Medicolegal Autopsy Research Articles

Escherichia coli in medicolegal autopsy causing symmetrical peripheral gangrene and psoas abscess

Postmortem microbiology (PMM) plays a crucial role in identifying infectious causes of death, which have significant legal and clinical implications. Not only determining the cause of death, PMM is vital in identifying infectious pathogens providing valuable medical insights. This case series presents two medicolegal autopsy cases where Escherichia coli infections led to rare and severe complications: Symmetrical peripheral gangrene (SPG) and psoas abscess. The first case involves a 28-year-old female hospitalized for 35 days after allegedly consuming sedatives. Postmortem findings included gangrene in her hands and feet and extensive lung consolidation with pus nodules. Blood cultures identified E. coli, while lung swabs revealed Klebsiella pneumoniae and Candida spp. The second case involves a 32-year-old female experiencing abdominal pain and breathing difficulties who died en route to the hospital. The autopsy revealed congested lungs and a psoas abscess, with blood cultures confirming E. coli infection. E. coli, typically associated with urinary tract infections, can cause severe complications such as SPG and psoas abscess. SPG involves ischemic damage to extremities without central vessel occlusion, often linked to septicemia and disseminated intravascular coagulation. Psoas abscesses result from hematogenous spread or direct extension from adjacent structures. These cases highlight the need to consider atypical pathogen presentations in critically ill patients. Recognizing E. coli’s potential for rare, fatal complications emphasizes the importance of thorough microbiological analysis during autopsies to improve diagnostic accuracy, guide clinical management, and inform public health strategies. Integrating PMM into routine autopsy protocol is essential for advancing medical and forensic knowledge.

Searching for a Serial Killer on a Hospital Ward

The recent case of Lucy Letby in the UK shows that exposing a serial killer in healthcare is challenging. Statistical evidence has been used in the courts, but the overturning of the life sentence of a Dutch nurse in 2008 due to inadequate data analysis suggests the need for objective statistical approaches. In our case, a nurse was convicted after injecting an infant with insulin following a dispute at a family party and killing a patient with insulin in an institute for disabled persons. The nurse had previously worked in a geriatric unit for seven months, during which 29 deaths occurred, some with suspicious features.We applied statistical methods developed for the evaluation of diagnostic tests to analyze the nurse's possible involvement in these deaths. We searched for discrepancies in the death certificates and performed medico-legal autopsies on exhumed deceased patients.During the 7 months, 69 nurses and practical nurses at the geriatric ward completed 27,324 shifts. Of the deaths, 16/29 (55 %) occurred during night shifts. The convicted nurse had worked a clearly higher number of night shifts, in particular, than others. She was among the highest 10 % whose work shifts coincided with the deaths in terms of sensitivity, specificity, and likelihood ratios. Of the deaths, 11/29 (38 %) occurred during or immediately after her shift. Unexplained suspicious blood glucose fluctuations or hypoglycemia-mimicking comas unrelated to known illnesses were reported in 6 (55 %) of the 11 deaths, and in one of these cases, the incident was supported by autopsy findings.Statistical methods for diagnostic accuracy may allow the targeting of the investigation when searching for a possible serial killer in a hospital. However, a statistical approach does not allow an unambiguous determination of a perpetrator nor does it replace a thorough examination of the circumstances and cause of death when investigating a small number of suspicious deaths among patients with serious illnesses and high mortality.

Perception, Attitude and Knowledge about Medico-Legal Post Mortem Examination: A Study on Para-Clinical Medical Students

Background: Medico-Legal Post-Mortem Examination (MLPME) is generally perceived negatively by the common population including medical students either due to their religious beliefs or due to their pre-conceived fear. Considering the preconceptions, this study is aimed to assess the attitude, perception and knowledge among the para-clinical medical students. Materials and methods: A cross sectional survey was conducted on 200 paraclinical medical students of Chattagram Maa-O-Shishu Hospital Medical College. A pretested questionnaire was used and data analyzed by SPSS22. Results: Among 200 para-clinical medical students, all attended MLPME but 96% not performed. 49% students first knew about this from TV news and from movies. 62.5% didn’t think doing MLPME was disrespectful to the body. 95.5% agreed that MLPME was necessary in medical education. 77.5% agreed that medical students should perform MLPME. 75.5% of participants felt that the MLPME they witnessed were not enough. 40.5% students were not confident on independently performing the MLPME after completion of their graduation but 39.5% were not sure. 90.5% thought MLPME necessary for all unnatural deaths. In MLPME, 94.5% knew that both external and internal examinations were done. 96.5% knew preserving viscera was necessary during MLPME on suspected case of poisoning. 77.5% thought that saturated salt solution used as preservative. Conclusion: Overall data analysis indicated that para-clinical medical students had reasonable knowledge and positive attitude on MLPME but they felt their exposure on MLPME insufficient. Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 24-28

