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Background Snake bite is a major public health problem, especially in the tropical areas of the world, which the World Health Organization aims to eradicate. According to the National Crime Records Bureau in India, where agriculture is the mainstay of employment attributes about 8660 mortalities in a year. Histopathological results are of immense help in establishing the cause of death in those snake bite cases where other circumstantial shreds of evidence are lacking. Results An autopsy-based prospective study was conducted on fatal cases of snake bite reported at a tertiary care center in south India over a period of 2 years. A total of 38 fatal snake bite cases were included in the study. Epidemiological data were collected and analyzed. Histopathological findings of the kidneys, heart, and endocrine glands (pituitary, adrenals, thyroid, and pancreas) were analyzed. The significant findings of the kidneys were distinct corticomedullary demarcation on the gross surface (65.8%) and congestion and acute tubular necrosis (55.3%) on histology. On the other hand, in the set of endocrine glands, adrenals and pituitary showed predominantly hemorrhagic infarction on the histological analysis (18.4% and 52.6%) respectively. Conclusion The results of the current study enlighten the findings such as distinct corticomedullary demarcation and acute tubular necrosis in the kidneys and hemorrhagic infarction in the endocrine glands in a case of snake bite. It highlights the need for histopathological analysis in the cases of a fatal snake bite when other circumstantial and gross features become indecisive. This can aid immensely in a medico-legal investigation of snake bite cases.

Prisoners are created, not born. For decades, custodial fatalities have become a thorn in the side of the mistreated police control. A 32-year-old male was found dead inside prison because of depression that he was prisoned. On investigation, a ligature mark above the neck was found to be suicidal in nature. Proper prisoner care, motivation within the prison, surprise visits from higher officials, and close surveillance by CCTV may all help to avoid suicidal behaviour within the prison. The current instance provides inspiration for police officers to motivate and monitor prisoners in order to prevent suicidal behaviour.

Death due to burns is a major public health problem worldwide. Most cases occur in middle and low-incomecountries. In India, deaths due to burns are commoner in women than in men. Fire is easily available weaponfor suicide and homicide and it can also cause accidental deaths. Death due to burns in newly marriedfemale is a common incident in our country and major fraction of such deaths happen as a result of dowryharassment or killing for not giving dowry. Our study aimed to identify some of the epidemiological factorsin deaths due to burns in newly married females in and around Pondicherry. Out of 48 cases during the studyperiod, 24 victims were in the age group of 22-25 years and 26 women died within 3 years of marriage.The majority of the cases occurred in less educated and homemaker wives and were living in a joint family.Major reasons or motive behind deaths were dowry harassment and torture, and quarrel with husband or inlaws. The most common manner of such deaths was suicidal followed by accidental.

Background In India the data on paraquat (PQ) poisoning are limited to case reports and small case series. Hence, this study was carried out to understand the clinical features and outcomes of PQ poisoning. We also briefly report the relevant Indian studies on PQ poisoning. Materials and methods This was a retrospective case record-based study of PQ poisoning victims admitted over a period of 5 years. Results Of the 55 patients included in this study, the in-hospital mortality rate was 72.7%. Acute kidney injury was the most common manifestation. The use of cyclophosphamide did not affect the clinical outcome. Hemoperfusion (HP) was not done for any patient. Pulmonary edema and acute tubular necrosis were the most common histopathological findings. Conclusion In India, this is one of the most comprehensive studies of PQ toxicity. Hence, we hope that this information would be of use to clinicians who deal with PQ poisoning. How to cite this article Ravichandran R, Amalnath D, Shaha KK, Srinivas BH. Paraquat Poisoning: A Retrospective Study of 55 Patients from a Tertiary Care Center in Southern India. Indian J Crit Care Med 2020;24(3):155-159.

