Defense Injury Research Articles

Gunshot Defense Wounds: Three Case Reports and a Literature Review

Defense wounds generally occur when a victim attempts to protect vital organs and blood vessels during an assault, and are therefore typically located on the forearms or hands. Gunshot-induced defense wounds are less frequent compared to stab wounds, which have been extensively described in the literature. We present three cases where victims unsuccessfully attempted to defend themselves from gunshots, and where the detailed description of injuries played a key role in the reconstruction of the crime scenes. In the first case, a man was shot with a smooth-bore shotgun, presenting a “through-and-through” gunshot wound on the lateral surface of the left forearm and a large gaping wound on the posterior surface of the same forearm. The second and third cases involved two men who were shot with handguns. The first displayed an entrance wound on the dorsal surface of the right hand, with burned edges and smoke soiling, and an exit wound on the palmar surface. The second case involved two wounds on the left hand: one on the dorsum and the other on the palm. To the best of our knowledge, few studies in the literature emphasize the role of gunshot defense wounds in aiding the reconstruction of crime dynamics. The cases presented in this study highlight the importance of precisely defining the pathological and morphological features of the wounds, as well as the bullet trajectories, to accurately identify defense wounds. These findings are valuable for reconstructing the dynamics of the assault and providing critical information to the public prosecutor.

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.

Frequent Presentation of Counterfeit Gunshot Wounds in a Tertiary Care Hospital in North India: A Case Series

Introduction: Self-inflicted wounds, or wounds produced by another acting in accord with him, are wounds inflicted by a person on his own body. The purpose of fabricating injuries is to file a false claim of assault against an opponent, to alter the appearance of a minor injury in order to attract more attention and a harsher punishment for the alleged accused. Someone may also pretend these as defence wounds, so as to conceal homicide.Result: In a short period of 1 year, i.e. from August 2020 to July 2021 in a single unit of Department of General Surgery, 8 cases of Counterfeit Gunshot Wounds are there which depicts that the foul play is at large scale and these gunshot wounds are not present over the vital organs of the body.Conclusion: The combined efforts of all investigating authorities and doctors can help to avoid injury fabrication, which will not only decrease wasteful litigation in the courts, but will also help to avoid harassment of innocent individuals.

Skeletal evidence of the ethnic cleansing actions in the Free City of Danzig (1939-1942) based on the KL Stutthof victims analysis

In the early days of World War II, many of the prominent and influential people of Polish nationality from the Free City of Danzig were arrested by the Germans and sent to the nearby concentration camp KL Stutthof. Nearly a hundred of them died within the next seven months upon their arrival, and were buried in a clandestine mass grave in a nearby forest. However, the exact nature of their death is unknown, as it is unclear what the attitude of the aggressors was toward the victims. We do not know whether there was only one executioner or there were several assassins, nor if the killing methodology was consistent with the other state-regulated executions.The studied material represents the commingled remains of a minimum thirty-four people, possibly all male, aged from under eighteen to over sixty at the time of death. Perimortem traumatic lesions are shown mainly on the skull bones. We asked whether the perimortem trauma lesions visible on the victims’ skeletons could be informative on the cause and manner of their death.Our results show the prevalence of the perimortem trauma inflicted by a blunt object are on the parietal bones above the Hat Brim Line (HBL), which is commonly associated with a violent attack. The gunshot trauma was usually localized on the occipital bone or posterior parietal, which could indicate a shot to the back of the head, and this was commonly encountered during executions. No signs of defensive injuries can be explained either by restraining of the hands or by a surprise attack. The abundance and variability of the trauma type can be evident of multiple assailants. Moreover, the multiple impact points detected on several crania prove unnecessary overkill and brutality, which reflects the personal attitudes of the executioners towards the victims.

Imaging of Intimate Partner Violence, From the AJR Special Series on Emergency Radiology.

