Medicolegal Autopsy Cases Research Articles

Vaginal cytomorphological profile in correlating suicidal deaths in medicolegal autopsy cases

Objectives: Vaginal cytology is a sensitive method for assessing women’s hormonal status, showing variations in menstrual cycle phases. Studies suggest a higher rate of female suicides during the luteal phase. This study aimed to link vaginal cytomorphological profiles with the manner of death and age of the deceased. Materials and Methods: Vaginal smears from 64 autopsy cases were microscopically examined for maturation index (MI) and value, reflecting hormonal profiles. Statistical Analysis: ANOVA between the mean of maturation value with manner of death was found to be significant. Results: Among the 48 suicides, 54.2% showed predominantly intermediate cells in the luteal phase, indicating a mid-zone shift in the MI. The remaining 16 non-suicidal cases showed fewer intermediate cells. Suicides shared a similar cytological profile and MI, especially in the reproductive age group. Conclusions: While vaginal smears are typically used in sexual assault cases to detect sperm, they also offer insights into women’s hormonal profiles. Understanding these profiles could provide clues about psychological status and its relation to the manner of death beyond sexual assault.

Prevalence of secondary brain injuries and association with trauma circumstances in neuropathologically examined medico-legal autopsy cases with primary head trauma

Primary head injury is often followed by secondary brain damage. However, the association between injury circumstances and the prevalence of secondary injuries remains unclear. We report the prevalence and association of secondary brain injuries with the circumstances in which a head injury was sustained. The sample comprised 76 neuropathologically examined medico-legal autopsy cases with an acute primary head injury. Neuropathology reports were analysed to determine the prevalence of various secondary injuries, i.e., hypoxic-ischaemic neuronal injury, brain oedema, and vascular axonal injury (VAI). The prevalences were compared between cases from three distinct injury circumstances, i.e., fall, assault, and strangulation. The sample had a median age of 49 years (interquartile range 27–73) and 71.1% were identified as male. As for distinct injury circumstances, the sample comprised 14 fall cases, 21 assault victims, and 6 strangulation victims. The prevalence of hypoxic-ischaemic neuronal injury was highest in strangulations (100.0%), followed by assaults (81.0%) and falls (64.3%); of specific brain regions, statistically significant differences between the three case groups were found in frontal and parietal cortex (p ≤ 0.018) and the hippocampus (p = 0.005). Brain oedema was present in approximately half of assault (47.6%) and strangulation cases (50.0%), contrastingly to the lower prevalence in falls (7.1%; p = 0.024). The prevalence of VAI appeared higher among assault (23.8%) and strangulation cases (16.7%) compared to falls (7.1%), but the differences were not statistically significant. We conclude that hypoxic-ischaemic neuronal injury and brain oedema were more prevalent among assault and strangulation cases compared to falls.

An epidemiological profile of medico-legal autopsies at a tertiary care center

Background: An essential and necessary component of any investigation into a sudden, suspicious death is the medico-legal autopsy. It's critical to understand the profile of medico-legal autopsy cases in order to ascertain the mortality rate from non-natural causes in a given area and addressing the demographic requirements in accordance with the region's unique mortality statistics. Material & Method: The present study was a retrospective study of autopsies performed at a tertiary care centre in southern Haryana, from January 2018 to December 2023. During this period a total of 886 medico legal autopsies were conducted. Relevant information and subjective data like age, gender, marital status & manner of death have been collected from medico legal autopsy register from January 2018 to December 2023. Results: It was observed that out of 886 cases male outnumbered females in ratio 2.06:1. Majority of the victims belonged to the age group 21-30 years. Majority of the deaths occurred due to poisoning (n=264, 29.79%), followed by road traffic accidents 26.74%. Conclusion: Majority of cases were in the 3rd decade of life, males outnumbered females. Poisoning and road traffic accidents were the leading cause of death. Public attention, awareness, preventive and remedial strategies should be undertaken to reduce similar incidents.

