Forensic Medicine Experts Research Articles

Nanomaterials and security in occupational and forensic medicine: insights from nanotoxicology

Nanoenergetics are defined as a class of nanomaterials that possess the ability to release energy in certain situations. These properties have been studied and deepened in recent years, so much so that nanoenergetics have been introduced into the use of the weapons industry, among others. It is therefore an emerging reality that deserves attention with regard to potential harmful effects on human and environmental health. it has been suggested that nanoenergetics may have genotoxic and immunotoxic effects, among others. Problems related to exposure to nanonenergetics can therefore potentially affect both exposed workers (both in the production and use phase) and the civilian population, if used in war scenarios, for example,. Starting from these assumptions, the INNOTOX research project aims to contribute to the in-depth study of the toxicity of nanonenergetics, through an integrated approach involving experts in occupational and forensic medicine, nanotoxicology and bioengineering.

Trend of medico-legal cases at a tertiary care teaching hospital of U.P.

Background:Trend of medico legal cases is a fundamental part of the prevention of avoidable causalities in future and to study the crime rate in area. In present study an attempt is made to know the burden of medico legal cases. The aim of present study is to describe the profile, pattern and trend of medico-legal cases and identify errors in the medico-legal reports. METHOD:This is a Retrospective, descriptive, non-interventional study, conducted in emergency department of Government Medical College and Hospital Jalaun during the period from 1st January 2023 to 31th December 2023. This is a tertiary care teachinghospital where patients are referred from most of private hospitals. Patients from district hospitals of the region are also admitted in this college. Conclusions:In majority of places, duty of casualty medical officer is accomplished by MBBS doctor whois not expert in handling of medico legal cases. Therefore medico-legal work should be doneunder the direction of forensic medicine expert to avoid inaccuracy in giving the opinion. The presentstudy showed that male outnumbered female and maximum cases were of youngergeneration. Most common aetiology was of road traffic injuries. Such incidences can beprevented by giving awareness through proper education and training of safety standards byadministrators through road safety programs.

Silent while living, speaks when dead- A case report of manual strangulation

Victim of throttling in majority of the cases die instantaneously as the perpetrator continues to apply pressure till death ensues. In certain cases, victim may survive for some time if pressure is withdrawn due to any reason. In such cases, after the incident, he/she may not be conscious or able to speak for giving history; but the injuries produced by application of pressure by palms and fingers, if looked for them carefully, may speak by themselves about the incident. Presenting here, a case of 52 years old female, where the “made-up” history by the relatives misdirected the thinking process of the clinicians as the patient could not speak at all at the time of admission to the hospital until death. Autopsy conducted on 5 day of hospitalization revealed typical signs of the homicidal act the victim was subjected to, which could have been identified in the “fresh” stage at the time of admission and could have helped in some more detailed medico legal investigations if it could have been referred to Forensic Medicine experts of the institute. This case report stresses on the need of multi-disciplinary approach at the time of treatment of any patient with suspicious history, to have some different angle of view with regards to medico legal concerns and hence, it is discussed here.

Forensic Medical Examiners’ Role in Resolving Malpractice Claims:Legal and Ethical Obligations

In the last few years, the trends of malpractice claims have escalated worldwide. In many judicial systems, forensic medical examiners manage malpractice lawsuits because of their experience in medical, legal, and ethical aspects of healthcare. They analyze medical records to objectively investigate consent-related issues and verify any neglect or deviations from standard medical care. Then, the extent of harm is evaluated in the surviving cases by determining the degree of resulting infirmity. Judicial penalty and compensation depend on the infirmity’s percentage. In cases involving patient death, comprehensive post-mortem examinations are performed to explore potential medical errors, death causes, and causal relations between error and the occurrence of death. It is essential to consider that evaluating technical errors necessitates the expert opinions of consultants from the same specialties as the accused physicians. The legal obligation for all forensic medicine experts is to provide objective, unbiased, evidence-based medicolegal reports. The ethical commitments include preserving the confidentiality of data of both patients and accused healthcare providers. Also, forensic medical examiners could actively participate in healthcare education to protect medical staff against future malpractice accusations.