Intimate partner violence (IPV) is a highly prevalent public health issue with multiple adverse health effects. Radiologists are well suited to assessing a patient's likelihood of IPV. Recognition of common IPV injury mechanisms and resulting target and defensive injury patterns on imaging and understanding of differences between patients who have experienced IPV and those who have not with respect to use of imaging will aid radiologists in accurate IPV diagnosis. Target injuries often involve the face and neck as a result of blunt trauma or strangulation; defensive injuries often involve an extremity. Awareness of differences in injury patterns resulting from IPV-related and accidental trauma can aid radiologists in detecting a mismatch between the provided clinical history and imaging findings to support suspicion of IPV. Radiologists should consider all available current and prior imaging in assessing the likelihood of IPV; this process may be aided by machine learning methods. Even if correctly suspecting IPV on the basis of imaging, radiologists face challenges in acting on that suspicion, including appropriately documenting the findings, without compromising the patient's confidentiality and safety. However, through a multidisciplinary approach with appropriate support mechanisms, radiologists may serve as effective frontline physicians for raising suspicion of IPV.

Study of Homicidal Deaths Autopsied in VSSIMSAR, Burla: A Three-Year Retrospective Study

Killing of an individual is the highest level of aggression found in society. Incidence of homicide is on the rise and its pattern is also changing with time. The present retrospective study was conducted in the department of Forensic Medicine and Toxicology, VIMSAR, st st Burla from 1 January 2018 to 31 December 2020. All the cases brought to the department for autopsy, either confirmed or later registered as homicide by investigating officer were considered for study. Among 4918 autopsies conducted during the period of 3 years 119 cases (2.41%) were of homicidal deaths. 66.4% of homicide victims are males. Majority of homicidal deaths occur in the age group 21-30 years and 31-40 years accounting for 52% of total cases combinedly. 46.2% homicide victims succumbed to injuries at the spot. Majority of cases (44 cases, 37%) occurred during night hours. Infliction of injuries are present in multiple areas in 42.8% of cases. Blunt weapons (29.4%) were the most commonly used. Defence wound were present in 19% of cases. Most common site of fatal injury is head in 46.2% of cases. In majority of cases (46.2%) cause of death was due to craniocerebral injury.

Overkilling: A specific type of homicide – Constructing the definition: Injuries and victim

Overkilling in the Forensic Medicine field is known as a specific type of homicide where the number of inflicted injuries greatly surpasses the number of fatal ones. Conducted research aimed to create a unified definition of the phenomenon and its classification criteria by analysing a vast majority of data concerning its various characteristics. From the population of homicide victims autopsied in the authors’ research facility a number of 167 cases were chosen consisting of both overkilling and other homicides. 70 cases were thoroughly analysed based on the completed court files, autopsy protocols and photographs. First part of the research concerned the facts regarding the injuries sustained and the victim’s characteristics. Conclusions of the statistical analysis allowed to characterize overkilling as a type of homicide where the number of injuries (sharp or blunt) is several times higher than the number of fatal injuries. Sharp force injuries predominate, and are often localized on the torso, neck and limbs, while blunt force injuries are localized mostly on the head. There is no significant dominance between the sexes of the victims, mostly they are in their 40-50′s. Victims with reduced abilities to resist predominated (mostly women), which is correlated with the position of their body (lying or sitting) at the begging of the incident. Also overkilling victims more often suffer from defensive injuries and post mortem trauma.

Effects of fresh-cut and storage on glucosinolates profile using broccoli as a case study

Glucosinolates (GLS) contribute to the unique flavour, nutrition, and plant defence of the Cruciferous vegetables. Understanding the GLS changes through postharvest processing is essential for defined preservation. In this study, four different fresh-cut types, whole flower (W), floret (F), quarterly cut floret (QF) and shredded floret (FS) of broccoli, were stored for 0, 1, 2 and 3 day (s) to explore GLS responses to postharvest treatments. As a result, seven GLS were identified, mainly including glucoraphanin (RAA), neoglucobrassicin (NEO), and glucobrassicin (GBC) and accounting for 52.69%, 20.12% and 14.99% of the total GLS (21.92 ± 0.48) μmol · g-1DW, respectively. FS had the sharpest decrease in GLS after three days of storage (6.55 ± 0.37) μmol · g-1DW, while QF had the least (10.16 ± 0.33) μmol · g-1DW. All GLS components decreased over storage, except for 4-methoxyglucobrassicin (4 ME) in FS and QF, suggesting its key role in serious wound defence. The results suggested certain postharvest approaches influenced the flavour and nutrition of broccoli.