Comparison of background characteristics and neuropathology findings between medico-legal autopsy cases with traumatic axonal injury, vascular axonal injury, or absence of axonal injury in β-amyloid precursor protein stain.

In forensic neuropathology, the β-amyloid precursor protein (β-APP) immunostain is used to diagnose axonal injury (AI). The two most common aetiologies are traumatic (TAI) and ischaemic (vascular; VAI). We aimed to identify background characteristics and neuropathology findings that are suggestive of TAI, VAI, or no AI in neuropathologically examined medico-legal autopsy cases. The dataset comprised 166 cases from Finland over the period 2016-2023. The diagnosis of AI was based on β-APP stain (TAI, VAI, or no AI). Data on background characteristics and neuropathology findings were collected from cause-of-death investigation documents. Prevalence ratios were calculated for each variable to enable comparisons between the AI categories. The sample were 71.7% males; median age was 41 years (range 0-96). There were 26 cases with TAI, 44 with VAI, and 96 with no AI. The variables that showed statistical significance and had at least two-fold prevalence among TAI cases compared to VAI cases were: a documented recent injury; and presence of any extracranial/cranial/intracranial injury (including subdural haemorrhage [SDH], subarachnoid haemorrhage [SAH], intracerebral/ventricular haemorrhage [ICVH], or contusion) in autopsy or neuropathology. Correspondingly, variables indicating TAI over no AI were: a documented recent injury; postinjury survival ≥ 24h; and presence of any extracranial/cranial/intracranial injury (including SDH, SAH, ICVH, contusion), herniation, or infarction in autopsy or neuropathology. Postinjury survival < 30min was identified as an indicator of no AI over TAI. Finally, variables indicating VAI over no AI were: postinjury survival ≥ 24h; lack of external injury to the head; and presence of SDH, brain oedema, herniation, or infarction in autopsy or neuropathology. In conclusion, we report several differences in characteristics and findings between cases diagnosed with TAI, VAI, and no AI. Our findings may help estimate the likelihood and potential aetiology of AI based on background characteristics and other neuropathology findings.

First year of in-house forensic neuropathology consultations in Helsinki, Finland.

In July 2023, an in-house forensic neuropathology consultation pilot was established at the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare. This offered an alternative to the previous practice of full outsourcing to a hospital neuropathology department. This paper aims to introduce the first year experiences of the pilot. The in-house consultant team comprised two forensic pathologists with special training in neuropathology. In-house consultations were offered for medico-legal autopsy cases with traumatic brain injury (TBI) and hypoxic-ischaemic encephalopathy. The in-house histology laboratory participated in the pilot, implementing beta-amyloid precursor protein (β-APP) stain at the end of the pilot year. An electronic database was also developed for data collection and reporting. The characteristics, costs, and duration of the first 25 consultation cases were reviewed. The cases involved mostly male decedents (84.0%) with TBI (84.0%). The median total cost of a pilot case was €624, which was substantially lower compared to the previous outsourced practice (€1013 per case + €38/84 for each microscope slide with special/immunohistochemical stain, respectively). After the implementation of β-APP stain into the in-house laboratory service, the median total cost of a pilot case was reduced further to €94. The median duration of an in-house consultation was 2.3 months. Thanks to a favourable in-house atmosphere, the first year experiences are encouraging. While the costs of the in-house consultation practice appear to be markedly lower than those of an external provider, both alternatives should be available for cases where sufficient expertise cannot be found in-house.