Folic acid is B-9 vitamin. Folic acid is prescribed commonly for pregnant women to prevent neural tube defects in the fetus, patients under chemotherapy, pernicious anemia and to reduce the risk of stroke and cardiovascular disease. Acute or chronic ingestion of a large dose of folic acid generally manifests as neurological complications, which are reversible. In this present case, a 23-year-old pregnant woman committed suicide by consuming folic acid tablets and succumbed to death within 36 h. Postmortem toxicological analysis detected folic acid in viscera. Death following acute consumption of folic acid is rare and has been not reported in the literature, to the best of our knowledge.

Paraphenylenediamine poisoning is among one of the emerging causes of poisoning in Asian countries, because it is a constituent of hair dye formulations and is easily available in market at low cost. Hair dyes are rampantly used in Asian households compared with the western world. Locally, hair dye constituents may have allergic adverse effects, and acute systemic poisoning presents with characteristic angioedema, upper airway obstruction, rhabdomyolysis, methemoglobinemia, myoglobinuria, and acute renal failure. This study reports about the death of a 24-year-old Indian housewife who committed suicide by taking hair dye emulsion. She had an argument with her husband, and because of fit of rage, took a bowlful (80 mL) of hair dye emulsion kept prepared for the use by husband. She developed angioedema, cervical swelling, and rhabdomyolysis and died of acute renal failure within 24 hours. Toxicological analysis of viscera and blood revealed varying levels of paraphenylenediamine. Histopathological samples of kidney showed features of acute tubular necrosis and myoglobin casts in renal tubules. The aim of the study is to create awareness about the adverse effects of the hair dye, its poisoning outcome, and possible preventive measures.

Electrocution fatality cases are difficult to investigate. High-voltage electrocution burns resemble burns caused by other sources, especially if the person survives for few days. In that case, circumstantial evidence if correlated with the autopsy findings helps in determining the cause and manner of death. In addition, the crime scene findings also help to explain the pattern of injuries observed at autopsy. A farmer came in contact with a high-voltage transmission wire and sustained superficial to deep burns over his body. A charred and deeply scorched area was seen over the face, which was suggestive of the electric entry wound. The exit wound was present over both feet and lower leg and was atypical in the form of a burnt area of peeled blistered skin, charring, and deep scorching. The injuries were correlated with crime scene findings, and the circumstances that lead to his electrocution are discussed here.

Commonly used household chemicals and pharmaceuticals agents which may range from pain killer remedies to anticonvulsant medications hair dye up to toilet cleaners all agents poses a potentially fatal poisoning tendency The most vulnerable groups in a household are children below years of age to accidental poisoning and young adults to intentional self harm although no age is barred from being poisoned by these agents Children are most at risk for poison exposures from household products as they do not have the ability to distinguish between safe and unsafe things that look very similar This is an issue that can affect anyone where children are at most risk This paper reviewed the present trend of household poisoning and observed that there is a striking increase in the number of household poisoning cases in the recent past The primary aim of the present paper is to review the existing burden of lsquo household poisons rsquo and to recommend appropriate preventive measures against such poisoning occurrences

The present paper highlights the steps followed to prevent the risks and hazards encountered at mortuary. Autopsy surgeons or Forensic pathologists and the personnel who assist in conducting the autopsy are liable to encounter a number of accidents and potential biohazards; who are at a continuous risk of acquiring various kinds of viral, bacterial infections from contagious body fluids, soft tissues of the dead and skin injuries. The prevailing practice of autopsy in major parts of world including India is empirical and crude and is due to ignorance, administrative apathy, under funding and lack of implementation of effective skill oriented programs on safe autopsy practice and for development of an optimally equipped mortuary. Safety in morgues is not only relevant to the team performing the autopsy, but also has adverse environmental effects e.g. contamination with radioactive and other contagious substances. By adhering to approved safety precautions and autopsy techniques, the risk of hazards at work place may be minimized. The present literature reviewed the risks related to the existing autopsy practice and discussed appropriate preventive, bio-safety measures to be taken. This paper highlights the preparation of safety guidelines for routine autopsy practice; which should be devised by forming appropriate committees which may include the practicing autopsy surgeons, mortuary personnel, the professionals from local infection control and occupational health and safety departments. The existing safety measures in a mortuary set-up should be evaluated and reconsidered after reviewing appropriate safety guidelines. Time to time organization of induction programs, workshops, continued medical education on safe autopsy practice will be a great help for the persons concerned. Nevertheless, the goal of such practice is to protect the concerned workers and

