Forensic Pathology - Science topic

This is a case of invasive myiasis. If eggs of the insect gain access, e.g. through a lesion, to blood vessels they can reach other organs. If eggs are swallowed, larvae and imagos can develop in the intestine. Some of the causing insects (e.g. (Cochliomyia hominivorax, Chrysomya bezziana, Chrysomya albiceps, Lucilia cuprina) are truly invasive.

This case needs to be published!!

One aspect of religious importance to forensic acses, according to secular sciences, might be that the less assorted ethnic crowds have additional amalgamated customs, philosophies, and performs about death, and such groups more often partake in autopsy-linked religious issues

Thank you Akshith

Thank you Jorge sir, Nilesh Tumram sir, Gustavo sir, Abhishek sir for your valuable guidance

For lower voltage contacts, there is about a 50% chance of there being no burn marking.  Because the burn mark is a local effect, the presence or absence of burns does not necessarily predict the severity of internal injury.  (Obviously severe and extensive full thickness burns are a predictor.)  The mechanism of internal electrical injury is not necessarily thermal.  Burning is the result of I-squared R heating where R is the localized resistance and I is directly proportional to voltage and inversely proportional to resistance between entry and exit points.  The greater the value of I-squared times R, the more likely that a burn will occur in a shorter time.  Energy imparted is I-squared x R x T where T is time.  Simply stated if there is enough current density and enough resistance and enough time to elevate the skin locally to a temperature that will induce a burn, then there will be a burn.  Absent those factors, a burn will not occur.  Wet skin causing lower Resistance and more diffuse entry causing lower current density can reduce the chance of burning even when the contact is quite significant.

This seems similar to gun shot wounds to the chest.  If the heart is hit, the victim still can continue to move for some time, until the brain stops functioning from the lack of oxygen.  A gun shot wound to the brain, however, will stop the victim immediately.

I am just curious to know, if crystal test ( Teichman or takayama) would come positive in such cases or not?

It is better to fix your sample before IHC, because fixation can preserve component of cell and cell morphology. Fixation by alcohol usually use for preserve the genomic content and  detecting antigen in nuclei. Alcohol only precipitate antigens, it does not cross-link them. So some antigens may be washed out during IHC process, especially the cytosolic antigens. You can fix your samples by 4% PFA + 1% Acetic acid in PBS at RT for 10 to 30 min after preparing your slices (the thickness should less than 30  micron). After fixation, wash slices by cold PBS 10 min for three times at 4 degree. Under this condition, you can preserve cell morphology very well, and short-term fixation will not mask antigen too much.

I agree with the 2 responders about combining the severity of symptoms and hair analysis. The latter test quantifies the duration of Methadone use. Urine toxicological testing is only qualitative. 

Manner is a difficult question. It needs all collation of all circumstantial evidence, along with the postmortem examination findings (thus scene, eye witness and participants in the case's evidence, etc. all play a key role). An even bigger contributor in determining the manner is if the victim was able to make a dying declaration about her circumstances of death.

I would think the one situation where all things come together in a decent system of death investigation and death investigators is the US Medical Examiners' system, but I have qualms about their interpretation of the manner of death automatically transcribed on all death certifications - where the ME's manner may be at variance with what the courts find out later!

In all cases of suspected electrocution, there should be an examination of the alleged source of the electrical current including electrical devices the individual was handling at the time of death. In low-voltage electrocutions, examination of the device rather than examination of the body will often provide the cause of death, because burns may not be present. Thus, one can make a diagnosis of electrocution without an electrical burn, based on the circumstances of the death, negative autopsy findings and the examination of the electrical device in use. In high-voltage electrocution, tissue from the victim may be adherent at the point of contact with the source of the current (e.g., a metal ladder).

It depends on the role of the autopsy that is being undertaken - is it merely to determine cause of death in a forensic setting, or to determine all relevant pathologies present?

As a pathologist, I am in the latter cohort, believing our duty of care extends to provide the family and referring clinician the most complete answer (within the limitations of the consent).

Complete autopsy examination entails assessing clinical, radiology, macroscopic and microscopic aspects, looking for primary (dominant) pathologies, determining how they relate to the terminal event, seeking underlying contributing factors to that pathology, and correlating with the observed clinical aspects. We also should be assessing concomitant unrelated pathology that may have caused later detriment to the patient.

