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Stereology and semiautomated binary image histomorphometry are two common methods used for morphometry of nerve fibres. Nucleator probe can be used for the estimation of morphometric parameters like diameter, perimeter, area and volume of a structure that is approximately either a circle or a sphere. In this study, we estimated these parameters with the help of ImageJ software on calibrated transmission electron micrographs. We procured samples of the cochlear nerve (CN) during winter months, within 6-12 hours of death, to reduce post-mortem autolytic changes. The temporal bones containing the CN were fixed by immersion in chilled paraformaldehyde. After dissecting out from the petrous part of the temporal bone, the CN were osmicated and processed for embedding in resin. From the resin blocks, silver coloured (70 nm) ultrathin sections were cut and picked on 300-mesh copper grids, stained with uranyl acetate and lead citrate and viewed under Tecnai G 2 -20 transmission electron microscope. The transmission electron micrographs had scale bars embedded into them by the software at the time of imaging, and the morphometric parameters of randomly selected nerve fibres were measured using the ImageJ software. The ImageJ software could become a low-cost and dependable tool for nerve fibre morphometry.•Nucleator probe is used for the estimation of morphometric parameters like diameter, perimeter, area or volume•Morphometric parameters were estimated by the ImageJ software on calibrated transmission electron micrographs•The ImageJ software could become a low-cost and dependable tool for nerve fibre morphometry., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Suicide is a preventable but escalating global health crisis. Genome-wide association studies (GWAS) studies to date have been limited, and some are underpowered. In this study, we aimed to perform the PsychArray-based GWAS study to identify single nucleotide variations associated with suicide in the Indian population. Methods: We recruited unrelated subjects who died by suicide as cases (N = 313) and the non-suicidal deaths as controls (N = 294). The 607 samples were genotyped, including cases and controls using the Illumina Infinium PsychArray-24 BeadChip v1.3 Results: In our study, four single nucleotide polymorphisms (SNPs) crossed the threshold of significance level <1 × 10−5. One of them is intronic at Chromosome2:rs1901851 and three are intergenic at Chromosome12:rs3847911, Chromosome8:rs2941489, Chromosome8:rs1464092. At a significance level of 5 × 10−5, we found a few more SNPs, with the majority of them being intergenic variants. The associated genes were associated with various important functions ranging from cell signaling, GTP binding, GPCR binding, and transcription factor binding. Conclusions: The SNPs identified in our study were not reported earlier. To our best knowledge, this study is one of the first GWAS for suicide in the Indian population. The results indicate few novel SNPs that may be associated with suicide and require further investigation. Their clinical significance is to be studied in the future., Competing Interests: The authors declare no conflict of interest.

