripartal hemoperitoneum, and rupture of subcapsular haematoma. However, it is noteworthy that, as per existing literature, hae mothorax secondary to HELLP syndrome characterised by “Haemolysis, Elevated Liver Enzymes, and Low Platelet counts” has not been documented. Case Presentation: In this present case, a 34-year-old multiparous woman (gravida 3, para 2) was referred to Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, presenting with a full-term pregnancy. The patient reported an alleged history of premature rupture of membranes and documented instances of self-induced falls, occurring on two separate occasions, accompanied by a noted tongue bite. She received a clinical diagnosis of HELLP syndrome, leading to the imperative intervention of an emergency lower (uterine) segment Caesarean section (LSCS), resulting in the delivery of a live baby. Tragically, the patient succumbed the very next day. This case presentation highlights a clinically overlooked haemothorax, identified solely during autopsy in a pregnancy-related fatality attributed to HELLP syndrome. The complicating factor was an antecedent trauma before being admitted to the hospital. After meticulous examination, we have excluded the possibility of traumatic haemothorax, instead attributing the gradual progression of haemothorax from the point of bleeding to be secondary to HELLP syndrome—an unprecedented cause of mortality in the reported literature. Conclusions: The conclusion drawn, indicating that the clinical presentation with a gradual progression of haemothorax from the bleeding point was secondary to HELLP syndrome, is supported by the evidence presented in the case. The recommendations for attending clinicians to consider performing ultrasonographical tests in both thoracic and abdominal cavities for pregnant women with HELLP Syndrome, particularly in the presence of low haemoglobin levels, is a valuable suggestion.