Infant death resulting from sharing a cot with a 10-year-old boy

An infant may die from unintentional suffocation if their exhausted, or inebriated or sedated mothers fall asleep while breast feeding or just sharing a bed and roll over on to them. The mother wakes up to find the baby dead in the morning. Diagnosis is complex due to minuscule autopsy findings and denial by parents about overlaying although it was accidental. Unusually, in this case, the baby was "over layed" by a young male child from the same family. The female baby was found listless next morning by her mother and died after three months of treatment. Death circumstances, non-sudden outcome, and unusual circumstances of overlaying the baby.

Algal-derived nanoparticles and their antibacterial potential: Current evidence and future prospectives

Green nanotechnology provides efficient solutions for converting biological systems to green approaches through nanomaterial synthesis and thus preventing any associated toxicity. Green nanoparticle (NP) synthesis involves the use of biological sources for synthesis of metallic NPs for pharmaceutical and biomedical applications in an eco-friendly and comparatively economical manner. Nanotechnology is a promising technology with a wide range of pharmaceutical applications in the modern world because it provides a higher surface area (SA) to volume (Vol) ratio. Compared to chemically synthesized NPs, algal-based NPs have recently received increasing attention from researchers worldwide as potential agents to treat and inhibit infections caused by microbial pathogens resistant to antibiotics. Algae produce various bioactive compounds such as chlorophyll, phycobilins, phenolics, flavonoids, glucosides, tannins, and saponins that can be used as therapeutic agents. Metallic NPs exert greater toxic effects on their targets than their macroscopic counterparts. Both macroalgae and some microalgae are used to synthesize metallic NPs that exhibit antimicrobial activity. The synthesis of algal-based NPs may provide potential drug candidates for use in nanomedicine against microbial diseases. To date, many studies have been conducted on algal-based NPs and their potential antimicrobial and antifungal activities. Therefore, in this review we have focused on the green synthesis of different NPs using algae and their therapeutic potential with reference to their antimicrobial activity.

Low-dose priming of gamma radiation enhanced cadmium tolerance in Chlamydomonas reinhardtii by modulating physio-biochemical pathways

Microalgae are natural biotic models for exploring the genotoxic effect of heavy metals, irradiation, other external stimuli and the toxicant elimination. The effective removal of heavy metals from the aquatic environment using microalgae has gained considerable attention. However, limited research was carried out on cadmum toxicity in microalgae and their use as bio-accumulants. Previous research suggested that low-dose priming with non-ionizing radiations, such as gamma radiation, increased heavy metal tolerance in plants and aquatic photosynthetic microalgae. In the present study, we have hypothesized the growth inhibitory physiochemical properties of cadmium (Cd) in Chlamydomonas reinhardtii, and analyzed the protective role of low-dose gamma radiations priming against Cd-induced growth inhibition by emphasizing mechanism of cell survival by antioxidant defence system. Experimentally, the gamma-primed C. reinhardtii exhibited higher cell survival and Cd tolerance with effective modulation of biochemical responses such as antioxidant enzymes. The current investigation revealed that low-dose priming of gamma radiation masks Cd-mediated oxidative stress and enhances cellular detoxification via intracellular antioxidant enzymes in C. reinhardtii.

Microalgal Phycoremediation: A Glimpse into a Sustainable Environment

Microalgae are continually exposed to heavy metals and metalloids (HMMs), which stifles their development and reproduction due to the resulting physiological and metabolic abnormalities, leading to lower crop productivity. They must thus change their way of adapting to survive in such a hostile environment without sacrificing their healthy growth, development, reproductive capacity, or survival. The mode of adaptation involves a complex relationship of signalling cascades that govern gene expression at the transcriptional and post-transcriptional levels, which consequently produces altered but adapted biochemical and physiochemical parameters. Algae have been reported to have altered their physicochemical and molecular perspectives as a result of exposure to a variety of HMMs. Hence, in this review, we focused on how microalgae alter their physicochemical and molecular characteristics as a tolerance mechanism in response to HMM-induced stress. Furthermore, physiological and biotechnological methods can be used to enhance extracellular absorption and clean up. The introduction of foreign DNA into microalgae cells and the genetic alteration of genes can boost the bio-accumulation and remediation capabilities of microalgae. In this regard, microalgae represent an excellent model organism and could be used for HMM removal in the near future.