In the case of tumour pathology, a macroscopic is rarely sufficient, and now in the era of genetics, paraffinized tissue may be useful for DNA archiving (within the limitation of autolysis). Other pathologies may give confusing macroscopic appearances (tumour mimics such as intestinal TB, perforated gastric ulcers, pulmonary fungal infections). Admittedly many pathologies, particularly cardiovascular ones, provide little further information histologically, and assessment is largely for excluding contributing factors (eg arteritis).

I remember being taught the addage "if you don't look, you will not find".

Autopsies that specifically target occult pathology (slicing the fixed thyroid and prostate) have quite high pick-up rates, though such examinations need to be age-appropriate. These "incidentals" may have relevance to family screening.

There is a significant diagnostic miss-rate for macroscopic-only autopsies, though this was often the result of them being performed by non-pathologists.

If resources are limited, histology should be targetted to the dominant pathology and determining possible contributing factors, but I would always be inclined to take some histology.

Like taking high-quality macroscopic photographs, histology sections provide documentation (that is reviewable), and in a forensic setting provides the higher level of proof that sometimes may be required.

Dear nilesh,

in Germany where I am from and in the UK. Blood test are not done routinely after death has occured. One exeption at least in Germany are trafiic accidents when alcohol or drugs are possibly involved.

Even during an autopsy blood is not taken routinly for toxicology. I have no figures for Germany but the Senior Coroner,s statistics 2012 for England & Wales gives the following rates for all autopsies

Level 1 autopsy only 67%, With histology 20 % and / or Toxycology 13 %

Genetics are performed here very rarely (no figures for that)

As you know probably much better then I do it's the costs that are the limiting factor.

In deaths (natural or not) occurring outside a hospital without an Inquest or. Autopsy there is never a blood testing.

I hope this helps. The source is below, the link is attached

Greetings

Stephan

Coroners Statistics 2012 England and Wales

Ministry of Justice Statistics

And the presumption in India that any MBBS doctor can undertake an autopsy is absurd and useless , the science is so advanced and technical now , it needs to have specialists who deal with it rather than police pressurising any poor doctor in a rural area to confirm the cause of death

Rule of nine is basically used to estimate the surface area involved with burns to estimate the iv fluid to be infused into the patient. As far as forensic medicine is concerned it can be said whether burn is sufficient to cause death in ordinary course of nature or not.

Dear colleagues, concrete autoptic strategy is defined by the case being examined in itself. Which method or protocol is the best one? Simple reply: none. Use the benefits of various approaches, combine them and be creative, be curious and be prepared for everything.

Brinkman and Madea published following data (earliest /regular/longest positivity):

P-selectin: 3 min/-/7 hours

Fibronektin 10-20 mins/over 4 hours/months

E-selectin 1hour/-/17 days

ICAM-1 1,5 hour/-/3,5 days

Proliferation Ki67 cca 1,5 days/-/-

Moreover, biochemical markers could be also used - changes in esterases pattern could be detected as early as 5 - 15 mins after injury.

The higher level of Strontium may be the cause of higher in take of STRONTIUM in Calcium contaminated food/drug or exposure to Sr related materials if MS result is correct.

Dr.K.Choudhary

Dear Petr, we used endoscopy in Freiburg, but with a rigid endoscope, as described by Amberg and Pollak in Forensic Science International 124 (2001) 157–162. I am still interested in postmortem endoscopy, especially in angioscopy of the neck vessels after traffic accidents. Endoscopy is an interesting tool, but nowadays postmortem computertomography seems to be the additional technique of choice. But this is another discussion...

thank u for ur reply however it has been sited in international journal of cardiology as well in other sitations that certain criteria that have been considered artifactual back in early 20th century &in late 60s r recently considered as diagnostic criteria of chaosic myofibrillar contractions defining ventricular fibrillation; from my work itruly find them applicable since in spite of being an arrhyrhmic event yet result in myofibrillar fragmentations with sqaure nuclei & nearby elongated streched ones & by refering these changes to relevant clinical data particularly ECG when done before death i was able to find consistent correlations as mentioned by many respectable aurhors

Dr. Dennis Chute, our deputy chief medical examiner who is also a board certified neurologist, stated: "It depends upon the percentage of phosphate buffered formalin one uses to fix the brain and the quantity of formalin put in the bucket, what condition the brain is in (e.g. atrophied brains fix quicker). One to two weeks, preferably the latter, with 10% PBF. "