Inequality in Forensic Medicine in India: The Current Scenario and Way Forward.

Background Forensic Medicine (FM) is one of the core specialties of medicine in India, which serves as a bridge between medical science and India's justice delivery systems. Although FM experts play a crucial role in handling medicolegal cases, there is an increasing deficit of FM experts in India. This may be due to the inadequate postgraduate (PG) seats across the states and the low uptake of PG seats in FM. This study was conducted to explore the current status of PG seats along with the Forensic Medicine Toxicology (FMT)/FM index across Indian states. Methodology In this cross-sectional study, data on the number of PGs in FMT/FM and the institutes offering PG courses in FMT/FM were searched on the official website of the National Medical Commission. The data available on the website until November 2023were incorporated. The FMT/FM index was calculated at the national and state levels, and the states were graded based on the national FMT/FM index. Results The national FMT/FM PG trainee index was 0.054. Considering this as the reference value, grading of the FMT/FM PG trainee index was done as the highest (1.159 to 0.308), higher than the nation (0.054 but less than 0.308), lower than the nation (0.054 but higher than 0.00), and zero. Among all the states and union territories, Andaman & Nicobar, Arunachal Pradesh, Dadra and Nagar Haveli, Jammu & Kashmir, Lakshadweep, Mizoram, Nagaland, Sikkim, and Ladakh had zero FMT/FM PG index due to non-availability of any PG seats for FMT/FM. In total, 20 states had an FMT/FM PG index higher than India's FMT/FM PG index headed by Pondicherry (1.159), followed by Chandigarh (0.429) and Goa (0.308). Conclusions PG seats were highly deficient in several states, which is more likely to affect justice delivery in the future across these states. This study has a few limitations, as we did not explore the actual intake of these PG seats across different states. We anticipate a lower intake of PG seats due to factors such as low demand, fewer job opportunities, and monetary gain. However, this needs further exploration in future studies.

The relationship between depth and diameter of the human acetabulum in the dry hip bone of Maharashtra population

Abstract Background: Anatomy of the hip must be taken into account to perform the various surgical procedures like reconstruction of the acetabulum in patients with significant acetabular bone deficiency. It remains a major challenge in total hip arthroplasty. Appropriate anatomic concepts for surgery to treat femoroacetabular impingement require a precise appreciation of the native acetabular anatomy. Since the acetabulum is not always of the same shape, width or depth, joint congruence is frequent with minor anatomical variations in the shape of the acetabulum. Hence, the present study was undertaken as controversies still exist on the importance of these variations and to prevent problems following surgical procedures such as acetabular reconstruction and femoroacetabular impingement. Method: 81 dry human hip bones of unknown sex were taken for observation from departments of anatomy at Dr SCGMC Nanded and SRTRGMC Ambajogai. All hip bones were adult-type. The exact age and sex of hip bones were not known. Measurements were taken in millimeters using a sliding digital vernier calliper. The mean and standard deviation of the acetabulum in various dimensions were calculated. Parameters of acetabulum depth and diameter were measured. Result: The overall goal of this study was to generate data that would be useful to the orthopaedics for geometric modelling. The study would also help the forensic experts. It would also be valuable for the anthropologists in their racial and population studies. The mean SD value of the depth of acetabulum on the right side is 27.121.02mm and on the left side is 27.021.03. The mean S.D. value of the diameter of the acetabulum on the right side is 47.501.27mm and on the left side is 47.451.33. Conclusion: Morphological study on adult hip bone is useful for anatomists, anthropologists, experts in forensic medicine and orthopaedics for performing surgical procedures in this area.

Evaluation of medicolegal death cases sent from abroad to the province of Denizli

Purpose: In this study, we aimed to contribute to the literature by discussing the difficulties encountered in the approach to suspicious death cases reported abroad and sent to our country.
 Materials and methods: The findings were obtained by retrospectively reviewing all medico-legal death cases sent from abroad to Denizli province between January 2012 and December 2022, in which death examination and autopsy were performed.
 Results: Of the 12 cases included in the study, 3 were female and 9 were male, the youngest case was 2 years old and the oldest case was 66 (median 49) years old. Germany was the country to which the most suspicious death cases were sent with nine cases (75%), while one case each was sent from Turkmenistan, the Netherlands and Austria. When the cases were evaluated in terms of origin, it was observed that 5 (41%) cases were of natural origin followed by 4 (33%) cases of suicide origin.
 Conclusion: : In order to minimize the problems encountered in the re-evaluation of medico-legal death cases from abroad, we think that it would be appropriate for all countries to perform medico-legal autopsy in accordance with international standards for suspicious death cases sent abroad, and to share the report containing the autopsy findings and all documents that may help to clarify the cause of death of the person with the forensic medicine experts in the country of destination.