Algal Phlorotannins as Novel Antibacterial Agents with Reference to the Antioxidant Modulation: Current Advances and Future Directions

The increasing drug resistance of infectious microorganisms is considered a primary concern of global health care. The screening and identification of natural compounds with antibacterial properties have gained immense popularity in recent times. It has previously been shown that several bioactive compounds derived from marine algae exhibit antibacterial activity. Similarly, polyphenolic compounds are generally known to possess promising antibacterial capacity, among other capacities. Phlorotannins (PTs), an important group of algae-derived polyphenolic compounds, have been considered potent antibacterial agents both as single drug entities and in combination with commercially available antibacterial drugs. In this context, this article reviews the antibacterial properties of polyphenols in brown algae, with particular reference to PTs. Cell death through various molecular modes of action and the specific inhibition of biofilm formation by PTs were the key discussion of this review. The synergy between drugs was also discussed in light of the potential use of PTs as adjuvants in the pharmacological antibacterial treatment.

Phytochemicals: Potential Therapeutic Modulators of Radiation Induced Signaling Pathways

Ionizing radiation results in extensive damage to biological systems. The massive amount of ionizing radiation from nuclear accidents, radiation therapy (RT), space exploration, and the nuclear battlefield leads to damage to biological systems. Radiation injuries, such as inflammation, fibrosis, and atrophy, are characterized by genomic instability, apoptosis, necrosis, and oncogenic transformation, mediated by the activation or inhibition of specific signaling pathways. Exposure of tumors or normal cells to different doses of ionizing radiation could lead to the generation of free radical species, which can release signal mediators and lead to harmful effects. Although previous FDA-approved agents effectively mitigate radiation-associated toxicities, their use is limited due to their high cellular toxicities. Preclinical and clinical findings reveal that phytochemicals derived from plants that exhibit potent antioxidant activities efficiently target several signaling pathways. This review examined the prospective roles played by some phytochemicals in altering signal pathways associated with radiation response.

Dietary polyphenols in chemoprevention and synergistic effect in cancer: Clinical evidences and molecular mechanisms of action

BACKGROUND

Epidemiological studies has revealed that a diet rich in fruits and vegetables could lower the risk of certain cancers. In this setting, natural polyphenols are potent anticancer bioactive compounds to overcome the non-target specificity, undesirable cytotoxicity and high cost of treatment cancer chemotherapy.

PURPOSE

The review focuses on diverse classifications of the chemical diversity of dietary polyphenol and their molecular targets, modes of action, as well as preclinical and clinical applications in cancer prevention.

RESULTS

The dietary polyphenols exhibit chemo-preventive activity through modulation of apoptosis, autophagy, cell cycle progression, inflammation, invasion and metastasis. Polyphenols possess strong antioxidant activity and control multiple molecular events through activation of tumor suppressor genes and inhibition of oncogenes involved in carcinogenesis. Numerous in vitro and in vivo studies have evidenced that these dietary phytochemicals regulate critical molecular targets and pathways to limit cancer initiation and progression. Moreover, natural polyphenols act synergistically with existing clinically approved drugs. The improved anticancer activity of combinations of polyphenols and anticancer drugs represents a promising perspective for clinical applications against many human cancers.

CONCLUSION

The anticancer properties exhibited by dietary polyphenols are mainly attributed to their anti-metastatic, anti-proliferative, anti-angiogenic, anti-inflammatory, cell cycle arrest, apoptotic and autophagic effects. Hence, regular consumption of dietary polyphenols as food or food additives or adjuvants can be a promising tactic to preclude adjournment or cancer therapy.

Chemical diversity of dietary phytochemicals and their mode of chemoprevention

Despite the advancement in prognosis, diagnosis and treatment, cancer has emerged as the second leading cause of disease-associated death across the globe. With the remarkable application of synthetic drugs in cancer therapy and the onset of therapy-associated adverse effects, dietary phytochemicals have been materialized as potent anti-cancer drugs owing to their antioxidant, apoptosis and autophagy modulating activities. With dynamic regulation of apoptosis and autophagy in association with cell cycle regulation, inhibition in cellular proliferation, invasion and migration, dietary phytochemicals have emerged as potent anti-cancer pharmacophores. Dietary phytochemicals or their synthetic analogous as individual drug candidates or in combination with FDA approved chemotherapeutic drugs have exhibited potent anti-cancer efficacy. With the advancement in cancer therapeutics, dietary phytochemicals hold high prevalence for their use as precision and personalized medicine to replace conventional chemotherapeutic drugs. Hence, keeping these perspectives in mind, this review focuses on the diversity of dietary phytochemicals and their molecular mechanism of action in several cancer subtypes and tumor entities. Understanding the possible molecular key players involved, the use of dietary phytochemicals will thrive a new horizon in cancer therapy.