Ultrastructural and molecular changes in the myelin of the cochlear nerve (CN) have been associated with decreased hearing-acuity with increasing age. But most of these are animal studies or with very few human samples. Hence, we studied the ultrastructure of the human CN at different ages. We obtained samples of CN from persons, who at the time of death belonged to young, middle or old age-groups; defined as ≤ 30, 31 to 50, and ≥ 51 years of age, respectively. These were processed for viewing under a transmission electron microscope (TEM). Morphology and morphometry were assessed after blinding the observer. Measurements of diameter (whole nerve fibre, axon), myelin thickness and calculation of G-ratio were made on calibrated images using ImageJ software. K-Means cluster analysis was performed based on total and inner nerve fibre area. Middle and old age CN showed degenerating axons, splitting of myelin sheath and myelin balloons. Between the middle and old age groups there was significant decrease in axon diameter (p<0.001), inner nerve fibre area (p<0.001), myelin thickness (p<0.001), nerve fibre diameter (p<0.001), and G-ratio (p<0.001). By clustering, we identified three distinct populations of myelinated nerve fibres: large, medium and small. The large fibres (by size), seen in the young, disappeared in the old age-group. We were unable to find any unmyelinated nerve fibres in this study. The morphological deterioration CN fibres may be a visible sign of molecular degeneration and contribute to decreased hearing-acuity., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Animal-studies associate age-related hearing loss (presbycusis) with decreasing number of spiral ganglion neurons (SGNs) in Rosenthal's canal (RC) of cochlea. The excitatory neurotransmitter for SGNs is glutamate (through its receptor NMDAR 2B), which can be neurotoxic through Ca 2+ overload. Neurotoxicity is balanced by calcium-binding proteins (CBPs) like Parvalbumin (PV), which is the predominant CBP of the SGNs. To estimate the volume of the RC and total number of SGNs that are immunoreactive to PV and NMDAR 2B, we used unbiased stereology in 35 human cochleae derived from cadavers of persons from 2nd to 8th decade of life (subsequently statistically divided into two groups) and compared them to the total number of cresyl violet (CV) stained SGNs. We also estimated the volume of individual neurons and their nuclei. Regression analysis was made on estimated parameters against age. Hierarchical-cluster analysis was done on the neuronal against neuronal nuclear volumes.The average volume of the RC did not change with increasing age (p = 0.4115). The total number of SGNs (CV-stained and those separately expressing PV and NMDAR 2B) significantly decreased with age (p < 0.001). We identified three distinct populations of neurons on the basis of their volumes among SGNs. Thus, there is significant age-related decline in the total number of SGNs, which starts early in life. It may be due to ambient noise and inadequate neutralisation of excitotoxicity., Competing Interests: Declaration of competing interest There was no conflict of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

It is well known that quality of hearing decreases with increasing age due to changes in the peripheral or central auditory pathway. Along with the decrease in the number of neurons the neurotransmitter profile is also affected in the various parts of the auditory system. Particularly, changes in the inhibitory neurons in the inferior colliculus (IC) are known to affect quality of hearing with aging. To date, there is no information about the status of the inhibitory neurotransmitter GABA in the human IC during aging. We have collected and processed inferior colliculi of persons aged 11-97 years at the time of death for morphometry and immunohistochemical expression of glutamic acid decarboxylase (GAD67) and parvalbumin. We used unbiased stereology to estimate the number of cresyl-violet and immunostained neurons. Quantitative real-time PCR was used to measure the relative expression of the GAD67 mRNA. We found that the number of total, GABAergic and PV-positive neurons significantly decreased with increasing age (p < 0.05). The proportion of GAD67-ir neurons to total number of neurons was also negatively associated with increasing age (p = 0.004), but there was no change observed in the proportion of PV-ir neurons relative to GABAergic neurons (p = 0.25). Further, the fold change in the levels of GAD67 mRNA was negatively correlated to age (p = 0.024). We conclude that the poorer quality of hearing with increasing age may be due to decreased expression of inhibitory neurotransmitters and the decline in the number of inhibitory neurons in the IC., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Estimation of total number of neurons in the spiral ganglion (SG) at various ages and their functional status is important as these neurons are constantly exposed to noise and other environmental factors that may lead to neuronal loss with aging due to excitotoxic damage. Parvalbumin (PV) is a calcium-binding protein (CBP), found in highly metabolically active neurons. It helps in buffering cytosolic calcium, which is essential for neurotransmitter release. The neurons in the adult human SG express PV more strongly than other CBPs like calbindin and calretinin. These CBPs can be used as signatures to recognise neurons. In the present study, we quantified the number of neurons expressing PV by unbiased stereology and compared it to the number of neurons stained by cresyl violet (CV), which is a Nissl stain, in the adult human SG. Five adult human cadaveric temporal bones were obtained from the forensic science mortuary, after due clearance from the institute ethics committee. Independent CV stained and PV immunostained sections were used to estimate the total number of neurons (optical fractionator), with StereoInvestigator (SI) software. The estimated total number of SG neurons was 27,485±3251 and 26,705±1823 in the PV and CV stained sections, respectively. There was no significant difference between the estimates (p=0.552). Therefore, CV staining is simpler and more cost effective when estimating neuronal number. Although PV stains spiral ganglion neurons (SGNs) with a greater intensity and provides a functional status, its tedious protocol limits its use for quantification., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Suicide messages on the skin are rare. Until now, in all reported cases, the writing tool used by the victims has been a pen. We report a suicide case by hanging in which the victim had written a note on her palm in mehndi, or henna, at a wedding ceremony three days before the fatal act. The note was discovered at autopsy., (© The Author(s) 2015.)