Histopathological Study of Liver in Medicolegal Cases: A Tertiary Care Centre Study

Background: The pathological examinations of medicolegal cases is not confined to determining the cause of death but also useful in teaching pathogenesis and demography of the disease. Liver is the principal site of many metabolic activities and is vulnerable to many metabolic, toxic, microbial and circulatory insults. Due to enormous functional reserve, many liver lesions are silent till late in the course of disease. Aims: This study aimed to analyse histopathological findings of liver diseases in medicolegal cases and correlate with clinical findings wherever available. Methods and Material: The present study is a retrospective observational study with 262 medicolegal autopsy cases over a one-year period conducted in the Department of Pathology of a tertiary care centre. Representative tissue from the liver was collected in 10% neutral buffered formalin and sent for histopathological examination. Results: Total 262 medicolegal cases studied showed predominance of male (68.65%). Maximum cases were in the age group of 21 to 30 years (20.14%) followed by 31 to 40 years (18.28%). The most common lesion was steatosis, accounting for 78 (30%) out of 262 liver specimens. There were 43 (16.5%) cases of congestion, 20 (7.8%) cases of hepatitis and 17 (6.5%) cases of steatohepatitis. Ten (4%) cases of cirrhosis were noted. Conclusions: The present study showed that Histological analysis of liver is important learning objective for pathologists and a significant role in ascertaining the cause and manner of death.

Assessing O.K.N.V.I. RESIST‑5 performance for post‑mortem biological samples: A prospective pilot study.

In recent years, the emergence of carbapenem-resistant strains has been increasing worldwide, including in Romania. Rapid tests for post-mortem examinations have been researched and currently have several applications. In the present study, we aimed to test the performance of O.K.N.V.I. RESIST-5 tests on impure post-mortem biological samples compared with a standard of pure cultures. When a death occurs during hospitalization and the issue of malpractice arises, the medico-legal practice would benefit from rapid tests applicable to post-mortem samples. Thus, detection and differentiation of the five targeted carbapenemases, namely oxacilinase-48, Klebsiella pneumoniae carbapenemase, New Delhi metallo-β-lactamase, Verona integron-encoded metallo-β-lactamase and imipenemase, could be useful in guiding sampling for third-party microbiological assessment and could also be an asset from an epidemiological standpoint. The present prospective and observational pilot study included medico-legal autopsy cases performed at Mina Minovici National Institute of Legal Medicine (Romania) between June and July 2022. A total of two sets of O.K.N.V.I. RESIST-5 tests were performed: Test I, which was performed on-site from biological samples obtained during autopsy; and Test II, which was performed on pure cultures after sample inoculation and incubation. Total of 39 O.K.N.V.I. RESIST-5 rapid tests were performed on 19 biological samples, at least one sample per case. The O.K.N.V.I. RESIST-5 tests performed on-site showed an overall sensitivity of 92.3% with a 100% specificity. The results obtained through rapid tests using post-mortem impure samples were comparable to the results obtained from sample cultures with good sensitivity and specificity. Through post-mortem screening for carbapenem resistance, it would be possible to narrow down the number of cases that require further bacteriological assessment.

The Role of Pathological Examination of the Liver in Medicolegal Autopsy: A Tertiary Care Center Study From North India.

The pathological examination of a medicolegal autopsy is a great learning opportunity for a pathologist as well as for a forensic expert, where the cause of death remains unknown. Liver disease epidemiology differs from one geographic area to another. This was a prospective observational study with 100 medicolegal autopsy cases over a one-year periodconducted in the Department of Forensic Medicine and Toxicology (FMT) and Pathology. Representative tissue from the liver was collected in 10% neutral buffered formalin and sent for histopathological examination. The mean age of the cases was41.98 ± 15.39 years, and ages ranged from 20to 90years with male preponderance. The most common histopathology and gross findings noted were mild to moderate chronic hepatitis (CH) (54%) and fatty change (36%), respectively. There was a significant association (p ≤ 0.05) between histopathology and gross findings, cause, and manner of death. Gross and histopathological examination of the liver in a medicolegal autopsy has a significant role in ascertaining the cause and manner of death.

Cardiac Enlargement in a Medicolegal Autopsy Setting.

A key element for diagnosing cardiac enlargement in an autopsy setting is relevant heart weight references. However, most available references are to a large extent not representative of a medicolegal autopsy population, implying that reference weights are likely lower than those in the relevant population.To establish more applicable heart weight references in a medicolegal autopsy population, we designed a heart weight model that accounts for undiagnosed cardiac enlargement using data from 11,897 nontraumatic Swedish medicolegal autopsy cases autopsied between 2010 and 2019. The model was validated in 296 nonobese young adult suicidal hanging cases.For a decedent of average height (174 cm), the evidence that a heart weight was enlarged reached weak support at approximately 430 g, substantial support at approximately 480 g, and strong support at 520 g. The modeled prevalence of cardiac enlargement was very high among elderly and obese decedents.We believe that our model is more applicable in a medicolegal setting than those previously published. The presented quantification of the degree of uncertainty regarding diagnosis can help the pathologist in diagnosing cardiac enlargement. To facilitate the use of this model, we also made it available through a simple online tool ( https://formedum.shinyapps.io/HeartWeightCalc/ ).

