Autopsy Examination Research Articles

Pathomorphological Features of Lung Fibrosis in Individuals Occupationally Exposed to Alpha Radiation

The aim of this study was to search for the specific morphological features of radiation-induced lung fibrosis compared to pulmonary fibrosis of another origin, using biological specimens of lung tissue collected from workers internally exposed to alpha radiation. The morphological features of lung fibrosis were defined using biological specimens of lung tissue that had been collected during autopsy examinations from 56 workers diagnosed with plutonium-induced lung fibrosis during life, from 34 workers with lung fibrosis of another origin (due to chronic inflammatory lung diseases) and from 35 workers without clinical pulmonary pathology (controls). The total lung-absorbed dose of gamma radiation from external exposure did not significantly differ among the studied groups, and the total lung-absorbed dose of alpha radiation from internal exposure was significantly higher in workers with plutonium-induced lung fibrosis. To investigate the extracellular matrix components, mono- and polyclonal labeled antibodies against type I, IV, and V collagens were used. In addition, to evaluate the system of extracellular matrix metabolism regulation, the antibodies against matrix metalloproteinases MMP-2, MMP-9, tissue inhibitors of matrix metalloproteinases TIMP-1 and TIMP-2 were used. The study revealed qualitative and quantitative morphological peculiarities of plutonium-induced lung fibrosis compared to lung fibrosis of another origin. This allows us to conclude that plutonium-induced lung fibrosis is a specific type of lung fibrosis, which is characterized with specific location and architectonics of fibrosis foci within the lung, and with changes in levels of collagen, elastic and reticular fibers in the pulmonary stroma. The analysis demonstrated that hyperproduction of type V collagen plays a key role in the development of plutonium-induced lung fibrosis. In addition, the imbalance between the expression of MMPs and their inhibitors plays an important role in the development of lung fibrosis.

Early structural valve deterioration following transcatheter aortic valve implantation in a patient with Scheie syndrome: a case report

BackgroundScheie syndrome, an attenuated subtype of mucopolysaccharidosis type I, is a rare storage disease that causes progressive glycosaminoglycans (GAGs) accumulation. Cardiovascular disorders determine the prognosis, and cardiac valve abnormalities are the most common cause. The patients are usually young so mechanical valve replacement is often performed, but because of the features of this disease, the surgical treatment is very risky. Recently, transcatheter aortic valve implantation (TAVI) has been reported as an alternative choice for aortic stenosis, but optimal choice is still unclear. Here, we introduce a patient that underwent TAVI and refer to the histological finding of a biological valve extracted in relation to GAGs accumulation.Case presentationA 54-year-old woman with Scheie syndrome underwent valve surgeries three times throughout her whole life. At age 41, she received a mitral valve replacement with a mechanical valve for mitral stenosis. She promptly developed severe diastolic dysfunction and low output syndrome after the release of aortic clamping, thus requiring temporary mechanical circulatory support4. At age 51, she suffered from heart failure due to severe aortic stenosis and underwent TAVI because conventional aortic valve replacement (AVR) was deemed too risky. Three years later, her heart failure relapsed, and an echocardiogram unexpectedly revealed thickened bioprosthetic valve leaflets and a significant pressure gradient across the valve, consistent with early structural valve deterioration. AVR was performed via median sternotomy with a mechanical valve. As with the first operation, she presented refractory heart failure requiring mechanical circulatory support and was meticulously managed. However, she steadily showed worsening of multiple organ systems and died 9 days after the operation. Pathological autopsy and histological examination revealed accumulation of tissue with GAGs on the leaflets of the bioprosthetic valve of TAVI, which may have been the cause of early structural valve deterioration.ConclusionFor patients with Scheie syndrome, a biological valve can be compromised by the accumulation of GAGs, thereby causing early SVD. These findings may support valve selection for these high-risk patients.