Focused assessment with sonography for trauma (FAST) is a limited ultrasound examination, primarily aimed at the identification of the presence of free intraperitoneal or pericardial fluid. In the context of blunt trauma abdomen (BTA), free fluid is usually due to hemorrhage, bowel contents, or both; contributes towards the timely diagnosis of potentially life-threatening hemorrhage; and is a decision-making tool to help determine the need for further evaluation or operative intervention. Fifty patients with blunt trauma abdomen were evaluated prospectively with FAST. The findings of FAST were compared with contrast-enhanced computed tomography (CECT), laparotomy, and autopsy. Any free fluid in the abdomen was presumed to be hemoperitoneum. Sonographic findings of intra-abdominal free fluid were confirmed by CECT, laparotomy, or autopsy wherever indicated. In comparing with CECT scan, FAST had a sensitivity, specificity, and accuracy of 77.27, 100, and 79.16 %, respectively, in the detection of free fluid. When compared with surgical findings, it had a sensitivity, specificity, and accuracy of 94.44, 50, and 90 %, respectively. The sensitivity of FAST was 75 % in determining free fluid in patients who died when compared with autopsy findings. Overall sensitivity, specificity, and accuracy of FAST were 80.43, 75 and 80 %, respectively, for the detection of free fluid in the abdomen. From this study, we can safely conclude that FAST is a rapid, reliable, and feasible investigation in patients with BTA, and it can be performed easily, safely, and quickly in the emergency room with a reasonable sensitivity, specificity, and accuracy. It helps in the initial triage of patients for assessing the need for urgent surgery.

Accurate estimation of post-mortem interval is of great importance in medico-legal autopsy cases. The present study is intended to compare the accuracy of estimating post-mortem interval from biochemical parameters of vitreous humour and cerebrospinal fluid (CSF). Both the fluids were collected from 100 medico-legal autopsies with known time of death and analysed for potassium, glucose, sodium, calcium, urea and creatinine. The current study found that vitreous humour is a better fluid in comparison to CSF for estimation of post-mortem interval. It is also observed that among the statistically significant parameters in both the fluids, level of potassium and sodium in vitreous humour are giving more accurate results in comparison to their corresponding parameters in CSF while accuracy of glucose is more or less same in both the fluid. Nevertheless potassium concentration in vitreous humour is a single best time honoured parameter to estimate post-mortem interval., (Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Aluminum phosphide is one of the commonest poisons encountered in agricultural areas, and manner of death in the victims is often suicidal and rarely homicidal or accidental. This paper presents an unusual case, where two humans (owner and housemaid) and eight dogs were found dead in the morning hours inside a room of a house, used as shelter for stray dogs. There was allegation by the son of the owner that his father had been killed. Crime scene visit by forensic pathologists helped to collect vital evidence. Autopsies of both the human victims and the dogs were conducted. Toxicological analysis of viscera, vomitus, leftover food, and chemical container at the crime scene tested positive for aluminum phosphide. The cause of death in both humans and dogs was aluminum phosphide poisoning. Investigation by police and the forensic approach to the case helped in ascertaining the manner of death, which was accidental., (© 2015 American Academy of Forensic Sciences.)

Though the necessity of cadaver dissection is felt by the medical fraternity, and described as early as 600 BC, in India, there are no practical guidelines available in the world literature for setting up a basic cadaver dissection laboratory for neurosurgery skills training. Hands-on dissection practice on microscopic and endoscopic procedures is essential in technologically demanding modern neurosurgery training where ethical issues, cost constraints, medico-legal pitfalls, and resident duty time restrictions have resulted in lesser opportunities to learn. Collaboration of anatomy, forensic medicine, and neurosurgery is essential for development of a workflow of cadaver procurement, preservation, storage, dissection, and disposal along with setting up the guidelines for ethical and legal concerns.