Quantitative estimation of TNF-α and IL-3 by using ELISA from human lung tissue in fatal asphyxial deaths

Asphyxia-related deaths have always been a challenging task in the specialty of forensic pathology. Apart from helpful macroscopical signs (e.g., strangulation marks, cyanosis, petechial haemorrhage, and lung edema), recent literature indicates that prolonged asphyxia is sufficient to induce an increase in mast cells (MC). Inflammatory cells migrate from the bone marrow to the lungs, aiding in the diagnosis of fatal asphyxial death. The present study analyzed human lung tissue samples from 90 medico-legal autopsy cases, including 45 asphyxial deaths and 45 controls (non-asphyxial deaths). The cases ranged from 2 to 68 years, with a mean age of 33.23 years. In 90 cases, 74 cases were of males, and 16 were of females. Human lung tissue samples were analyzed by using the sandwich ELISA method. The results indicated a statistically significant increase in TNF-α and IL-3 concentration in fatal asphyxial deaths, including those caused by hanging, drowning, and smothering. Mean ± SD in asphyxial and non-asphyxial cases for the TNF-α and IL-3 concentration statistically analysed. In asphyxial cases, the average IL-3 concentration (Conc.) was 1558.50 ± 350.53 pg/ml, and the average TNF-α concentration (Conc.) was 499.75 ± 479.41 pg/ml. In contrast, in non-asphyxial cases, the average IL-3 concentration (Conc.) was found to be 849.73 ± 484.99 pg/ml, and the average TNF-α concentration (Conc.) was 208.08 ± 81.23 pg/ml. The mean change in IL-3 and TNF-α (Conc.) values are found to significant (<0.01) in asphyxial cases as compared to non-asphyxial cases. The ROC (Receiver operating characteristic curve) analysis revealed that TNF-α (AUC = 0.89) and IL-3 (AUC = 0.87) concentration (conc.) were stronger predictors of asphyxial deaths with an optimal cut-off value of 455.20 pg/ml for TNF-alpha and 1700.62 pg/ml for IL-3 respectively. Our findings imply that mast cells (MC) are critical in fatal hypoxia-related mortality and that TNF-α and IL-3 can be reliable markers for detecting mast cells in asphyxial deaths. It could be very beneficial to forensic pathologists tasked with differentiating fatal asphyxial fatalities from other causes of death.

Post-mortem pulmonary tuberculosis: comparison of available diagnostic methods.

Tuberculosis (TB) caused by Mycobacterium tuberculosis remains a serious public health threat with the World Health Organisation (WHO) reporting 5.8 million cases and 1.3 million deaths in the year 2020 due to TB. TB can be diagnosed by imaging, histopathological and bacteriological methods with culture remaining the gold standard. This study was performed to look at the sensitivity and specificity of post-mortem computed tomography (PMCT) imaging when compared to culture in diagnosing pulmonary tuberculosis. This was a retrospective comparative study looking at post mortem cases where lung tissue samples sent for TB culture at Hospital Kuala Lumpur were compared against PMCT imaging. Exclusion criteria included contaminated samples, decomposed cases, immunocompromised subjects and those below 18 years of age. Subjects included 80 medico-legal autopsy cases at the National Institute of Forensic Medicine, Hospital Kuala Lumpur, Malaysia who had whole body PMCT done in accordance with the Institute's protocol and tissue samples sent for bacteriology culture for tuberculosis. PMCT findings were positively associated with acid-fast organisms in 23.5 out of 33 cases (71.2%). Our study also showed that PMCT had a sensitivity of 71.3% and specificity of 54.3% (95% CI: 39.5-68.4) in diagnosing TB based on the protocol set in this study. This study showed that there was relatively good agreement between radiological PMCT findings and bacterial culture, suggesting that radiological examination is a relatively reliable tool for preliminary screening and possible diagnosis of TB prior to a postmortem examination which would be beneficial in reducing the risk of transmission of TB to health workers during autopsy.