Study of delayed deaths in hanging: Unravelling post-obstructive pulmonary oedema as the primary cause of death

Suicide by hanging is a significant public health concern globally, with delayed deaths presenting unique challenges in understanding the underlying pathophysiology.In this observational study, cases of suicidal hanging resulting in delayed death were isolated, and comprehensive analyses were performed. Data collection included detailed histories of the suicidal attempts, circumstances surrounding the events, medical treatment records, and thorough autopsy examinations, including histopathological analyses. : This study aims to investigate cases of delayed death by hanging and analyse the associated pathophysiological mechanisms.Three cases of delayed death by hanging were identified and analysed in this study. Each case involved individuals who initially survived the suicidal attempts and received medical treatment. Despite efforts, all three individuals succumbed to their injuries after a period of time. Autopsy findings revealed characteristic signs of hanging, along with evidence of post-obstructive pulmonary edema as the cause of death in each case. This study highlights the occurrence of delayed deaths following suicidal hanging and underscores the importance of understanding the pathophysiological mechanisms involved. The identification of post-obstructive pulmonary edema as a significant contributor to mortality in these cases emphasizes the need for timely and effective medical interventions to mitigate adverse outcomes in individuals who survive hanging attempts.

Neoplasia in pet guinea pigs: a retrospective analysis of 2,474 autopsy examinations.

Neoplasia is a common disease in guinea pigs (Cavia porcellus); however, few studies have evaluated the prevalence of neoplasia in all organ systems. We retrospectively analyzed the tumor prevalence in pet guinea pigs and the frequency of metastasis in a multi-institutional study population of 2,474 autopsy cases. Tumors were found in 508 guinea pigs (prevalence: 20.5%), of which 95 cases had >1 tumor, resulting in a total of 627 tumors. The tumor prevalence increased from 1.4% in animals <0.5-y-old to 53.6% for guinea pigs >5-y-old. The most common tumor type was lymphoma or leukemia, affecting 174 guinea pigs (tumor prevalence: 7.0%). Lymphomas or leukemias were disseminated to various organs and/or lymph nodes in 146 (83.9%) cases and localized to 1 organ or 1 lymph node in 28 (16.1%) cases. Primary non-lymphoid tumors were most frequent in the female genital tract (62 of 1,235 cases, mostly uterus), respiratory system (116 of 2,474), skin including mammary gland (81 of 2,474), endocrine system (66 of 2,474, mostly thyroid gland), and alimentary tract (35 of 2,474). Tumors of the alimentary tract were dominated by gastrointestinal stromal tumors. Metastasis was detected in 42 of 453 non-lymphoid tumors (9.3%), with a surprisingly low frequency for pulmonary carcinoma and splenic hemangiosarcoma compared to other species. Our postmortem study demonstrates a high prevalence of disseminated lymphoma or leukemia in pet guinea pigs at the time of death or euthanasia. Additional studies are needed to further characterize these tumors.

Death by Frostbite: From Theory to Reality: A Case Report

Background: When the body temperature falls below 35 °C, a condition known as hypothermia occurs. This renders it impossible to regulate the body temperature and produce heat. In these cases, death is due to a cessation of vital functions and is triggered by a body temperature below 25 °C. A multidisciplinary approach is typically required when hypothermia is suspected to combine circumstantial evidence, external examination, autopsy, microscopic and biochemical findings, and other data useful to assess the diagnosis of fatal hypothermia. Post-mortem diagnosis of death by hypothermia frequently presents a medico-legal dilemma. Methods and Results: The authors present a case of hypothermia in which site inspection, autopsy, and histological examination simultaneously revealed the forensic and anatomopathological characteristic findings of hypothermia with some peculiar evidence: paradoxical undressing, thanatochronological phenomena, frost erythema, polyvisceral congestion and Wischnewski spots, and subnuclear vacuolization of renal tubular epithelial cells.

Forensic Pathological Identification Report of Early Death after Orthotopic Heart Transplantation: A Case Study

This report aims to determine the cause of death from a forensic pathological perspective in a case of early death after heart transplantation. Using methods such as external examination, autopsy, and histopathological examination, we analyze the multiple factors leading to death in this case, particularly focusing on the heart donor aspects. Heart donors must meet strict criteria regarding structural abnormalities, age, low body weight, cold ischemia time, donor infection, and poisoning, and heart function. However, this case suggests the need for further refinement of these standards. Preoperative pathological diagnosis of the donor heart is necessary to determine any primary diseases, establish pathological diagnostic standards, evaluate heart survival indices, and ensure the quality of life for recipients, thereby avoiding deaths caused by primary diseases of the donor heart.

Maternal Cytomegalovirus (CMV) Serology: The Diagnostic Limitations of CMV IgM and IgG Avidity in Detecting Congenital CMV Infection.