The trochlear and abducens nerves (TN and AN) control the movement of the superior oblique and lateral rectus muscles of the eyeball, respectively. Despite their immense clinical and radiological importance no morphometric data was available from a wide spectrum of age groups for comparison with either pathological or other conditions involving these nerves. In the present study, morphometry of the TN and AN was performed on twenty post-mortem samples ranging from 12-90 years of age. The nerve samples were processed for resin embedding and toluidine blue stained thin (1µm) sections were used for estimating the total number of myelinated axons by fractionator and the cross sectional area of the nerve and the axons by point counting methods. We observed that the TN was covered by a well-defined epineurium and had ill-defined fascicles, whereas the AN had multiple fascicles with scanty epineurium. Both nerves contained myelinated and unmyelinated fibers of various sizes intermingled with each other. Out of the four age groups (12-20y, 21-40y, 41-60y and >61y) the younger groups revealed isolated bundles of small thinly myelinated axons. The total number of myelinated fibers in the TN and AN at various ages ranged from 1100-3000 and 1600-7000, respectively. There was no significant change in the cross-sectional area of the nerves or the axonal area of the myelinated nerves across the age groups. However, myelin thickness increased significantly in the AN with aging (one way ANOVA). The present study provides baseline morphometric data on the human TN and AN at various ages.

The human auditory system is highly susceptible to environmental and metabolic insults which further affect the biochemical and physiological milieu of the cells that may contribute to progressive, hearing loss with aging. The cochlear nucleus (CN) is populated by morphologically diverse types of neurons with discrete physiological and neurochemical properties. Between the dorsal and the ventral cochlear nucleus (DCN and VCN), the VCN is further sub-divided into the rostral (rVCN) and caudal (cVCN) sub-divisions. Although, information is available on the age related neurochemical changes in the mammalian CN similar reports on human CN is still sparse. The morphometry and semiquantitative analysis of intensity of expression of glial fibrillary acidic protein (GFAP), calcium binding proteins (calbindin, calretinin and parvalbumin), gamma amino butyric acid (GABA) and nicotinic acetyl choline receptor (nAchR) beta 2 immunostaining were carried out in all three sub-divisions of the human CN from birth to 90 years. There was increased GFAP immunoreactivity in decades 2 and 3 in comparison to decade 1 in the CN. But no change was observed in rVCN from decade 4 onwards, whereas intense staining was also observed in decades 5 and 6 in cVCN and DCN. All three calcium binding proteins were highly expressed in early to middle ages, whereas a significant reduction was found in later decades in the VCN. GABA and nAchR beta 2 expressions were unchanged throughout in all the decades. The middle age may represent a critical period of onset and progression of aging changes in the CN and these alterations may add to the deterioration of hearing responses in the old age., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Death due to ice pick injury rarely reported in forensic literature. We report death of a 16-year old male, who was allegedly assaulted on chest, back and thigh by his school-mate, with an ice pick. The accused had got the ice pick from his father's ice shop to attack the victim. The multiple stabs to the chest region had perforated the lung and penetrated the heart chambers. The victim succumbed to death on the way to hospital and medico-legal autopsy was conducted. The injuries inflicted by the ice pick are highlighted and its pattern is discussed in this article, owing to the peculiar nature of the wounds produced by the ice-pick., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Death in custody causes one of the most embarrassing situation for the law enforcement agencies and medicolegal experts. The doctors has to follow the guidelines given by National Human Rights Commission while conducting postmortem examination in such cases and many a times doctors have been blamed for giving a biased opinion under influence to protect the interests of police and jail officials. This paper discusses postmortem examination in cases of custodial deaths and incidence of custodial death in India as well as other parts of the world. The cases of custodial deaths for which autopsy was conducted at AIIMS has also been discussed.