Forensic analysis of fabricated long bone fractures for gain.

Self-inflicting injury is a recognised psychiatric disorder. Such cases are regularly seen in the emergency department, with a false history of assault. Most of these are easily detected by a forensic medicine expert as they present as described in literature but are difficult to explain if altered by professionals for nefarious reasons. This was a prospective study carried out at a tertiary centre. The data was collected and analysed from the office records of medico-legal reports prepared at our institute between 25 February 2022 and 25 February 2023. 21 cases were recorded, that met with our criteria. Most involved males (90.5%). Minimum age was 27 years and maximum age 66 years with a mean of 48.6 years and a standard deviation of ±11 years. Most offenders were unemployed (38.1%). Most fractured bone was tibia (47.6%). Left-sided fractures were more common (61.9%). Injuries corresponded with the findings on clothes in three cases (14.3%). Fabricated wounds will reflect the intentions of the fabricator and may range from superficial wounds to grievous injury. Only a critical analysis of all medico-legal cases will identify them, and they will have similarities of presentation. Such findings have rarely been reported in other parts of India. A diligently prepared medico-legal report and profiling of all cases can help establish patterns of such injuries.

Anthropometric study of facial and nasal indices of the Akan ethnic population of Ghana

Introduction: Facial anthropometry is required in many medical and dental disciplines, particularly for prosthodontists, orthodontists, plastic surgeons, maxillofacial surgeons, and forensic medicine experts. An individual's facial shape is a reflection of their race, age, and gender. The present study aimed at determining the facial and nasal indices among the Akan ethnic group in Kumasi, Ghana.Methodology: A total of 307 (182 males and 125 females) Akan adult volunteers between the age of 18 - 30 years were recruited for the study. Standard procedures were used to obtain the necessary facial and nasal measurements for generating the appropriate indices. A p-value of 0.05 or less was judged statistically significant.Results: In males, the facial index ranged from 75.28 to 117.90, while in females it ranged from 76.58 to 97.87. The nasal index ranged from 52.0 to 115.3 in males and 52.0 to 105.7 in females. There were significant differences between males and females in all facial parameters utilized to calculate facial and nasal indices. The facial index, but not the nasal index, differed significantly between Akan males and females. Mesoprosopic was the most prevalent face type in both male and female Akan populations, whereas mesorrhine was the most common nose type.Conclusion: The findings of this study can be used as a reference to improve the outcome of cosmetic and reconstructive facial surgery and rhinoplasty, as well as for medico-legal purposes in the Akan people of Ghana.

Individual Tolerance to Acute Ethanol Intoxication

Relevance: In order to figure out the cause of death and present the evidences to the court, law enforcement authorities instructed forensic medicine experts to carried out differential diagnosis, by using the posthumous exogenous alcoholemia to differentiated between the severity of acute ethanol intoxication, and death caused by alcohol poisoning. However, the experts are difficult to carried out the assessment to determine the severity of alcohol intoxication, even using the following criteria: exogenous alcoholemia level, signs of conditionally fatal ethanol poisoning with trauma. There are differences in the ethanoloxidizing dehydrogenase enzymatic activity, make it easier to determine individual ethanol tolerance, which can be used for forensic medical substantiation to determine severity of acute alcohol intoxication and fatal ethanol poisoning. Purpose of the Study: We carried out the research by evaluating the severity of the acute alcohol intoxication, by taking into account the blood ethanol concentration level and the death caused by the fatal ethanol poisoning; we use the 2 indicators of the ethanol- oxidizing enzymatic activity, which are the alcohol dehydrogenase in liver, and acetaldehyde dehydrogenase in the brain. Material and Methods: Forensic medical experts using 72 corpses to carried out the research, we had identified ethanoloxidizing enzymatic activities in the brain stem and liver and divided into 3 observation groups : Group I – death from fatal ethanol poisoning (FEP) with blood ethanol concentration between the range from 3.0 to 5.3 g/L (22 cases); Group II – death caused by car accidents as the drivers who are having severe ethanol intoxication with vehicle’s mechanical damage, the blood ethanol concentration between the range from 3.0 to 4.8 g/L (25 cases); Group III (controlled group) – death caused by car accidents with vehicle’s mechanical damage without exogenous alcoholemia (25 cases). Results: In the fatal ethanol poisoning group, we compared with the controlled group, there are decrease in enzymatic activities, and there were significant statistically decreases (P<0.05). When comparing these enzymatic activities between IInd and IIIrd group , there were no significant statistically differences (P>0.05).