The Most Common Type, Severity, and Expected Frequency of Injuries Vary by Defensive Position in Professional Baseball Players

Background: Location, frequency, and severity of in-game injuries by defensive position played have never been determined in professional baseball players. Hypothesis: Catchers would have a higher frequency of hip and knee injuries; infielders and outfielders would have a higher frequency of general lower extremity injuries; and pitchers would have a higher frequency and severity of shoulder and elbow/forearm injuries. Study Design: Descriptive epidemiology study. Methods: The Major League Baseball Health and Injury Tracking System database was queried for all injuries in Major League Baseball and Minor League Baseball during the 2011-2019 seasons. Injuries were stratified by the following variables: athlete’s level of play at the time of injury, anatomic region injured, whether the injury occurred during a game, and position played at the time of injury (infielder, outfielder, catcher, or pitcher). Number of days missed from competition immediately after an injury was used as a surrogate for injury severity: mild (0 days missed), moderate (1-5 days), and severe (>5 days). Observed versus expected injury ratios were calculated for each anatomic region based on position played, and ratios were adjusted by the number of players per position type during a standard inning of play. Results: A total of 112,405 work-related injuries were reported, with the majority of injuries (86,520; 77%) occurring in Minor League Baseball athletes. Injuries to the leg, hand, shoulder, torso, and foot were the most common for athletes in both leagues, while hip/groin injuries were the least common. Catchers sustained the most in-game defensive head/neck injuries, while infielders and outfielders had the highest number of knee injuries. Starting and relief pitchers had the greatest total proportion of in-game defensive injuries across every other body region. Infielders and outfielders sustained injuries less frequently than expected across all body regions, while pitchers experienced more injuries than expected for all body parts. Catchers experienced more injuries than expected to the head/neck, hand, hip/groin, knee, and foot, and were more likely than other position players to sustain a knee injury that was categorized as severe based on time missed. Conclusion: The location, severity, and frequency of injuries vary by defensive position among professional baseball players.

Characteristics and outcomes of homicidal and accidental stab wounds in emergency hospitals: A medicolegal comparative study

Differentiation between the various manner of stab cases is challenging in forensic medicine. Although the distinction between homicidal and suicidal stabbing is well defined, there is a lack of discrimination between accidental and homicidal cases. Therefore, this study aimed to assess the characteristics of and outcomes for stab patients admitted to multiple emergency hospitals to highlight the distinction between accidental and homicidal stab wounds. This prospective cohort study assessed all patients with stab wounds admitted to multiple emergency hospitals from February 2021 to October 2021. Data collected on admission were demographics, trauma circumstances, internal organ damage, and patients' outcomes. Afterward, patients were categorized into homicidal or accidental stabs. Most of the included 51 stab cases were homicidal (78.4%). Most homicidal stabs were in middle-aged male drivers; were caused by sharp weapons, such as a penknife; and occurred in fights outdoors during the summer daytime. In contrast, most accidental stabs were occupational among building carpenters. Although homicidal stab wounds were significantly associated with a regular elliptical shape, oblique orientation, and defense wounds, the existence of a regular elliptical wound shape increased the likelihood of a homicidal stab. Additionally, penetrating stab type and a higher Injury Severity Score (ISS) were the dominant predictors of complications and mortality in stab patients, respectively. For fatal vague stab cases scenarios, the presence of an elliptical wound suggests the probability of homicidal injury than accidental. The initial ISS and stab wound type should be assessed to stratify stab patients who need intensive management in emergency hospitals.

Men’s Suicide by Self-abdominal Cut and Disembowelment: A Literature Review and Analysis of Three Cases

Introduction: Suicide by abdominal cut wounds and consequent disembowelment is a modality rarely described in the literature, with rates between 1.6% and 3%. The incidence is higher in men. This type of suicide might be so unusual as the abdominal injuries are not supposed to be related to immediate death (compared to the wrists or throat, which involves rapid bleeding, for example). Considering the infrequency of suicides by abdominal self-cutting, in such cases, the main hypothesis is a homicide, especially in those with multiple injuries or occurred in a complex setting. These cases require a detailed autopsy report with the analysis of the injuries and circumstances of death (e.g., farewell note, history of depression, previous suicide attempts, defense injuries, and signs of hesitation) to allow a differential diagnosis between suicide and homicide. This study aims to highlight the characteristics of suicides through self-cut wounding, focusing on those that determine a large abdominal opening and evisceration. Methods: The authors conducted the literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, on PubMed and Scopus databases, using the following keywords: “(suicide) AND (abdominal stab wounds)”, “(suicide) AND (abdominal sharp injuries)”, “(suicide) AND (abdominal self-stabbing)”, “(suicide) AND (abdominal cut wounds)”. Results: 7 articles were included in the systematic review, for a total of 11 cases of suicide by abdominal self-cutting. Of these cases, 3 were women and 8 were men. Conclusions: The analysis of the external examination findings versus the crime scene results is essential to clarify if injuries are self-inflicted with suicidal intention. Suicide through a violent act can also be practiced by people who have no history of psychiatric conditions or other risk factors. Therefore, in cases of abdominal cut and evisceration with victims’ survival time, the forensic pathologist has to consider that the deceased himself could cause modifications to the crime scene, turning it into a complicated suicide.