Knowledge of human anatomy is essential for all those practising medicine. The human skeleton is invariably used to study the anatomy of body structures. For this, many human skeletons are obtained from the market by students and teachers and are kept at home or in hostel rooms. However, after use the skeleton has to be disposed off properly. In the present case, a human skeleton used for study purposes was thrown away in garbage and someone informed the police about presence of skeletal remains in the garbage. The case was registered by the police and the skeletal remains were brought for medico-legal autopsy.

Anatomic trauma scoring systems are fundamental to trauma research. The Abbreviated Injury Scale (AIS) and its derivative, the Injury Severity Score (ISS), are the most frequently used scales. In a prospective study, 400 autopsies of road traffic accident victims performed between January 2002 and December 2003 were coded according to the AIS and ISS methods. All the cases were classified into different injury groups according to the Injury Severity Scale. Fifty-eight cases (14.5%) were assigned an ISS value of <25; 244 (61%) cases were valued between 25-49; 38 cases (9.5%) were valued between 50-74 and 60 (15%) cases had a value of 75. On analysis of medical care, in cases with ISS<50, about 96% of the victims did not receive optimal care quickly enough with a lack of pre-hospital resuscitation measures and lengthy transportation time to hospital being of major importance.

Exposure to arsenic has been associated with several health hazards. Worldwide the main reason for chronic human intoxication with arsenic is intake of contaminated drinking water. Air acetylene type of atomic absorption spectrophotometer in combination with hydride generator accessory was used to analyze arsenic level in 25 water samples collected from 25 booster pumping stations and 313 water samples collected from tap water supply of 62 areas of Delhi. Results were analyzed using SPSS and Barlett's Chi Square Test. Mean arsenic level detected in water samples collected from booster pumping stations was 0.00976 ppm (Range 0.000-0.017 ppm, Standard Deviation 0.006 and Standard error of Mean 0.00118). Maximum arsenic level (0.017 ppm) was found in water samples of booster pumping stations of Mehrauli, Punjabi Bagh and Ramjas Road. Mean arsenic level detected in samples collected from tap water supply was 0.013 ppm (Range 0-0.0430 ppm, Standard Deviation 0.00911 and Standard error of Mean 0.000515). In water samples of 42 areas arsenic level detected was exceeding WHO/EPA permissible limit of 0.01 ppm (10 ppb). The mean arsenic level detected in water samples of booster pumping station was within WHO/EPA permissible limit while mean arsenic level detected in tap water samples was marginally higher. Mixing of ground water and contamination through broken or leaking channel could be the possible reason of higher arsenic level in tap water. Continuous monitoring of quality of drinking water is required particularly in view of water contamination caused by industrial waste and uncontrolled ground water extraction.

Any change produced, or feature introduced, in a body after death which is accidentally or physiologically unrelated to the natural state of the body is termed as an artefact. Since artefacts may lead to misinterpretation of post-mortem findings, it is important to rule them out. Artefacts may be produced for a variety of reasons. We present a case report where a young male in his late twenties committed suicide by hanging. He was suffering from haemorrhoids. Because of his posture, there was post-mortem bleeding, which was interpreted by the police as bleeding due to the self-cutting of his veins. Hence, we felt the need to report this case.

Surveillance of drinking water is essentially a health measure intended to protect the public from water borne diseases. Hydride generator accessory coupled with atomic absorption spectrophotometer was used to analyze arsenic level in 49 ground water samples collected from different areas of Delhi. Arsenic level in ground water samples was in the range of 0.0170 to 0.100 ppm (Mean-0.0431, Standard Deviation-0.0136, Std. error of Mean-0.00194) with minimum concentration at Raney Well No. 7 (0.0170 ppm) and maximum at Kotla Mubarak Pur (0.100 ppm). Arsenic containing sediments and percolation of chemicals into soil as the result of dumping of garbage rich in chemicals into open landfills could be the possible source of arsenic in ground water of Delhi. Extensive survey and continuous monitoring is required to be made to assess the magnitude of problem and earlier intervention.