Further explorations into the role of mast cells in deaths associated with fatal asphyxia: an immunohistochemical study utilizing CD 117 marker

Asphyxia-related deaths have always been a challenging task in the speciality of forensic pathology. Apart from helpful macroscopical signs (e.g., strangulation mark, cyanosis, petechial haemorrhage, and lung oedema), recent literature indicates that prolonged asphyxia is sufficient to induce an increase in mast cells (MC). Inflammatory cells migrate from the bone marrow to the lungs, aiding in the diagnosis of fatal asphyxial deaths. HIF1-α, a key regulator protein, is released from lung tissue capillaries during catastrophic hypoxia circumstances, as previously demonstrated in immunohistochemistry (IHC) research. The present study analyzed lung samples from 164 medico-legal autopsy cases, including 57 asphyxia/hypoxia deaths and 107 controls (non-asphyxial deaths). Peribronchial, perivascular and perialveolar MCs were detected using CD117 antibody, and the average of MCs in each of these locations was noted in each case. The results indicated a statistically significant increase in peribronchial and perialveolar mast cells (MC) in fatal asphyxial deaths, including those caused by hanging, drowning, or postural asphyxia. Peri-bronchial MC in lung sections of asphyxial deaths were in the range of 0.2–5.4 and in non-asphyxial samples were in the range of 0.0–2.2. Peri-alveolar MCs in lung sections of asphyxial deaths were in the range of 0.0–0.6 and in non-asphyxial samples were in the range of 0.0–0.2. Our data suggest that mast cells (MC) play an important role in fatal hypoxia-related mortality and CD 117 may be a reliable marker for detection of mast cells in asphyxial deaths. It could be very beneficial to forensic pathologists tasked with differentiating fatal asphyxia fatalities from other causes of death.

Postmortem pericardial fluid sLOX-1 levels and LOX-1 immunostaining in forensic specimens: Relation to cause of death

Lectin-like oxidized LDL receptor-1 (LOX-1) is the endothelial receptor for oxidized LDL. This receptor's extracellular domain is released into the blood as soluble LOX-1 (sLOX-1) and has been linked to ischemic heart disease (IHD), cerebrovascular diseases (CVDs), obesity, and diabetes. We recently reported that sLOX-1 fluid levels in postmortem pericardial fluid were comparable to clinical values in live patients and that significant increases in sLOX-1 were observed in patients with IHD. However, postmortem serum and urine sLOX-1 levels were higher than serum levels in living patients. Here, we conducted LOX-1 immunostaining in forensic specimens (aorta and heart) and evaluated pericardial fluid sLOX-1 in 221 medicolegal autopsy cases (67 IHD, 11 CVD, 17 inflammatory diseases, and 126 control cases) with a postmortem interval < 72 h to assess the diagnostic efficiency of postmortem pericardial fluid sLOX-1. Furthermore, we evaluated the relationships between pericardial fluid sLOX-1 and body mass index (BMI), blood HbA1c, serum C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-C), and low-density-lipoprotein cholesterol (LDL-C). LOX-1 immunostaining positivity was found in the aortic intima. Pericardial fluid sLOX-1 levels were considerably higher in patients with IHD and CVD. However, there were no significant differences in patients with inflammatory diseases and controls. No associations between pericardial fluid sLOX-1 and BMI, HbA1c, CRP, HDL-C, or LDL-C were found. These results indicate sLOX-1 utility in the postmortem diagnosis of IHD and CVD.

An Evaluation of Profile of Medico-Legal Autopsy Cases Reported at Department of Forensic Medicine &amp; Toxicology inA Government Medical College of Garhwal Region, Uttarakhand: A Retrospective Study

Background: The profile of medico-legal autopsy cases is crucial to determining the mortality rates in a specificlocation owing to new causes and also aids in addressing the demographic demands in accordance with thoserates.Materials and Methods: The present study is a retrospective study of autopsies performed at Department ofForensic Medicine &amp; Toxicology,VCSGGIMS &amp; R, Srikot, Srinagar, Pauri Garhwal, Uttarakhand, from 1st January2020 to 31st December 2021. During this period a total of 156 autopsy cases were conducted. Relevant informationand subjective data like age, sex, marital status &amp; manner of death have been collected from medico legal autopsyregister.Results: Out of 156 cases analysed, maximum number of autopsies were in the age group of 21-30 years with 41cases (26.28%) andmajority of were males 119(76.2%). Accidents accounted (58.3%),suicide (24.3%) and suddendeath (17.3%) cases. Maximum number of deaths were due to road traffic accidents with 82 cases (52.5%) followedby natural death with 27 cases (17.3%).Conclusion: In our study we found that majority of cases were in 3rd and 4th decade of life, majority cases weremales as compared to females, and Hindus being majority in number formed bulk of cases.