A review: Challenge in conducting medico legal autopsies in custodial death

A review: Challenge in conducting medico legal autopsies in custodial death

Background characteristics and neuropathological findings of medico-legal autopsy cases with acute head injury and chronic alcohol use

Chronic alcohol use is often associated with traumatic brain injury (TBI). This study aimed to compare background characteristics, injury circumstances, primary head injuries, and secondary brain injuries among TBI cases with and without a documented history of chronic alcohol use. The sample comprised neuropathologically examined medico-legal autopsy cases with acute head injuries from Helsinki, Finland, over the years 2016-2022. Data on chronic excessive alcohol use were collected from medical records and police files; other background and circumstantial data were collected from medical records, police files, and cause-of-death investigation documents; and data on primary head injuries and secondary brain injuries were collected from autopsy and neuropathology reports. The dataset comprised 47 cases, of whom 19 had a history of chronic alcohol use (40.4%). Assault was the most common circumstance of injury among chronic alcohol users (47.4%) while falls prevailed among control cases (32.1%); unknown circumstances were common among both groups. There were no statistically significant differences in the prevalence of primary head injuries or postinjury survival between the groups. As for secondary brain injuries, hypoxic-ischaemic neuronal injury was significantly more common among chronic alcohol users in the frontal cortex (84.2% vs. 28.6%), parietal cortex (84.2% vs. 32.1%), hippocampus (63.2% vs. 25.0%), and lenticular nucleus (73.7% vs. 21.4%). Our findings suggest that chronic alcohol users may not necessarily have more diverse or complex primary injuries, but they may have more extensive secondary injuries. Further research should aim to explore the potential aetiology of hypoxic-ischaemic neuronal injury among chronic alcohol users.

Seasonal variation of unexpected sudden cardiac death in northern Finland.

Data on the occurrence of unexpected sudden cardiac death (SCD) in different seasons are limited. All unexpected sudden death victims have to undergo medico-legal autopsy obligated by the Finnish law. Consecutive series of all unexpected autopsied SCD victims (n = 5,869) were prospectively collected from the geographically defined area in the Northern Finland during a twenty years period from 1998 to 2017. We evaluated the seasonal variation of SCD and its possible causes. Unexpected SCD occurred more frequently during the first quarter of a year (from January to March) than during the other quarters. The occurrence of SCD during the twenty years follow-up was 4.5 ± 0.24 during the first quarter of the year per month and 3.9 ± 0.12 during the other quarters of the year per month on average (SCDs during the quarter of a year per month on average per 100,000 inhabitants per year, p < 0.001). The weather was colder during the first quarter of the year (average temperature -9.1 degrees centigrade) than during the other quarters (average temperature +5.7 degrees centigrade). The subjects who experienced SCD during the first quarter of the year had more commonly severe (75 %-90 %) coronary artery stenosis, (p < 0.001). Unexpected SCD occurred more commonly during the first quarter of a year (from January to March) than during the other quarters (from April to December). Cold weather with its physiological consequences and more severe coronary artery disease predisposing to ischemia may have contributed to the increased occurrence of SCD during the first quarter of the year.

Digital detectives: Exploring the integration of artificial intelligence in Indian forensic medicine

Forensic Medicine is the application of medical knowledge for law and administration of justice, which involves conducting the medico-legal post-mortem examination, estimation of the age of the individual, victim-accused examination and the study of poisons in all aspects. Many times, minute details of the examination are often missed by the naked eye, especially if the expert is inexperienced or if the autopsy is conducted at night time leading to high numbers of negative or obscure autopsies. As Artificial Intelligence is booming the smoothening of the work in all specialities like finance, administration, transportation, health care and the medical field, its applicability can smoothen the work of forensic medicine experts. It can offer the result more accurately, efficiently, precisely and within no time at low cost as compared to contemporary services. This review explores the applications, benefits, challenges, and prospects of AI in forensic medicine within the Indian context. By examining recent advancements and case studies, this paper aims to offer a comprehensive understanding of AI's impact on forensic practices in India.