A 29-year-old male was found dead lying in a pool of blood inside a community toilet locked from inside. The individual is alleged to have committed suicide by cutting his throat with a safety razor blade, which was found at the scene by the investigating police authority. The deceased, as per his relatives, was suffering from depression for the last few days., (Copyright 2004 Elsevier Ireland Ltd.)

Autoerotic asphyxial activity may at times result in unexpected death. Although the majority of deaths that occur during autoerotic asphyxial episodes are accidental, the possibility of suicide must always be entertained. In the case presented here, a 22-year-old married male was found hanging by his neck in his bedroom, which was locked from the inside. He was suspended by a 'lungi' (male wrap-around cloth) from the ceiling fan hook in his room, with his feet touching the ground. He was dressed in a brassiere, panties, and silver anklets. There was no evidence of previous perverse behaviour, and investigation disclosed no evidence of previous autoerotic sexual activity, homosexual behaviour, drug abuse or suicidal ideation.

A 20-year-old girl along with four of her friends, all in their early 20s, met with a fatal accident in the early hours of the day. Their car was hit by a speeding truck at a crossing. All the occupants of the car sustained multiple injuries and died on the spot. The girl was decapitated in the accident. Her head was recovered outside the mangled remains of the vehicle and the rest of the body was extracted from the co-driver's seat of the damaged vehicle.

Since the legal consequences taking in consideration of Indian evidence Act 1857 of an unwarranted release of confidential information are uncertain and even the consequences may be serious, it is necessary that a physician be most cautious when divulging any information about a patient. Although there are exceptions to the proposition that all confidential information acquired from a patient should be kept secret, the basic rule to remember is that confidential information should not be revealed without obtaining the patient's consent unless law of the land like provision in criminal procedure code of India requires the physician to report the information, to any person or insurance company. Whenever a physician believes it is necessary to reveal a professional secret to protect the welfare of a patient, a third person, or the community, he should exercise caution in the method of disclosure. The following suggestions have been made to guide physicians under these circumstances: 1. Assure yourself that the person informed is sometime entitled to the information, such as the patient's parent or guardian. 2. Do not give information by telephone if you do not recognize the voice of the person making the request. 3. Avoid the use of telegrams or letters to communicate medical information of patient. 4. If you are in doubt about your right to release the information consult your legal council. 5. A person in police custody as an undertrial prisoner has the right not to permit the doctor who has examined him, to disclose the nature of his illness to any person. If a person is convicted, he has no right and the doctor can disclose the result to the authorities. 6. Never release the treatment history without written consent from patient or its legal heirs to any insurance company.

Serum haptoglobin, transferrin and albumin were studied electrophoretically in 50 patients with carcinoma of breast and in 50 normal healthy women. Results on haptoglobin show a preponderance of products of gene Hp1 (0.26) in patients as compared to controls (0.14). No variation was observed at the transferrin locus in either sample. The most notable finding was the detection of four cases of alloalbuminaemia (8%) in breast cancer Patients. The high incidence of alloalbuminaemia prompted us to extend our observations further. For this purpose sera from 41 patients was collected. One more case of alloalbuminaemia of the fast type was detected. However, in contrast to our first series of patients, quite high incidence (12.2%) of transferrin variants was recorded in this sample. Family studies were conducted on all the patients with protein anomalies.

Serum albumin, ceruloplasmin, transferrin and haptoglobin were studied in 50 patients with both toxic and non-toxic forms of goitre. Albumin was monomorphic in all cases and its amount was substantially lower than normal in two patients. Ceruloplasmin was both qualitatively and quantitatively normal in all patients. No genetic variants of transferrin were encountered but 22% of the patients had this protein, at levels barely detectable by electrophoretic means. Such cases of hypotransferrinaemia occurred oftener in patients with the toxic form of goitre than in those with the non-toxic one. The distribution of haptoglobin types in patients was much the same as in the control blood donors. However, the patients had a greater incidence of ahaptoglobinaemia.

Two cases of liposarcoma of the jaws were reported. These appear to be the first cases of their kind in the literature. Pathological and clinical features were discussed. Early diagnosis and radical treatment after accurate histological typing were stressed.