Evaluation of Chronic Kidney Disease in Sudden Death Cases – A One Year Autopsy Study in Tertiary Care Hospital

Autopsy is the ultimate diagnostic test, typically the gold standard with an assumed 100% sensitivity for establishing the causes of death. Medicolegal autopsies are conducted in cases of sudden, suspicious and unnatural deaths. The frequency and spectrum of renal pathologies on medicolegal autopsy specimens are not well documented in the literature. Our study aimed at diseases in sudden death cases based on the histomorphological findings by microscopical examination of renal tissue. Kidney specimens of 120 Medicolegal autopsy cases were received, processed and examined in our department over a period of 2 years. Out of 120 cases chronic kidney cases (CKD) was identified in 45 ( 37.5%) cases. In our study 28 cases were male (62.22%) and 17 cases were female (37.78%). The different lesions suggesting CKD were, glomerulosclerosis 2 cases (4.44%), Chronic pyelonephritis in 6 (13.33%) cases, Vascular sclerosis 32 cases (71.11%) and in 5 cases (11.11%) interstitial nephritis. This study analyzed various entities of chronic kidney disease found in medicolegal autopsies. These entities either contribute or directly responsible for the death of the individuals.

Trends of Medicolegal Autopsy Cases in a Government Medical College in Southern Odisha: An Autopsy based study

introduction: Background: Koraput district is one of the largest forest districts of Odisha with a dominant tribal population. This study was done with the objective to assess the cause and manner of death along with the epidemiological profiling of medicolegal cases and was the first attempt to conduct an autopsy-based study at this recently established Government Medical College of Southern Odisha. Materials and Methods: A record based cross sectional study of total number of 1168 medicolegal autopsies was done conducted at SLN Government Medical College, Koraput during the period 1st January 2019 to 31st December 2021. results: 72.43% of the cases were males with male to female ratio of 2.62:1 with 87.21% cases belong to rural population. Almost 50 percent of cases belonged to young adult age group (21-40 years). The cause of deaths in majority of the cases were due to road traffic accidents (416;35.62%) followed by poisoning cases (278;23.81%). Natural disease was observed in 114 cases (9.77%). Our study revealed that 53.51% of cases were accidental in a manner with 27.22% being due to intentional self-harm. The most preferred method in suicide cases was due to poisoning (206; 64.77%) followed by hanging (64; 20.12%). Unnatural death due to suicidal poisoning was seen more in females (109; 52.9%) as compared to males whereas male preponderance was observed more in hanging (49;76.56%). conclusion: This study could provide valuable insight to authorities for future multidimensional studies.

Retrospective Study of Ligature Material on Suicidal Hanging

Background: Hanging is one of the most common methods of suicide. It is always suicidal unless otherwise proved. Recent evidence showed that the incidence of suicide by hanging has increased especially among young adults. Ligature material plays an important role in leading investigation in hanging. The ligature material depends on its accessibility and availability. Various ligature materials are being used like nylon rope, cotton rope, wire, synthetic saree, lungi etc.&#x0D; Objective: Present study is a humble effort to find out the choice of ligature material used by the victim at Dhaka Medical College.&#x0D; Materials and methods: A retrospective study was conducted at the mortuary of Forensic medicine department, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2017 to December 2018. During this period data were collected from 112 cases of medicolegal autopsies by purposive sampling.&#x0D; Result: A total of 112 medicolegal autopsies were analyzed. In this hanging death, the most common ligature material used was rope in 58% of cases followed by dupatta (13%), lungi (11%) and saree (9%). Electric wire and kamiz were other ligature material used for hanging. The consistency of ligature material observed was hard (71%) &amp; width is narrow width is (71%). Majority of cases (71%) were observed is male. Complete hanging was seen in 67% of cases &amp; among them 85% cases are atypical hanging.&#x0D; Conclusion: Hanging is always suicidal unless otherwise proved. It is the form of painless violent asphyxia death that is widely practiced method of suicide. The most used ligature material is rope. Rope is chosen as ligature material due to its availability and accessibility. Young people in the justice system may need personal and psychological support to reduce the incidence of suicide.&#x0D; Eastern Med Coll J. Jan 2023; 8 (1) 12-14