Congenital cytomegalovirus (cCMV) is a common congenital viral infection. Testing for cCMV usually begins with assessing maternal CMV serology, specifically IgM and IgG antibodies. A negative maternal CMV IgM suggests a low risk of recent maternal CMV infection, thereby suggesting a low risk of cCMV in the fetus. Consequently, cCMV is often ruled out when maternal CMV IgM is negative. In our perinatal autopsy and placental pathology database, we identified 5 cases of cCMV despite negative maternal CMV IgM results in the second trimester. In all 5 cases, fetal abnormalities were first detected by ultrasound in the second trimester, prompting maternal CMV testing. Since second trimester maternal CMV IgM was negative in all cases, cCMV was considered unlikely, thus precluding further prenatal CMV testing in 4 of these cases. The diagnosis of cCMV was subsequently made through placental and/or autopsy examinations. Following this diagnosis, retrospective CMV serology and IgG avidity testing was performed on stored frozen first-trimester maternal blood samples in 3 cases. Among these, the first-trimester samples in 2 cases were IgG+, IgM+, and exhibited low IgG avidity, suggesting a primary maternal CMV infection around the time of conception. In the third case, both first and second-trimester maternal blood samples were IgG+, IgM-, and showed high IgG avidity, suggesting a non-primary maternal CMV infection (i.e., reactivation or reinfection of CMV). A negative maternal CMV IgM in the second trimester cannot exclude cCMV infection. While CMV IgG avidity testing and analysis of stored frozen first-trimester maternal blood samples provide valuable insights, they have limitations. CMV PCR performed on amniotic fluid is a useful prenatal diagnostic tool. For cases of unexplained fetal abnormalities or death, autopsy and placental examination are recommended.

Molecular epidemiological studies of Leucocytozoon caulleryi in commercial layer flocks in Southern peninsular India reveal the presence of new subclusters.

The Leucocytozoon parasites are one of the important protozoa species affecting domestic poultry and wild birds. Though there are frequent reports about the incidence of Leucocytozoon in wild birds, the information regarding the occurrence of commercial poultry is underestimated. From October 2015 to August 2022, ailing and dead birds from 39 commercial layer flocks were submitted to the Poultry Disease Diagnosis and Surveillance Laboratory, Namakkal, with a history of brief illness, followed by mortality with oozing of blood from oro-nasal orifice. The presence of Leucocytozoon caulleryi was confirmed in all the flocks by laboratory examination and PCR. All the Leucocytozoon-positive cases were reported after heavy rainfall and the affected farms were inhabited with Culicoides flies. The infected birds were dull and depressed, exhibited labored breathing, and blood-tinted ropy mucous from the oro-nasal cavity. Necropsy examination revealed pale-anaemic comb and wattles, massive haemorrhagic clot over the surface of the kidney, peritoneum, and trachea, and scattering of greyish-white/reddish military megaloschizonts throughout the serosa of viscera and skeletal muscles. Histopathological examination revealed many spherical cysts or megaloschizonts in the intestine, pancreas, gizzard, spleen, liver, kidney, heart, and breast muscles. The cysts were deeply seated within the above organ's parenchyma or embedded in the serosa. There was extensive connective tissue proliferation with mononuclear cell infiltration around the cyst. Leucocytozoon-specific DNA was detected in all the flocks by PCR. Phylogenetic analysis of the cytochrome b gene of L. caulleryi reported from various parts of the world revealed that L. caulleryi is grouped into two major clusters (Cluster I & II). Further, Indian L. caulleryi sequences fall under sub-cluster I and II along with L. caulleryi reported from Taiwan, Egypt, China, Myanmar, Japan, South Korea, and Thailand.

Histopathological and medico-legal aspects in a case of death related to an undiagnosed cerebral large B-cell lymphoma.

We report an unusual and undetected case of primary central nervous system lymphoma presenting as multiple lesions in the periventricular occipital lobe in an immunocompetent host, which had manifested as a stroke. The neoplastic diagnosis was made only after death following a thorough autopsy and histopathological examinations which enabled the diagnosis of a rare cancer (primary cerebral lymphoma) which remained undetected and undiagnosed during life.