Medicolegal Aspects of Victims of Assault Admitted to a Tertiary Care Hospital in Sri Lanka.

Violence with physical assault is a common cause of morbidity and mortality prevalent but not limited to underdeveloped countries. The opinion of the forensic expert is often indispensable in such cases to determine the penalties. This study was planned to describe the pattern of presentation of the victims and evaluate the strengths and limitations in formulating a scientific medicolegal opinion based on the findings of the victim. A retrospective descriptive study based on the case records of the victims of assault admitted to Colombo North Teaching Hospital, Ragama, Sri Lanka, was conducted for four years. Out of the 400 victims, the majority (72% n = 290) were males and of the age-group of 21 to 40 (n = 216). The reason for assault in the majority was sudden provocation (n = 99, 25%), followed by previous long-duration enmity (n = 89, 22%). The majority (83%) had isolated blunt force trauma, and the injuries were nongrievous (74%). Defense injuries were significantly associated with attempted defense (p = 0.000) and sharp force trauma (p = 0.002). The underlying reason for the assault was not significantly associated with the causative weapon (p = 0.228) or body region injured (p = 0.195). Even though the presentation and the pattern of injures are definitely of value in formulating a scientific opinion, the study identified the limitations of the forensic experts, and the need for a holistic approach at the investigations was highlighted.

Optimal Conditions for Diapause Survival of Aprostocetus fukutai, an Egg Parasitoid for Biological Control of Anoplophora chinensis.

Simple SummaryDiapause is a critical state of an insect’s life cycle when it undergoes arrestment of growth and/or reproduction to survive adverse environmental conditions and/or food shortage. Aprostocetus fukutai is a specialist egg parasitoid of the citrus longhorned beetle, Anoplophora chinensis, a high-risk invasive woodboring pest. The parasitoid overwinters as diapausing mature larva in the host egg and emerges in early summer in synchrony with the egg-laying of A. chinensis. Here, we determined the optimal conditions for diapause survival of this parasitoid. We showed that the parasitoid had a low (36.7%) diapause survival rate inside host eggs laid on potted plants due to desiccation or tree wound defense response under semi-natural conditions. Under laboratory rearing conditions, when parasitized host eggs were extracted from wood, the parasitoid did not survive at low humidity (44% RH). Survival rate increased with humidity, reaching the highest at 100% RH. Survival rate also increased with increasing chilling period temperature from 2 to 12.5 °C. Post-diapause developmental time decreased with increased humidity or temperature, but the reproductive fitness of the parasitoid was not significantly affected by the temperature regimes. Overall, high humidity (100% RH) and mild temperatures (12.5 °C) are the most suitable survival conditions for the diapausing parasitoid and thus should be used in laboratory rearing.Aprostocetus fukutai is a specialist egg parasitoid of the citrus longhorned beetle Anoplophora chinensis, a high-risk invasive pest of hardwood trees. The parasitoid overwinters as diapausing mature larvae within the host egg and emerges in early summer in synchrony with the egg-laying peak of A. chinensis. This study investigated the parasitoid’s diapause survival in parasitized host eggs that either remained in potted trees under semi-natural conditions in southern France or were removed from the wood and held at four different humidities (44, 75, 85–93 and 100% RH) at 11 °C or four different temperature regimes (2, 5, 10 and 12.5 °C) at 100% RH in the laboratory. The temperature regimes reflect overwintering temperatures across the parasitoid’s geographical distribution in its native range. Results show that the parasitoid resumed its development to the adult stage at normal rearing conditions (22 °C, 100% RH, 14L:10D) after 6- or 7-months cold chilling at both the semi-natural and laboratory conditions. It had a low survival rate (36.7%) on potted plants due to desiccation or tree wound defense response. No parasitoids survived at 44% RH, but survival rate increased with humidity, reaching the highest (93.7%) at 100% RH. Survival rate also increased from 21.0% at 2 °C to 82.8% at 12.5 °C. Post-diapause developmental time decreased with increased humidity or temperature. There was no difference in the lifetime fecundity of emerged females from 2 and 12.5 °C. These results suggest that 100% RH and 12.5 °C are the most suitable diapause conditions for laboratory rearing of this parasitoid.