Determination of sex by morphometric study of malleus bone in human cadaver

Identification is the process of determining a person's uniqueness, whether they are alive or dead. Skeletal remains contain an abundance of information which is helpful in determination of identity of an individual. This is an Analytical Cross-Sectional Study carried out on 45 adult male and 45 female cases that came for medico-legal autopsy at Guru Teg Bahadur Hospital, Dilshad Garden, and East Delhi with known sex and of any age from January 2021 to Aug 2022.The three measurements were taken for malleus bone i.e. Total length of malleus bone, the length of manubrium (handle) of malleus bone and Index of malleus bone. The bone was then measured by using digital vernier calipers of least count 0.001mm. In this study, we found that length of malleus bone was range from 7.15mm to 8.83mm inMales (Mean±SD, 7.97± 0.433) whereas in females it range from 6.67mm to 8.29mm (Mean±SD, 7.73± 0.296).The Maximum length of Handle (5.41mm) of malleus bone was in Males (Mean±SD, 4.79 ± 0.297) whereas in Females the maximum length of handle of malleus bone observed was 5.29mm (Mean±SD, 4.54± 0.282).The Total length of Malleus bone, Handle of malleus and Malleus index were more is Male as compared to Female and which is found to be statistically significant (p=0.003), (p=0.001) and (p=0.019) respectively. There is a clear-cut demarcation between the values of male and female bone and considered fairly good criteria in sex determination. The sexual dimorphism is most marked in the Total length of Malleus bone, Handle of malleus and Malleus index of Malleus bone, and there is a significant difference was observed.

A Cross-Sectional Study on Age-Related Changes in Knowledge and Perception of Medico-Legal Autopsies.

Our study investigated the knowledge, attitudes, and perceptions of medical students, residents, and the general public towards medicolegal autopsies in Northern region, India, in the year 2023. Significant disparities were identified in knowledge perspectives, influenced by age. Younger adults, particularly those falling in the age group of 20-29 years showed higher levels of knowledge (35.33%) about autopsies as compared to the older adults falling in the age group of 60 and above showed lower levels of knowledge (100%). Overall, 802 participants (72.6%) had a negative perception in regards to medicolegal autopsy while 302 participants (27.4%)​had a positive perception towards medico legal autopsy. This research study highlights the varying levels of knowledge and perception towards medicolegal autopsies among different age groups, emphasizing the need for targeted educational strategies to bridge the knowledge gaps and calls for collaborative efforts among stakeholders to build public trust, advance forensic medicine practices, and improve public health outcomes.

Study Of Unknown Dead Bodies Brought For Post Mortem In Tertiary Hospital

Background: Medico legal autopsies are conducted in India in two circumstances: cases where a person has died because of unnatural circumstances and where the body of the deceased is unidentified. The present study relates to the latter of the two aforementioned circumstances, i.e. where the dead body is not identified. Methodology: In present descriptive prospective study the size and magnitude of problems regarding unidentified bodies. Also the profile of unidentified dead bodies such as age, cause of death, post-mortem interval, manner of death, seasonal trends, area (urban or rural), place from where the body was recovered was studied Results: Total 1919 bodies were brought to us of which 169 cases were selected. The mean age of the patients was 44.82±14.83 years with male predominance. Most of the cases were identified on the basis of the clothes belonging and 16.57% bodies were brought from the rural areas. Majority of the unidentified bodies were found in the autumn season (28.99 %). Maximum unidentified dead bodies were discovered at religious places (n= 64, 37.87 %). In the present study, most deaths were natural, n=114 (67.46 %) and the majority of autopsies were performed between 4 and 6 days (n= 73, 43.20%) Regarding the cause of death according to police records in the present study, it was determined that there were the most cases of illness/ diseased condition (n=55). Conclusion: Unknown/unclaimed should be presented for autopsy forthwith without any delay so that decomposition and other artifacts do not set in and obscure the findings of the postmortem examination

Epidemiology of Fatal Poisonings from Organophosphorus Compounds in Rangpur District, Bangladesh