Autopsy doesn’t always tell all: The importance of exhuming skeletal remains of cemetery unidentified decedents

The process of personal identification differs according to the state of preservation of the corpse, becoming more complicated when dealing with remains altered by taphonomic variables. Since 2015, the staff of the Laboratory of Forensic Anthropology and Odontology (LABANOF) of the University of Milan has been engaged in recovering the skeletons of 36 unknown people from the cemeteries of the city of Milan, to redraw their biological profiles and give them back the possibility of being identified. Of the 36 starting skeletons, 7 have been identified and therefore are not the object of this study, 25 individuals were previously subjected to an autopsy examination and 4 skeletons were studied for the first time in the present work. The post-mortem data of all the individuals who had previously undergone autopsy and had not yet been identified (n = 25) have been retrieved from the archives of the Institute of Forensic Medicine in Milan and allowed for a comparison with those obtained from the new anthropological study of each exhumed skeleton. The authors aim to present the three most interesting cases to better highlight the results that emerged from the comparison. The autopsy information alone lacked important details. In all cases, the anthropological examination proved to be capable of detailing the biological profile of the unknowns even after a long period of inhumation (even more than 20 years). The limitations of instrumental investigations in achieving the goal single-handedly and the importance of recovering the unknown skeletons from cemeteries for identification purposes are discussed.

The influence of fixing condition on myoglobin stainability of striated muscle as a tool for forensic diagnosis

It is reported that immunostaining of Myoglobin (Mb) is useful for forensic diagnosis. In this study, we investigated the condition of fixation of striated muscle in 10 % neutral-buffered formalin to obtain appropriate stationarity of Mb in immunostaining. Firstly, criteria for staining intensity and definition of the stainability of examined were determined for sheep muscle tissue. Sheep myocardial tissue was fixed using 10 % neutral-buffered formalin under the 21 different conditions based on combinations of the following: three ratios of volume of formalin (mL) to weight of myocardium (g) (RFM) of 1, 4 or 9, 7 durations of fixation (DF) of 0.5, 3 or 6 h, and 1, 2, 5 or 7 days. Secondly, detection of Mb diffused form skeletal muscle from autopsy cases into formalin during fixation were confirmed by ELISA. Finally, the evaluation of stainability of Mb of striated muscle in routine autopsy examinations was confirmed using sheep staining intensity standards. From this experimental investigation, it has been demonstrated that the most suitable formalin fixation condition for using Mb staining in forensic diagnosis is RFM4 with a fixation time of at least DF 3 h up to 1 day. It was evident that staining intensity decreases with fixation durations exceeding 2 days, irrespective of the RFM. Thus, the fixation time was deemed the most influential factor affecting the staining properties of Mb staining in skeletal muscle tissue. When conducting Mb staining using striated muscle as an evaluation sample, particular attention should be paid to the fixation time.

Situs inversus partialis (levocardia): an incidental discovery of an extremely rare case during the autopsy of a female with suicidal poisoning

BackgroundSitus inversus is a rare congenital anomaly. In this condition, the abdominal and chest organs are positioned in reverse, a mirror image of the normal anatomical position. It is divided into two categories. 1. Situs inversus totalis, in which the apex of the heart points toward the right side. 2. Situs inversus partialis or incompletus, in which the apex of the heart points toward the left side. Situs inversus totalis is present in 1 per 10,000 to 50,000 individuals of the general population, whereas situs inversus partialis is a much rarer condition and is present in 1 per 2,000,000 individuals of the general population. The term situs ambiguous is also used for the arrangement of organs and vessels in an unordered manner.Case presentationIn this paper, we present an extraordinary case of situs inversus partialis discovered incidentally during the autopsy of a female body with a documented history of suicidal poisoning. This unique finding sheds light on the diagnostic challenges and implications of situs inversus partialis, especially in patients with underlying medical conditions.ConclusionsThis report underscores the importance of thorough and systematic investigations during autopsy examinations to identify and comprehend rare anatomical anomalies that may otherwise remain unnoticed. Increased awareness of such rare congenital anomalies may contribute to a better understanding of their prevalence and potential clinical implications for healthcare professionals and researchers.

Nonclinical safety and immunogenicity assessment of a combined DTacP vaccine in animal models.