Analysis of Defence Injuries in Homicide Cases Categorised in Accordance to Homicide Injury Scale

Introduction: The instinct of self-preservation drives a person to defend themselves from any violent attackwhich in itself may produce injuries on the body. These are termed as defence injuries. This study aims toanalyse defence injuries in homicide cases which are categorised based on its severity as determined byHomicide Injury Scale (HIS).Methods: This is a retrospective study which included all homicide cases which were autopsied during atwelve year period in a tertiary care hospital. Each of these cases were categorised according to the HIS. Thepresence, type and distribution of defence injuries were then tabulated and analysed.Results: A total of 85 homicide cases were autopsied during the specified study period. Out of these 85cases, 53 cases showed defence injuries (62%) and majority of these cases fell under higher categories ofHIS. Cases categorised under HIS 2,3 and 4 had defence wounds which were more blunt force in naturewhile cases under HIS 5 and 6 had more sharp force defence injuries. Passive defence injuries were founduniformly across all categories of HIS, however active defence injuries were found more in higher categoriesof HIS than in lower ones.Conclusion: This is rare study where the pattern and distribution of defence injuries was analysed based ona standardised scale. Active defence injuries were more commonly seen in homicide cases placed on higherscales of HIS.

0729 Sleep Apnea Diagnosis And Severity And Their Impact On Cognition After TBI: A VA TBI Model Systems Study

Abstract Introduction For persons with moderate-to-severe traumatic brain injury (TBI), chronic cognitive impairment contributes to long term disability. Health comorbidities may contribute to the neurologic burden in TBI. Indeed, obstructive sleep apnea (OSA) is associated with neuropathological and cognitive changes. The objective of this study was to examine the relationship between OSA and cognition after TBI. Methods Participants were prior inpatient rehabilitation patients drawn from the Tampa VA TBI Model Systems longitudinal study. Post-discharge interviews occurred 2 to 6 years post-TBI. Participants reported whether they were diagnosed with OSA and completed the Brief Test of Adult Cognition by Telephone (BTACT) which measures recall, working memory, processing speed, fluency, and reasoning. Participants with polysomnography (PSG) were separately analyzed to examine the impact of sleep apnea severity (i.e., Apnea-Hypopnea Index [AHI]) on cognition. Results Participants (N=104) were mostly male (95.2%), age M=37.7 (SD=12.5), Education M=13.6 years (SD=2.1), and 45.2% were diagnosed with OSA. Participants with and without OSA did not differ by age, education, gender, or time since injury at time of BTACT (ps > .05). ANCOVAs were conducted examining OSA diagnosis on BTACT subscale scores, covarying TBI severity level, but results did not reach statistical significance (ps > .05). A subset of participants with OSA had PSG (n=27), AHI score quartiles = 6.7/10.4/21.6. Higher AHI was associated with poorer reasoning (Spearman ρ = -0.45, p = .019). Nonsignificant results were found for word recall (Spearman ρ = -0.35, p = .074) and processing speed (Spearman ρ = -0.36, p = .069). Conclusion Severity of sleep apnea may influence aspects of cognition among persons with TBI, although these results are preliminary and need replication with a larger and more representative sample. Support This work was supported by the Veterans Health Administration Central Office VA TBI Model Systems Program of Research and subcontract from General Dynamics Information Technology [W91YTZ-13-C-0015, HT0014-19-C-0004] from the Defense and Veterans Brain Injury Center (DVBIC); and from the United States Department of Veterans Affairs [W81XWH-13-2-0095]; and from the United States Department of Defense Congressionally Directed Medical Research Programs; and from the Patient Centered Outcomes Research Institute (PCORI) [CER-1511-33005].