Background: Organophosphorus compound (OPC) poisoning represents a significant public health issue in low- and middle-income countries. Globally, the WHO estimates three million annual cases of pesticide poisoning, resulting in 220,000 deaths, predominantly in international settings. In Bangladesh, OPCs are frequently used for suicide in rural areas due to their affordability, toxicity, and accessibility. Objective: This study aimed to determine the prevalence, incidence by age and sex, and marital status of victims in cases of fatal organophosphorus poisoning in Rangpur District. Methods: This retrospective study analyzed all medicolegal autopsies conducted between October 2005 and January 2007 at the mortuary of Rangpur Medical College based on the history and preliminary findings of the deceased. Results: Of the 282 medicolegal autopsies performed during the study period, 60 (21%) resulted from organophosphorus poisoning. Females accounted for the majority of victims (31, 52%) compared to males (29, 48%). The highest prevalence of organophosphorus poisoning occurred in the Mithapukur area (17, 28%), with the age group 21-30 years showing the highest incidence (38%). Acute poisoning was more prevalent among married individuals (80%) compared to unmarried individuals (20%). Conclusion: Organophosphorus poisoning remains a significant healthcare challenge in Bangladesh. Enhanced awareness, restricted availability, and preventive measures are crucial for reducing mortality and morbidity associated with OPC poisoning.

Decoding Demise: A Comprehensive Analysis of Unnatural Deaths in Rahim Yar Khan

A medico-legal autopsy is a systematic examination of a deceased body conducted under the law of the state to determine the cause, and manner of death and to verify or dismiss any potential involvement of foul play related to the deceased. Objective: To assess the spectrum of unnatural deaths in the district of Rahim Yar Khan. Methods: This retrospective descriptive study was done at the Department of Forensic Medicine and Toxicology, Sheikh Zayed Medical College, Rahim Yar Khan from 1st January 2021 to 31st December 2023. Variables were age, gender, cause and manner of death, weapon, and residence. All autopsies referred by police were included except hospital, police torture and custodial deaths, and putrefied or exhumed bodies. Data from police, hospital records, and autopsy reports were recorded on a pre-designed form. Results: There was male preponderance of 72.57% to female with 27.43%. In general, 78% of all deaths were homicidal, compared to 12% suicidal, 9% accidental and 1% remained undetermined. The 21-30-year age range is the most often afflicted group. Firearms as the leading cause of death followed by blunt objects, asphyxia and sharp weapons accounted for the majority of fatalities respectively. The instances involved 44.25 % urban inhabitants as compared to 55.75% peri-urban ones. Conclusions: It was concluded that men accounted for the majority of unnatural deaths. The most common cause of death was murder. Guns and blunt weapons were the leading causes of death. Compared to the surrounding area, the city had a higher number of unnatural fatalities.

Postmortem analyses of myocardial microRNA expression in sepsis

BackgroundSepsis can lead to myocardial depression, playing a significant role in sepsis pathophysiology, clinical care, and outcome. To gain more insight into the pathophysiology of the myocardial response in sepsis, we investigated the expression of microRNA in myocardial autopsy specimens in critically ill deceased with sepsis and non-septic controls.Materials and methodsIn this retrospective observational study, we obtained myocardial tissue samples collected during autopsy from adult patients deceased with sepsis (n = 15) for routine histological examination. We obtained control myocardial tissue specimens (n = 15) from medicolegal autopsies of cadavers whose cause of death was injury or who were found dead at home and the cause of death was coronary artery disease with sudden cardiac arrest. RNA was isolated from formalin-fixed paraffin- embedded (FFPE) cardiac samples using the RecoverAll Total Nucleic Acid Isolation Kit for FFPE (Invitrogen). Differentially expressed miRNAs were identified using edgeR v3.32. MicroRNA was considered up- or down-regulated if the false discovery rate was < 0.05 and logarithmic fold change (log2FC) ≥ 1 for up-regulated or log2FC ≤ -1 for down-regulated miRNAs. The mean difference and 95% confidence interval (CI) were calculated for normalized read counts. Predicted miRNA targets were retrieved using Ingenuity Pathway Analysis (IPA) software, and pathway enrichment and classification were performed using PantherDB. For miRNA – mRNA interaction analysis, differentially expressed genes were analyzed by 3`mRNA sequencing.ResultsDifferential expression analysis identified a total of 32 miRNAs in the myocardial specimens. Eight miRNAs had a significant change in the mean difference based on the 95% CI, with the largest increase in mean counts in septic samples with hsa-miR-12136 and the highest fold change with hsa-miR-146b-5p. The threshold for down-regulated miRNAs in sepsis compared to controls was obtained with hsa-miR-144-5p and hsa-miR-451a, with the latter having the largest decrease in mean counts and fold decrease. The miRNA – mRNA interaction analysis identified eight miRNAs with target genes also differentially expressed in septic hearts. The highest number of potential targets were identified for hsa-miR-363-3p.ConclusionsSeveral regulatory miRNAs were up-or down-regulated in the myocardial tissue of patients deceased with sepsis compared to non-septic subjects. The predicted target genes of miRNAs and miRNA-mRNA interaction analysis are associated with biological functions related to cardiovascular functions, cell viability, cell adhesion, and regulation of inflammatory and immune response.