Prevalence Estimates of Symptom Feigning and Malingering in Spain

Symptom feigning and malingering should be evaluated in forensic contexts due to their important socio-economic consequences. Despite this, to date, there is little research in Spain that evaluates its prevalence. The aim of this study was to investigate this issue using the perception of the general population, students, and professionals of medicine and forensic psychology. Three adapted questionnaires were applied to a total of 1003 participants (61.5% women) from 5 different groups. Approximately two-thirds of participants reported knowing someone who feigned symptoms, and one-third disclosed feigning symptoms themselves in the past. Headache/migraine, neck pain, and anxious–depressive symptoms were the most commonly chosen. Experts in psychology and forensic medicine estimated a prevalence of 20 to 40% of non-credible symptom presentations in their work settings and reported not having sufficient means to assess the distorted presentation of symptoms with certainty. Professionals and laypersons alike acknowledge that non-credible symptom presentations (like feigning or malingering) are relevant in Spain and occur at a non-trivial rate, which compares with estimates in other parts of the world.

Bomb explosions fatalities in civilian area: Two unusual cases

While bomb blasts are often associated with wars and terrorism in military and terrorism-prone areas, these events are incredibly rare in other civilian areas. Consequently, forensic medicine experts are rarely exposed to such cases. Explosion injuries produce a distinctive pattern on the body that can help determine the cause of death and reconstruct the crime scene. As such, it is imperative for an autopsy surgeon to be aware of the pattern of bomb blast injuries as well as their mechanisms. In this article, we present autopsy findings of two scrape yard workers who were killed by a bomb blast while breaking scrapes that they received from an army firing range. Furthermore, we have tried to correlate autopsy findings with the circumstances of the blast.

Importance of Crime Scene Visits by a Forensic Medicine Expert: A Survey-Based Study.

BackgroundThis study is intended to compare the Indian system of inquests, which is conducted by nonscientific people like police and magistrate (who are compulsorily neither qualified in science nor in law), and the medical examiner system of the USA which is done by doctors specialized in forensic medicine/pathology.AimsThe goal of this study was to see if bringing in a medical examiner system makes a difference in determining the cause, manner, and time of death as compared to the current system of conducting inquests and autopsies by two different agencies, namely, the police and forensic medicine experts.Material and methodsIn the present study, a peculiar case (in which the police were clueless and the autopsy surgeon was confused during the autopsy) was chosen for getting an expert opinion from 50 forensic medicine experts from different parts of the country in which police were not clear regarding cause, manner and time of death, but later after a crime scene visit by forensic medicine experts who had conducted the autopsy, it was clarified. Opinion regarding the cause, manner, and time since death was taken from 50 medico-legal experts in two steps. In the first step, only the autopsy finding and history obtained from police were provided and in the second step, additional information obtained from the crime scene visit by forensic medicine experts was provided.The sampling method was purposive sampling.ResultIn the cause of death, Cohen’s Kappa coefficient was 0.30% (z-statistic = 3.87, p-value = 0.0001), indicating a significantly low agreement between the first and second steps by the experts, as their decision changed after getting the evidence of the crime scene visit. In the manner of death, Cohen’s Kappa coefficient was 0.06% (z-statistic = 0.66, p-value = 0.2540) indicating a very low agreement between the first and second opinions by the experts as their decision regarding the suspected manner of death changed drastically after getting the evidence of crime scene. In the time since death, Cohen’s Kappa coefficient was 0.5531% (z-statistic = 7.25, p-value = 0.0001), which also indicates significant difference.ConclusionTherefore, in this study, the usefulness of the medical examiner system in the Indian setting has been proved beyond doubt expecting drastic improvement in criminal investigation by introducing the medical examiner system in India.