Analysis of Post Mortem Findings in Suicidal Hanging- Study in a Tertiary Care Hospital

Background: Suicide is the act of intentionally taking your own life. Hanging is always suicidal unless otherwise proved. It is a from of violent asphyxial death. It produces painless death for the victims so that it is a widely practiced method of suicide. Every year, 8 lac people die for hanging. In Bangladesh hanging in one of the Commonest methods of suicide. Objectives: The objective of this study was to find out Socio-demographic characterizes of victims, common ligature materials used by victims and post mortem findings. Materials and method: A retrospective cross sectional study was done in Shaheed Suhrawardy Medical College mortuary during the period of July 2018 to December 2020. During this period data were collected from 1815 cases of medico legal autopsies by purposive sampling. Results: A total of 1815 medico legal autopsies were analysed of which 818 (45.06%) were deaths due to hanging. out of these 818 cases maximum 395(48.28%) deaths due to hanging were in age group of 21-30 years. Majority of the cases 546(66.74%) were observed in female and others in male 272(33.25%). Majority 425 (51.95%) of victims had used Dopatta (Orna) as a ligature material. Cyanosis of finger tips and nail beds was the commonest 797 (97.43%) finding in cases of asphyxia death due to hanging. Conclusion: In this study all the cases of hanging were suicidal and no case of post-mortem hanging was documented. Majority of the victims were between 21-30 of age (48.28%). Twothirds of them were females. Most frequent occupation was students. More than two thirds belonged to low socio-economic condition and none of the case were from higher socio-economic condition. More than 70% victims were found inside house with locked door. In more than threefourth of the cases, the ligature material was dopatta (orna), apparently because of cost and availability. In most cases the point of suspension was ceiling fan. Complete hanging was most frequent type of hanging. Other external and internal autopsy findings were like book picture. J Shaheed Suhrawardy Med Coll 2021; 13(1): 36-40

Assessing age-related heart changes by comparing cases of sudden death during bathing and control cases in Japan

We analyzed 400 deaths that occurred in the bathtub during a 10-year period in the central area of Kanagawa prefecture in Japan. There were 72 (18%) medico-legal autopsy cases. The average age at death was 76.4 ± 11.9 years. Drowning (n = 21, 70.8%) was the most common cause of death in the 72 autopsy cases. The study examined the bodies of 40 cases within a postmortem interval of 3 days. The mean age of the 40 cases of sudden death during bathing was 68.6 ± 12.5 years. Results revealed cardiac hypertrophy in 12 cases (30%), lipofuscin deposition in 39 cases (97.5%), basophilic degeneration in 12 cases (30%), anisocytosis of the nucleus of myocardial cells in 18 cases (45%), perivascular fibrosis in 17 cases (42.5%), amyloid deposits in 1 case, and aortic valve calcification in 1 case. The hearts of control subjects who had lived to 20–99 years were also examined; the frequency of each change was higher in people older than 70 years. There was no statistically significant difference in age-related cardio-pathological changes between cases of sudden death during bathing in people in their 70s and controls in their 70s. It can be concluded that this age-related histopathological index is not related to sudden death during bathing. A large number of elderly people, including those without heart disease, have died during bathing. Preventive measures against sudden death during bathing are strongly recommended, e.g., elderly people should not be left totally unsupervised while they bathe.

An epidemiological retrospective profile of medico-legal autopsy cases reported at a tertiary care center in Dhulikhel, Nepal