The (diphtheria, tetanus, and pertussis [acellular, component] [DTacP]) vaccine is a combined vaccine designed to prevent three potentially fatal diseases including pertussis, tetanus, and diphtheria in both children and adults. We utilized advanced technology to develop a novel DTacP vaccine that was previously unavailable in China. The nonclinical studies were performed to evaluate the immunogenicity, potential toxicity, and local tolerance of the vaccine in animal models. In the immunogenicity study, three batches of the vaccine were intraperitoneally administered to National Institutes of Health (NIH)mice, resulting in 100% seropositivity for all three batches. Additionally, antibody levels notably increased as the immunization dosage increased. In acute toxicity study, no mortality was observed among the animals during the 14-day observation period, and no abnormalities in clinical signs were reported. Active systemic anaphylaxis assessment in guinea pigs showed no evidence of serious allergic reactions in the vaccine groups. In the repeat-dose toxicity study, where five intramuscular doses were administered every 2weeks, gross autopsy and histopathological examination revealed no vaccine-related systemic pathological changes in rats, with dose site irritant reactions mostly recovered at the end of recovery period. In conclusion, the vaccine demonstrated good local and systemic tolerance, supporting its clinical development.

Exogenous Lipoid Pneumonia Diagnosed on Paediatric Autopsy Examination – A Case Series

Exogenous Lipoid Pneumonia Diagnosed on Paediatric Autopsy Examination – A Case Series

Ascending colon cancer metastasized to the right testicle: a case report

BackgroundTesticular metastasis from malignant solid tumors is extremely rare. It is usually found by chance during autopsy or pathological examination of testicular specimens. Therefore, we consider it necessary to report our patient’s case of testicular metastasis from colon cancer.Case presentationWe report a 61-year-old Han Chinese male patient who presented to our clinic with progressive painless swelling of the right testicle for 2 years. Positron emission tomography–computed tomography scans showed increased 18F-fluorodeoxyglucose metabolism in the right testicle, possibly owing to distant metastasis. His previous medical history suggested that he had undergone laparoscopic-assisted right hemicolectomy for ascending colon cancer 4 years ago. Considering the ascending colon cancer metastasis to the right testicle, we performed a right radical testicular resection through an inguinal approach. Postoperative histological examination showed intestinal metastatic adenocarcinoma.ConclusionColon cancer metastasis to the testes is uncommon. The clinical and imaging manifestations of this tumor are nonspecific, so the diagnosis relies on postoperative pathology. If testicular metastasis is found, treatment principles for advanced colon cancer should be followed.

A rare case of fatal Emamectin poisoning

Emamectin is a macrocyclic lactone-ring insecticide widely used on various vegetable crops and fruits. Emamectin acts through high-affinity gamma-aminobutyric acid (GABA) receptors by increasing the chloride permeability, thus causing muscle paralysis in invertebrates. Here we report a fatal case of intentional ingestion of emamectin in an adult. A 53-year-old male presented to the emergency department with an alleged history of suicidal ingestion of emamectin benzoate 5% water soluble granules mixed with around 180ml of ethyl alcohol following which he developed vomiting and was immediately taken to a nearby hospital. Gastric lavage was performed; however, he succumbed to death the following day. The autopsy examination showed evidence of stomach mucosal erosions, alveolar oedema, and hepatic necrosis. Chemical analysis of viscera detected qualitatively the presence of emamectin benzoate in blood and tissues. Toxicological analysis of emamectin and its potential limitations was discussed. Death following emamectin poisoning in humans has been reported very little in the literature due to which its spectrum of clinical features is difficult to comment upon. Future case studies and literature will help better understand the range of clinical and autopsy features to aid the prompt diagnosis.

Two-year carcinogenicity study of a novel plasticizer, bis(2-ethylhexyl) cyclohexane-1,4-dicarboxylate (Eco-DEHCH), by oral diet in Han Wistar rats

Plasticizers are necessary for the usability of various products, including food contact materials. Exposure to plasticizers is most commonly made through the oral route. Several plasticizers have been reported to have adverse effects on humans and the environment. Thus, the present study aimed to determine the long-term toxicity and carcinogenicity of a novel plasticizer called bis(2-ethylhexyl) cyclohexane-1,4-dicarboxylate (Eco-DEHCH), which is an ecofriendly and biologically less harmful replacer. Groups of 50 male and 50 female Han Wistar rats were fed Eco-DEHCH at daily doses of 1,600, 5,000, or 16,000 ppm in their diet for at least 104 weeks. The rats were regularly monitored for mortality, clinical signs, body weight, food consumption, food efficiency, and perceivable mass. All animals were subjected to complete necropsy and histopathological examination. The results indicate that the rats well tolerated chronic exposure to Eco-DEHCH at highest daily doses of 16,000 ppm, with was equivalent to 805.1 mg/kg/day in males and 1060.6 mg/kg/day in females and did not show signs of toxicity or carcinogenicity. In conclusion, Eco-DEHCH could be a safe and promising alternative plasticizer.