Evaluation of the anti-bacterial activity of methanolic extract of Chlorella vulgaris Beyerinck [Beijerinck] with special reference to antioxidant modulation

Background

The natural antioxidants from Chlorella have potent therapeutic implication in several diseases. However, the anti-bacterial activity and their molecular mode of action have not been investigated yet. The present study focussed on the assessment of antioxidant potential as well as free radical scavenging activity such as DPPH, hydroxyl radical, hydrogen peroxide, and superoxide anion radical assay of Chlorella vulgaris Beyerinck [Beijerinck] (BUACC25) isolated from marine habitat. Furthermore, the anti-bacterial activity and their molecular mode of action have been evaluated.

Results

In the present study, the preliminary phytochemical screening of methanolic algal extract revealed the presence of alkaloids, glycosides, proteins, terpenoids, saponins, coumarin, phenols, and tannins, which was confirmed by in an UV-visible and FT-IR spectroscopy, indicated the distinct spectral peaks. The methanolic algal extract was found to be rich in phenolic content (45 ± 0.06 mg GAE g−1) and flavonoid content (470 ± 0.25 mg of RUE g−1). Furthermore, the methanolic extract was revealed potent antioxidant scavenging activity to scavenge various free radicals with minimum IC50 values of DPPH, hydroxyl, H2O2, superoxide 2.82 ± 0.30, 2.30 ± 0.25, 3.24 ± 0.32, and 3.15 ± 0.02 μg ml−1 respectively. Furthermore, the methanolic extract of C. vulgaris exhibited potent anti-bacterial activity which was evident with the reduction in cfu × 107/ml and % of cell viability. Mechanistically, reduction of SOD, CAT, and GSH activity provoked ROS-mediated cell death after drug treatment. Moreover, in combination with norfloxacin and ciprofloxacin, methanolic extract of C. vulgaris demonstrated enhanced anti-bacterial activity with an evident reduction in cfu/ml and % of cell viability.

Conclusion

This study advocates that C. vulgaris (BUACC25) has promising antioxidant activity owing to the presence of phenolic and flavonoids evidenced by scavenging of DPPH, hydroxyl, H2O2, and superoxide radicals. In addition to this, it sustained anti-microbial activity against E. coli through modulation of SOD, CAT, and GSH. This study carved a path for uncovering a better therapeutic agent against disease-causing bacterial pathogens.

Enteromorpha compressa extract induces anticancer activity through apoptosis and autophagy in oral cancer

Marine algae are an auspicious source of innovative bioactive compounds containing possible therapeutic agents against mammalian cancers. However, the mechanism by which bioactive algal compounds exhibit anticancer activity against oral squamous cell carcinoma (OSCC) is scant. The main objective of the current study was to explore the properties of the Enteromorpha compressa solvent extracts that induced autophagy and apoptosis with reference to their potent phytochemical and antioxidant properties. The presence of bioactive compounds were confirmed by UV and FT-IR spectroscopy. The free radical scavenging activity were analyzed by evaluating H₂O₂, DPPH, superoxide and hydroxyl activity. The anticancer activities of the extracts were investigated by employing clonogenic and scratch assay. The apoptosis potential was evaluated by DAPI and MMP by Rh123 fluorescence assay. Moreover, the CAT, SOD, GPX, APX, and GR activities were measured. The autophagy potential was evaluated by LC3 puncta formation, acridine orange in addition to LysoTracker staining. The present investigation revealed that the methanolic extract of E. compressa elicited robust free radical scavenging activity that discerns its antiproliferative potency. Moreover, the methanolic algal extract boosted intrinsic apoptosis against OSCC by downregulating protective antioxidant enzymes. Furthermore, it also revealed induction of autophagy to promote cell death in oral cancer cells. The presence of novel bioactive compounds in E. compressa has uncovered possible therapeutic value against OSCC by modulating antioxidant defense system, apoptosis and autophagy that could be used to explore very competent algal candidates for the development of potential alternative anticancer drugs.