Identifying latent subgroups of primary head injury: an explorative latent class analysis on neuropathologically examined medico-legal autopsy cases.

Traumatic brain injury (TBI) is a significant global health concern and frequently encountered in medico-legal autopsies. Previous studies suggest that certain TBI subtypes are more likely to co-occur than others. Therefore, we aimed to explore the potential of latent class analysis (LCA) to identify and characterize primary head injury combinations in neuropathologically examined medico-legal autopsy cases. The dataset comprised 78 cases from the Forensic Medicine Unit of the Finnish Institute for Health and Welfare over the period of 2016-2022. Data on background and circumstantial characteristics as well as primary and secondary head and brain injuries were collected from police documents, medical records, general autopsy reports and neuropathology reports. Latent class solutions with two to five classes were explored to identify clustering of primary head injuries among the sample. The dataset comprised 69.2% males and the median age was 49 years. In LCA, the solutions appeared reasonable, and each class appeared to represent a distinct TBI profile. The two-class solution was found to fit the present dataset best. Class 1 was characterized by older age, presence of an underlying CNS disease, and less diverse primary head injuries; these were interpreted as suggestive of lower traumatic forces. Class 2 was characterized by male sex and assaults as a prominent injury circumstance; subarachnoid and intracerebral/ventricular haemorrhages and contusions were classified exclusively into this class. In conclusion, this study identified two distinct subgroups of primary head injuries. Understanding typical injury combinations related to distinct circumstances could assist not only forensic pathologists but also clinicians treating TBI patients. However, the present latent class solution should not be interpreted as "ground truth", but instead further research is needed.

Abstract 4116148: Seasonal Variation of Unexpected Sudden Cardiac Death

Introduction: Data on the occurrence of unexpected sudden cardiac death (SCD) in different seasons are scanty and needs further exploration. Methods: Consecutive series of all unexpected SCD victims (n=5,869) who underwent medico-legal autopsy obligated by the Finnish law were prospectively collected from the geographically defined area in the Northern Finland during a twenty years period from 1998 to 2017. The seasonal variation of SCD and its possible causes were assessed in this large SCD victim cohort. Results: Unexpected SCD occurred more frequently during the first quarter of a year (from January to March) than during the other quarters (Figure 1). The occurrence of SCD during the twenty years follow-up was 4.5±0.24 during the first quarter of the year per month and 3.9±0.12 during the other quarters of the year per month on average (SCDs during the quarter of a year per month on average per 100,000 inhabitants per year, p&lt;0.001) (Figure 2). The weather was colder during the first quarter of the year (average temperature -9.1 degrees centigrade) than during the other quarters (average temperature +5.7 degrees centigrade). The snow cover was the largest during the first quarter of the year. Conclusion: Unexpected SCD occurred more commonly during the first quarter of a year (from January to March) than during the other quarters (from April to December). Cold weather, and perhaps winter-time physical activities in cold environment such as removal of snow, may have contributed to the increased occurrence of SCD during the first quarter of the year.

Location and accumulation of primary head injuries, and prevalence of secondary injuries among neuropathologically examined medico-legal autopsy cases – A comparative study of falls and assaults