Sharp Force Homicide in Denmark 1992-2016.

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992-2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.

Fatal Abdominal Stabbing: A Confusing Picture in Differentiating Homicide and Suicide

Background : Differentiating between homicide and suicide can be difficult and even impossible. In this report, we presented a fatal stabbing injury, which made a challenge in the verification of the manner of death. Case Report : A 45-year-old man was found dead in his workplace with a knife beside him. His mouth was closed with a scarf, his clothes were intact, and no evidence of a struggle was observed in the scene investigation. There was a vertical stab wound on the midline of the victim’s belly and his intestines were tangled out of the wound. In the autopsy, no defense wound was found. There was blood in the abdominal cavity and retroperitoneal region and several perforations were observed in the intestine and liver along the superficial wound. Painful death and torturous extraction of visceral organs resembled homicide, but nothing indicative of hostility and homicide was found by the forensic exploration and police investigation. Finally, the manner of death was assigned as suicide and the cause of death was a hemorrhagic shock as a result of sharp force injuries. Conclusion : This case represents a bizarre suicide, which is rare and highly suspicious of homicide. In such mysterious cases, the evidence of autopsy and crime scene and police investigation should be regarded to make a decision.

Treatment using the Progressive Return to Activity Clinical Recommendation may return individuals with elevated symptomatology to normal levels at an expedited rate

Abstract Objective To determine whether the use of a clinical recommendation (CR) for activity progression to treat concussion will benefit symptom profile months post-injury beyond what is seen with usual care. Methods This study included 58 individuals who participated in the Defense and Veterans Brain Injury Center Progressive Return to Activity (PRA) Study. Eligibility included sustaining a concussion within 72 hours of study enrollment and no previous concussion within 12 months of injury. Poisson regression with robust error variance was used to evaluate the relationship between treatment group assignment (usual care versus PRA-CR) and having normal symptomatology (Neurobehavioral Symptom Inventory score below the upper 10th percentile) at the 1-, 3-, and 6-month follow-up. Participants with normal symptomatology within 72 hours post-injury were excluded from analyses. Results Among participants with abnormal symptoms within 72 hours post-concussion, those receiving the PRA-CR to treat concussion had a 70% (CI = 1.06, 2.72) greater prevalence of normal symptomatology by 1 month post-injury, and a 39% (CI = 1.04, 1.87) greater prevalence of normal symptomatology by 3 months post-injury compared to those receiving usual care. By 6 months post-injury, there was no difference in the prevalence of having normal symptoms between groups. Conclusion The findings of this study show that participants with abnormal symptomatology decreased in symptom level to normal at a faster rate among those receiving the PRA-CR compared to those receiving usual care, providing evidence for the use of the PRA-CR as a means to enhance treatment of patients with concussion.

Homicide patterns for the last 20 years in South and South East Delhi, India.

Homicide patterns are a useful indicator of social stress in a community, and they provide law-enforcement authorities with helpful information. This study was undertaken at the All India Institute of Medical Sciences, New Delhi, India, in order to understand the regional pattern of homicide. Data from the last 20 years were analysed. There were a total of 1048 male and 323 female homicide cases. The male/female ratio was about 3:1, and the proportion of total autopsies was approximately 4% for both sexes. The most common age group was 11-40 years old. Female cases were more common during the monsoon season, but male cases did not show any such variation. Blunt-force head injury, stabbing, strangulation and shooting were the most common methods, and the head, neck and chest were the most commonly targeted areas. Defence injuries were seen in 7.9% cases, significantly more often amongst men, most of which were active and in the form of incised wounds. About 17% of cases survived in hospital for up to a month before succumbing to their injuries, with males being in their 50s and 60s and females in younger age groups. Most of these cases suffered a gunshot wound, followed by a head injury and a stab wound.

Death in the work place; Accident or homicide? The role of death scene examination

Death scene examination is an essential component of a complete medico-legal autopsy. The present case is that of a 58-year-old male who died very late at night in an unclear circumstance. He had suffered severe multiple craniofacial fractures, and injuries to the left hand and digits (defense wounds), mimicking homicidal death. The altered scene was examined 4 weeks after the incident, and with the autopsy conducted at the same time, the manner of death was concluded to an accident.