Autopsy is a systematic scientific examination of dead body that helps in manifesting the information about the cause of death in case of an unnatural death. Medico legal autopsy profiling helps to understand the nature of casualties, it helps to assess the social and economic profile for understanding the nature of crime in particular area, helps to address the demographic needs according to the mortality statistics specific to that region and helpful to identify the need necessary to take preventive measures to stop the crime or unnatural deaths by means of spreading awareness and psychological course. This study aims to analyses the pattern of autopsy cases with manner and various causes of death which was conducted in a tertiary level hospital. This is a retrospective study conducted over a period of one year (Oct 2020 to Oct 2021) at Dhulikhel hospital, Nepal. During the study period on one year, a total of 258 cases of medicolegal autopsies were performed at Department of Forensic Medicine and Toxicology. Out of the 258 cases analyzed maximum incidence of the postmortems were reported in the age group of 43.80% was reported from 20 to 39 years aged group which are the most productive years in one’s life. The maximum incidence of the postmortems was reported in the male population of 70.54% compared to the female population (29.46%). Our strongest conclusion is that male/female differences in medicolegal autopsies are highly dependent on historical time and geographic location. The maximum incidence 32.56% was reported within 6 – 12 hours’ time group and minimum incidence 12.02% was reported within 0 – 6 hours’ time group. The maximum incidence 48.06% was reported from Suicide group and minimum incidence 6.20% was reported from Homicide group. The maximum incidence 33.72% was reported by Hanging group and minimum incidence 0.39% were reported from Choking and Traumatic Asphyxia groups during the medicolegal autopsies, , , , ,

English

BACKGROUND Medicolegal autopsy is an important procedure to ascertain the causes of sudden and unexplained deaths. It provides direct access to organ and tissues which otherwise is not possible with other diagnostic modalities. In addition to the morphological examination of tissues and organs we can also take representative samples from these tissues and organs. These samples may be subjected to histopathological examination and biochemical examination. These types of examinations prove quite helpful in cases of poisoning and sudden unexplained deaths where simple morphological examination may be inconclusive. It provides us an opportunity to study the natural course of evolution of many diseases. Incidental histopathological findings in autopsy also prove useful to account for many clinically undiagnosed diseases in the community like clinically undiagnosed neoplasms, infections and inflammatory diseases. We wanted to study the pattern of histopathological findings in medicolegal autopsy specimens and also age and sex distribution of cases of medicolegal autopsies. METHODS This prospective and descriptive study was conducted on three hundred and twenty specimens received randomly from one hundred and four cases of medicolegal autopsies irrespective of cause of death in Department of Pathology, Government medical college, Jammu. The specimens were processed and then stained with haematoxylin and eosin stain. RESULTS Maximum patients were seen in the age group of 31-40 yrs. (37.5%) followed by 21- 30 yrs. (25.9%). Males constituted (70.1%), females constituted about (29.8 %). Most common organ received was heart (31.8%), lung (30.6%) and liver (30.3%). Most common cause of death was sudden death 31(29.8%), myocardial infarction 21(20.1%), poisoning 20 (19.2%), assault 7 (6.7%), drowning 7 (6.7%), hanging 6(5.7%), road traffic accidents 5 (4.8%), firearm injuries 4 (3.8%) and electrocution 3 (2.8%). The lungs constituted 44.1% of all the histopathological findings, heart (20.5%), liver (10.2 %) kidney (7.3 %), spleen (5.8%), brain (4.4%), skin and neck structures (4.4%) and uterus (2.9%). CONCLUSIONS Atherosclerosis has become quite frequent cause of sudden and unexplained death in younger age group. So, we need to educate this age group about healthy lifestyle and importance of prophylactic screening to those having risk factors for cardiovascular diseases. KEY WORDS Medicolegal Autopsy, Sudden Death, Atherosclerosis

Morphological study of the spectrum of lesions encountered in the heart and coronaries on autopsy.

This research study has been carried out to study the various morphological changes in the heart in medicolegal autopsies and to compile data for the frequency of heart diseases found in autopsy cases. The present study comprised 430 medicolegal autopsy cases. Details of the cases were entered in a proforma prepared for the study. The heart was fixed in 10% formalin, and then, opened along the flow of blood. The findings were based on gross and microscopic examinations. Out of 430 adult hearts, 211 (49.0%) cases showed 253 cardiac lesions; 35 (8.1%) cases of coronary atherosclerosis and 196 (45.5%) aortic atherosclerosis were noted; 7 cases of ischemic lesions (1.6%) were identified; 12 (2.7%) cases of hypertrophy; 2 cases of valve calcification; and 1 of cardiomyopathy were noted. In the present study, among medicolegal autopsies, atherosclerotic disease was the most frequently encountered lesion followed by hypertrophy. The incidence of atherosclerosis was found to be 47.6%. This study shows the high prevalence of atherosclerosis in the population.