Variations of Tentorial Notch Anatomy in Autopsy and NCCT of Head Injury Patients to Correlate Its Impact over Brainstem—An Observational Study

Abstract Background Tentorium cerebelli divide cranial cavity into supratentorial and infratentorial compartment. Tentorial notch is a gap in tentorium cerebelli located centrally and anteriorly, related to upper brainstem, first six cranial nerves, cerebrum, and cerebellum. The aim of this study was to analyze morphometric variation in tentorial notch anatomy in autopsy and computed tomography (CT) of head injury patients and to find out correlation between tentorial notch anatomy and uncal herniation and changes over brainstem surface in case of uncal herniation. Materials and Methods Autopsy examination of head injury patients was done between July 1, 2021, and Jan 31, 2023. Skull was opened in a standard manner and midbrain sectioned at the level of tentorial edge. Tentorial notch parameters (anterior notch width, maximum notch width, notch length, posterior tentorial length, apicotectal distance, interpedunculoclival distance) were measured using geometry compass and vernier caliper. These parameters were also measured on noncontrast computed tomography (NCCT) head of same patients. Evidence of uncal herniation was sought for in both NCCT head and autopsy examination. Impact of uncal herniation over brainstem in form of indentation over lateral surface of midbrain and macroscopic brainstem hemorrhage was noted. Results In 65 autopsy cases, there were 56 male and 9 female specimens; their mean age was 40.63 ± 16.78 years (range: 7–86 years). The most frequent type of tentorial notch observed in our study was typical type (32.30%). Relative frequency of uncal herniation was present predominantly (75%) in large type of tentorial notch and least (20%) in small type of tentorial notch. A significant correlation (p-value &lt; 0.01) was found between uncal herniation and indentation over lateral surface of midbrain, while no significant correlation (p-value &gt; 0.05) was found between uncal herniation and macroscopic brainstem hemorrhage in autopsy specimens. Conclusion The results of our study provide a baseline data about tentorial notch anatomy and it may facilitate neurosurgical decision making as well as help in deciding the best trajectory for lesions approaching in the vicinity of the tentorial notch

Fat Embolism Syndrome in a Patient with Osteogenesis Imperfecta: A Case Report

Fat embolism syndrome (FES) can be challenging to diagnose by forensic pathologists. For the diagnosis of FES, there is no benchmark test. Postmortem diagnosis requires a full autopsy and specific ancillary examination. However, the high variability in the clinical presentation of FES represents a relevant issue, and there is no consensus on the postmortem assessment. This is the case of a 33-year-old man who died of FES one week after a car accident. He suffered multiple fractures, but was hemodynamically stable and showed no neurological changes. The patient died a few days after hospital discharge. Additionally, he had osteogenesis imperfecta type III, a genetic disorder associated with bone fragility. To the best of our knowledge, no study has assessed whether and how osteogenesis imperfecta contributes to the onset of FES. Despite the heterogeneous manifestations of FES, the present case met many of the proposed clinical and histological diagnostic criteria. Therefore, we briefly review FES diagnostic criteria, show the postmortem diagnostic workup, and discuss the hypothetical link between osteogenesis imperfecta and FES.

The Role of Fingernails in Death Investigation.

In forensic pathology, forensic onychology studies fingernails and toenails for medicolegal purposes. It mainly deals with DNA profiling from nails, toxicological analysis for detecting poisons, and the collection of trace evidence present under the nails. Injuries to fingernails and their interpretation for medicolegal purposes are the neglected areas of this study. We have discussed the most common types of fingernail injuries and their significance. We found that their notification has significant value in drowning cases, defense wounds on the palm, self-inflicted cuts, burns, electrocution, blunt trauma, physical assault, sexual offenses, and other issues like torture. We emphasize the examination of fingernails in the autopsy and medicolegal clinical examination for better administration of law and justice.