Incidence of Metopic Suture in Adult Human Crania in Uttar Pradesh

Introduction: Failure of ossification in the vertical direction between the two halves of the frontal bone is called a metopic suture; this suture is present in between the superciliary arch and tubers of the frontal bone so it is also called a median frontal suture. At birth, the frontal bone present is two half, in the 1st year they contact each other, and within the 7th to 8th year, they fused together. Sometimes, bones may not be fused completely and it becomes metopic fontanelle. Materials and Methods: The goal of the current study was to determine the prevalence of metopic suture in adult human skulls in Uttar Pradesh. One hundred and fifty macerated skulls of undetermined age and sex were used for this. The anatomical departments of Teerthankar Mahaveer Medical College and Research Center (Moradabad), King George Medical College (Lucknow), SRMS Institute of Medical Science (Bareilly), Govt. Medical College Kannauj, and Govt. Medical College Saharanpur provided these skulls. Results: This study has found the incidence of metopic sutures of about 12.90%. The two types of metopic sutures were found in this study, namely complete metopic suture 4.52% and incomplete metopic suture 8.38% in which found 0.64% "V" shape metopic suture. Conclusion: The morphological study of metopic sutures on adult crania is useful for anatomists, experts in forensic medicine, and neurologists for performing surgical procedures in this area.

A Guide to Forensic Photography: An Indispensable Tool in Modern Forensic Medicine Practice and Medicolegal Cases

Forensic photography has become an important tool in the medicolegal system, so as to it give a complete picture for investigating crime scenes. It is the easiest and effectual way to capture the crime scene, in a way what could’ve happened that even the most illustrative and descriptive words could not do. However, appropriate selection and implementation of the proper photography and computer equipment combined with effective training and correct workflow patterns is required for incorporating photography into the field of forensic practice with proper documentation. This paper highlights basic aspects to gain clear and focused photographs both in living individuals and Medicolegal Postmortem examination. The paper contains the propositions for a draft protocol for Forensic Photography in Crime Scene Examination, Medicolegal examination, postmortem examination and examination of exhibits. The authors aim to make a guiding document by virtue of their experience so as to guide the young Forensic Medicine experts/ Forensic Scientists.

Determination of Sex of Sacrum in Adult Bangladeshi People by Morphometric Study

Background: Sex determination from bones is of vital importance in anthropological studies and medico-legal cases. Sacrum is one of the bones, which exhibits sex differences. Literature available on this bone shows that not much study has been done in the population of Bangladesh. In the present study, an attempt has been made to test the validity of the parameters that are useful in differentiating male and female sacra. The present study was conducted to see the sexual dimorphism and morphometry of sacrum in adult Bangladeshi people. This study will be useful for anatomists, experts in forensic medicine and physical anthropologist for more accurate sexing of sacra.
 Materials and methods: Descriptive, cross-sectional study was conducted in the Department of Anatomy, Chittagong Medical College, Chattogram on 100 dry human sacra of known (Male-46, female-56) sex during January 2014 to December 2014. The measurements included for the study were maximum length, maximum width, mid ventral curved length, transverse diameter of first sacral vertebra, length of ala, maximum length of auricular surface and indices like curvature index, sacral index, corporo-basal index, alar index, index of body of S1, auricular index were calculated and statistically analyzed.
 Results: In the present study the male sacrum showed significantly higher values for ventral straight length, ventral curved length, transverse diameter of S1 and antero-posterior diameter of S1 than the female sacrum, while the female sacral index showed higher value compared with the values of male.
 Conclusion: From the above parameters and indices in the present study revealed demarking points for each have statistical significant role in determining the male and female sacrum.
 IAHS Medical Journal Vol 4(2), June 2021; 2-4