Poisoning, hanging, and burning are the usual methods adopted by people to commit suicide. Suicide by electrocution and that too high voltage is one of the rarest methods adopted for the purpose. We report the case of a young man who committed suicide by climbing up a 25-ft-high electric pole. The deceased was a regular alcoholic and was under severe depression for a long time because of his personal problems. He survived for more than 2 days after the incident. His serum urea and creatinine levels were elevated, so were the creatine kinase total and creatine kinase-MB level. The method adopted and the findings make this case a rare scientific report. Moreover, to the best of our knowledge, this is the first reported case in an English scientific literature of a high-voltage suicidal electrocution with multiple exit wounds. The circumstances surrounding the manner of electrocution and the features of electric injuries are presented and discussed.

This review article is based on concepts of medical ethics related to the day-to-day practice of surgery. Over the last two decades, with the development of advanced surgical methods, robotic surgeries, or telesurgeries, etc. there is increased reporting of associated ethical issues as well. Nevertheless, the ethical issues encountered by surgeons are reasonably different and critical when compared to what physicians face during their practice. There are extensive deontology literatures available for physicians while the same is not available sufficiently for surgeons. In this review, we have discussed the common queries asked by practicing surgeons who had faced medico-legal litigation and had come to us for consultation. This discussion is made in the light of comparison with ethical issued faced by practicing physicians. In the practice of medicine just fulfilling the basic ethical requirements, e.g. autonomy, beneficence, non-maleficence, is often sufficient. However, for surgical practice the ethical requirement is beyond the level of such basic deontological requirements. Hence, in this paper we have tried to search and discuss all deontological dimensions of surgical practice, e.g. Normative ethics: concerned with a moral course of action for a surgical practice, Meta-ethics: concerning determining the truth and reference of moral values, and the Applied ethics: concerning what a person is obligated to do in a specific situation or a particular domain of action. Hopefully, these will be useful to guide the surgeons' behaviours in particular circumstances encountered during their surgical practice.

Bees, wasps and ants are the common insects to sting. Fatalities due to wasp sting are uncommon. The wasp venom contains various biologically active compounds like histamine, phospholipase, hyaluronidase, adrenaline and noradrenaline. Various factors predispose the outcome of envenomation. Usually within 48 hours the victim recovers but when there is massive envenomation, serious complications like rhabdomyolysis, acute renal failure and anaphylaxis may develop. An elderly female was stung by a swarm of wasps. She presented to hospital with hypotension, stridor and swelling of the face. Biochemical investigations indicated azotemia. The creatinine kinase and immunoglobulin E level had increased twenty and 14 folds respectively. Histopathology report revealed acute tubular necrosis with red blood cell casts and eosinophilic infiltrates in the kidney, edema and intra alveolar hemorrhage in the lungs. Within 30 hours of the incident, the victim succumbed to the complications of the venom. Death in wasp envenomation may be due to anaphylaxis or multiple organ dysfunction. It is difficult to delineate the exact mechanism of death due to massive envenomation. The present case had a combination of multiple organ dysfunction and anaphylaxis.