Even though traumatic brain injury (TBI) is a major cause of death globally, detailed data on the location and accumulation of primary head injuries, and prevalence of secondary injuries in distinct injury circumstances such as falls and assaults is limited. This study aimed to highlight the differences in injury patterns between falls and assaults among neuropathologically examined medico-legal autopsy cases. Data were collected on a total of 128 cases from the Forensic Medicine Unit, Finnish Institute for Health and Welfare, between the years 2016 and 2022. All cases had suspected or confirmed acute head injuries and underwent a full neuropathological examination. Background and circumstantial variables, as well as the presence of head and brain injuries, were extracted from the medico-legal autopsy case files. Comparative analyses were conducted between assured falls (n = 26) and assaults (n = 23). Any primary head injury was observed in 57.0 % of the full sample; the most common primary injuries were scalp haemorrhage (47.7 %), subarachnoid haemorrhage (SAH) (24.2 %), and diffuse traumatic axonal injury (13.3 %). Assault cases showed a significantly higher prevalence of scalp haemorrhage (82.6 % vs. 46.2 %, p = 0.016) and SAH (52.2 % vs. 11.5 %, p = 0.004) compared to fall cases. In assault cases, the left hemisphere was clearly more frequently affected than the right one (91.3 % vs. 65.2 %). Of secondary injuries, brain oedema was more common in assaults than falls (47.8 % vs. 7.7 %, p = 0.003). In conclusion, this study highlights differences in head and brain injury patterns between falls and assaults. Scalp haemorrhage and SAH are more common in assaults than falls. Assaults appear to lead to a higher frequency and diversity of injuries, particularly in the left hemisphere.

Age estimation on post-mortem CT based on pelvic bone mineral density measurement and the state of putrefaction: a multivariate method.

Age-at-death estimation is an important issue in forensic medicine and anthropology. Initially, methods relied on morphological criteria, but with the advancement of radiology, new techniques such as morphological studies on multi-slice computed tomography (CT) reconstructions have emerged. Recent studies have shown promising results by investigating the correlation between age and bone mineral density (BMD). However, there is currently a lack of data on post-mortem CTs (PMCT) involving decomposed bodies, and limited information exists regarding changes in Hounsfield Units measurement in a post-mortem context. In light of these gaps, our study aimed to examine the relationship between age at death and pubic and ilium BMD using a sample of forensic bodies. We also aimed to determine whether post-mortem processes, such as putrefaction, could interfere with this correlation. Our retrospective analysis encompassed 637 PMCTs conducted before medicolegal autopsies at Tours University Hospital. Utilizing simple and multiple linear regressions, we investigated the correlation between age and pubic and ilium BMD, as well as the relationship between BMD and the radiologic alteration index (RAI), a scale employed to quantify the degree of putrefaction. Our findings indicate promising outcomes in age-at-death estimation using pubic and/or ilium BMD for bodies exhibiting no or moderate decomposition (RAI < 80), particularly among individuals under 40years old. However, for highly decomposed corpses (RAI ≥ 80), the presence of gas infiltration significantly influences the BMD of both the ilium and pubis. Consequently, we advocate for the incorporation of the RAI score into the age estimation equation to enhance the accuracy of our results in such cases. Further investigation involving a larger cohort of decomposed bodies could facilitate refinement and validation of our method within this specific population.

Estimation of Stature from Anthropometric Measurements of the Sternum in Nepalese Population at the Tertiary Health Care Hospital

Introduction: Stature estimation is crucial for identifying human remains in forensic and anthropological contexts, aiding in mass casualties, criminal investigations, and archaeological studies. Traditionally using long bones, alternative methods are necessary when these bones are unavailable or fragmented. Objectives: The main purpose of this study was to access the morphometric measurements of the study population and compare the findings between the two sexes. Method: A study of 100 medico-legal autopsies at Department of Forensic Medicine, Maharajgunj Medical Campus, Nepal investigated stature estimation from sternal lengths. During autopsies, cadaver length was measured using a steel tape. An incision was made from the suprasternal notch to the pubis, the sternum was removed, and the combined manubrium and mesosternum length was measured with sliding callipers. Results: The study included 67 male and 33 female cadavers, with a mean age of 37.46 years. The mean length of the manubrium was 43.34 ± 6.88 mm (44.58 ± 7.15 mm for males, 40.81 ± 5.59 mm for females). The mesosternum averaged 101.85 ± 15.65 mm (104.40 ± 16.68 mm for males, 96.66 ± 11.92 mm for females). The combined sternal length was 146.12 ± 16.64 mm. Body length correlated weakly but significantly with manubrium, mesosternum, and combined sternal lengths (r = 0.242, 0.206, 0.320 respectively). Conclusion: Stature estimation from sternal length is valuable for identifying mass casualty victims, with males showing greater measurements. Combined manubrium and mesosternum lengths are better stature estimators.