Sexual Dimorphism of Adult Human Spleen in Haryana State of North India

introduction: Spleen is an important lymphoid organ of human body in the upper left part of the abdomen. Spleen performs various functions as it produces immune response against blood-borne antigens and acts as the graveyard of defective and aged erythrocytes. It exhibits sexual dimorphism. The present study is conducted to evaluate sexual dimorphism in morphometry of spleen (spleen weight, length, width, thickness and surface area) in the Haryana region. Region-wise assessment of spleen size gives a broad perspective of spleen sizes and also helps in understanding the ranges in morphometry of spleen with respect to gender. The study proves helpful in context of providing spleen size for spleen transplantation. materials and methods: After taking permission from Institute Ethics Committee, 30 male and 30 female adult human spleens in the age group of 16-70 years belonging to the Haryana region of North India were included in the study. The study was conducted in the Anatomy department along with collaboration from the Forensic department at Pt. B.D. Sharma PGIMS, Rohtak. The data thus obtained was recorded and analysed using suitable software. results: Statistical significance in dimorphism of splenic weight, length and splenic total surface area in males and females. The results of the present study would be useful for anthropologists, and forensic medicine experts to identify a spleen.

Application of 3D scanning and 3D printing in forensic practices - A preliminary survey among forensic practitioners in India

Three-dimensional scanning and printing technologies have influenced our society in recent years. It is gaining favour in forensic science and medicine, as the depth and spatial information are retained when the virtual models are 3D printed. To assess the knowledge, attitude and practice of forensic professionals in India regarding the use of 3D scanning and 3D printing in forensic practice. In this descriptive cross-sectional study, we collected data through online self-administered questionnaire consisting of 20 questions circulated among the forensic practitioners in India. 64 participants responded, out of those, 54 were forensic medicine experts and 10 were scientific officers at Govt. Forensic Science Laboratory. The findings highlight the knowledge regarding this technology is limited amongst the forensic practitioners in India. The technology is practised only by the scientific officers at handful laboratories and not by any of the forensic medicine doctors. With developing technologies, there is no doubt that for better investigation of crime in 21st century, 3D technology can be of great aid. This would further encourage researches to include this high potential modality and transform the current forensic practices in India and abroad.

Correlation of Morphometric Parameters of Spleen and Height of the Deceased: A Cross-sectional Study in North Indian Population

Introduction: Estimation of stature is a major forensic anthropological concern used in the identification of unknown and mutilated human remains. Studies considering spleen morphometric parameters to decipher the height of the deceased are very rare especially in Haryana though research studies involving correlation between height and other body organs have been done. Aim: To determine the correlation between the morphometric parameters of the spleen and height of the deceased. Materials and Methods: The cross-sectional study was carried out in the Department of Anatomy in collaboration with the Department of Forensic Medicine in Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from September 2010 to September 2012. The spleen specimens (30 male and 30 female) obtained from deceased adults in the age group of 16-70 years (both age inclusive) belonging to North India from the Department of Forensic Medicine during autopsy. The measurement of splenic parameters (weight, length, breadth, thickness and surface area) was done using direct measurement (standard methodology) accepted by anthropologists. The data was analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0. Pearson’s correlation test was used to evaluate the association between the splenic parameters and height. Correlation formula was derived to calculate the height from the splenic measurements. Results: Correlation of height was positive with splenic measurements (weight, length, breadth, thickness and total surface area) in both males and females and was significant with splenic weight (r-value=0.54 and p-value=0.02) and splenic length (r-value=0.548; p-value=0.002) in females. It was significant for splenic thickness in males (r-value=0.042; p-value=0.018) and significant for total surface area of spleen for both males and females (r-value=0.80 and p-value <0.00001 in males and r-value=0.58 and p-value=0.000781 in females). Conclusion: Correlation of height was significant for splenic weight and length in females; significant for splenic thickness in males and significant for total surface area of spleen for males and females. This study would help Anthropologists and Forensic Medicine Experts to calculate the height of the deceased using various regression equations if spleen is intact and is measured.

Journey of a forensic medicine expert

Journey of a forensic medicine expert