Homicidal burning of married women in India is a major concern for the Government, law-enforcing authorities, the judiciary, the police and medico-legal experts all over the country who are associated with dowry disputes. Dowry death, a heinous crime, is gradually engulfing and polluting the entire society. Sections 304(B) and 498(A) of the Indian Penal Code (IPC) have been introduced and Sections 174 Criminal Procedure Code (Cr PC) and 176 Cr PC have been modified but, instead of deterring dowry deaths, the occurrences are increasing day by day and the number of cases coming for post-mortem examination is rising. Both parties, that is, the parents and in-laws of the deceased, are becoming adept at manufacturing circumstantial evidence to serve their own interests. Therefore, to establish the truth and for the smooth administration of justice, reliable unbiased medical evidence has to be corroborated. This study presents retrospective research carried out in the tertiary care teaching hospital of MKCG Medical College, Berhampur, Eastern India, for a five-year period between January 1998 to December 2002. From a total of 58 burned wives, 32 (55.1%) were homicidal burns. These cases were analyzed in view of epidemiological and medico-legal aspects. The majority of the affected women (90.63%) were in the 18 to 26 years of age group. Death occurred within the first few years of marriage and most of them had no children. All the victims belonged to the Hindu religion and 62.5% of incidents occurred during the daytime. In 71.87% cases the incident occurred in rural areas. Eighty-three per cent of cases occurred in a joint family within the house. In most cases, kerosene was the accelerant and flame was the causative agent. In more than 68.75% of cases the total body surface area involved was more than 80%. Most victims died at the time of the incident, or within the subsequent 24 hours, due to hypovolumeic shock. The education status in 70.21% cases was either illiterate or under matriculation. More stringent laws and female independence both mentally and economically will reduce the homicidal burns in young brides.

Electrical injuries currently remain a worldwide problem. These injuries are responsible for considerable morbidity and mortality, but are usually preventable with simple safety measures. A retrospective study was undertaken of deaths due to electrocution that occurred over a five-year period from January 2002 to December 2006. The bodies were autopsied at the Department of Forensic Medicine, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India. A total of 118 cases were identified and all were accidental: 107 males (91%) and 11 females (9%) (male:female ratio = 9.72). The majority of deaths occurred in the 21–30 year age group ( n = 57, 48%). Most deaths ( n = 98; 83%) were due to low-voltage circuits (

Frotteurism is a perverted sexual behaviour wherein the person tends to rub or bring about physical contact between his genitals and an unrelated female or male to derive sexual pleasure. Moreover, frotteurism is a common phenomenon among the general population which usually goes unnoticed or overlooked. Nevertheless, public frottage has legal implications in almost all countries over the world. But, when frotteurism manifests on the backdrop of psychiatric illness or as a developmental abnormality then it is worth discussing what the legal liability would be. The present case report is based on hypersexual frotteuristic behaviour manifested on the background of a concealed psychiatric illness, featuring depression and obsessive compulsive disease. The hypersexual behaviour manifested in the form of masturbation with features of frotteurism and subsequent development of depression. Nevertheless, compulsive manifestation of frotteuristic behaviour and subsequent development of morbid depression is rare. This paper describes a 12-year-old boy having unrestrained impulsive frotteurism with his peers, school mates and with his younger brother. He was conscious of the fact and feeling guilty of what he was doing but unable to restrain himself. It was followed by the development of symptoms of depression which was treated with Sertraline. Concurrent psychiatric counseling and rehabilitation measures were taken too. There was complete remission of the symptoms 6 months after the onset of treatment and without relapse thereafter. The paper discusses the differential diagnosis and management of hypersexual behaviour.

In India motor vehicle population is growing at a faster rate than the economic and population growth. This study was conducted from November 2011 to april 2013 at JIPMER, Puducherry. In this study there were 268 deaths due to road traffic accidents with head injury in a period of 18 months (November 2011 to April 2013). Males outnumbered females (81.71% vs 18.28%) with a ratio of 4.5 to 1. Road Traffic Accidents (RTAs) are more commonly seen in the age group of 31-45 years followed by 16-30 years. The major culprits are the two wheelers which amount to 198 vehicles (53.08%). In our study the number of pedestrian involved in accidents is 89 (33.20%) and the motor cyclists are 97 (36.19%). Frontal (51 cases; 28.33%) and occipital (50 cases; 27.77%) parts of the skull are more commonly fractured. In basal skull fractures posterior cranial fossa (PCF, 36 cases; 26.66%) and middle cranial fossa (MCF, 35 cases; 25.92%) are more commonly fractured. The most common type of haemorrhage is the combination of subdural and subarachnoid haemorrhage 134 cases (54.69%). Language: en