Chemotherapeutic efficacy of curcumin and resveratrol against cancer: Chemoprevention, chemoprotection, drug synergism and clinical pharmacokinetics

The frequent inefficiency of conventional cancer therapies due to drug resistance, non-targeted drug delivery, chemotherapy-associated toxic side effects turned the focus to bioactive phytochemicals. In this context, curcumin and resveratrol have emerged as potent chemopreventive and chemoprotective compounds modulating apoptotic and autophagic cell death pathways in cancer in vitro and in vivo. As synergistic agents in combination with clinically established anticancer drugs, the enhanced anticancer activity at reduced chemotherapy-associated toxicity towards normal organs can be explained by improved pharmacokinetics, pharmacodynamics, bioavailability and metabolism. With promising preclinical and clinical applications, the design of drug-loaded nanoparticles, nanocarriers, liposomes and micelles have gained much attention to improve target specificity and drug efficacy. The present review focuses on the molecular modes of chemoprevention, chemoprotection and drug synergism with special emphasis to preclinical and clinical applications, pharmacokinetics, pharmacodynamics and advanced drug delivery methods for the development of next-generation personalized cancer therapeutics.

Multifunctional role of fucoidan, sulfated polysaccharides in human health and disease: A journey under the sea in pursuit of potent therapeutic agents

Fucoidan is a complex polysaccharide (molecular weight 10,000-100,000 Da) derived from brown algae which comprises of L-fucose and sulfate groups have potential as therapeutic diligences against several human diseases. The fucoidan has expanded a widespread range of pharmacological properties as an anti-inflammatory, anticoagulant, antiangiogenic, immunomodulatory, anti-adhesive, anticancer, antidiabetic, antiviral and anti-neurodegenerative agents owing to their diverse chemical conformation and potent antioxidant activity. The antioxidant and immunomodulatory activities of the fucoidan contribute towards their disease preventive potency through dynamic modulation of key intracellular signalling pathways, regulation of ROS accumulation, and maintenance of principal cell survival and death pathways. Additionally, it also reduces cancer-associated cachexia. Despite the wide range of therapeutic potency, the fucoidan is heavily regarded as an unexplored plethora of druggable entities in the current situation. The isolation, screening, biological application, pre-clinical, and clinical assessment along with large scale cost-effective production remain a foremost task to be assessed. Moreover, the chemical synthesis of the present bioactive drug with confirmational rearrangement for enhanced availability and bioactivity also need tenacious investigation. Hence, in the present review, we give attention to the source of isolation of fucoidan, their principle strategic deployment in disease prevention, and the mechanistic investigation of how it works to combat different diseases that can be used for future therapeutic intervention.

Demarcating antioxidant response against aluminum induced oxidative stress in Westiellopsis prolifica Janet 1941

Aluminum metal pollution is considered as a primary limiting factor that reduced crop yield in South Asian subtropical country like India. In national context, Odisha contributes around more than 40% of total ore availability. Moreover, industrial mining and smelting aid are major concern for aluminum metal toxicity in territorial vicinity affecting the soil fertility, ecosystem and human health through food chain. The aluminum metal accumulation limits the soil fertility by antagonistic regulation of photosynthetic and nitrogen fixing microbiota. The increasing concern regarding aluminum pollution enterprise critical investigations for their bioremediation in contamination sites. In this notion, the current study was hypothesized to decrypt the rate limiting factors, their explicit mode of action and intracellular detoxification in a cyanobacterium, i.e., Westiellopsis prolifica isolated from ash pond of NALCO (National Aluminum Company Limited), Angul, Odisha. In the experimental setup, treatment with different concentrations of AlCl₃ (0-0.1 mM) was marked a decline in the growth of the strain due to the adverse regulation of photosynthetic pigments. However, the enforcement of catalase (CAT), ascorbate peroxidase (APX), superoxide dismutase (SOD), guaiacol peroxidase (GPX) and glutathione reductase (GR) was critical for sustaining strain viability under oxidative imbalance. The observation of an increase in the antioxidant enzyme and MDA content was evident to sustain strain viability under such oxidative imbalance. The outcome of the anticipated study was apparent to demonstrate a colossal interlink between Al mediated induction of oxidative stress and their cellular detoxification via intracellular antioxidant enzymes and removal of H₂O₂ accumulation in cyanobacterium, W. prolifica. Statement of novelty Aluminum metal toxicity renders growth of Westiellopsis prolifica via affecting photosynthesis associated pigments. Westiellopsis prolifica deploys antioxidant defense enzymes to combat against aluminum mediated oxidative upset. Intracellular antioxidant enzymes provoke cellular survival of Westiellopsis prolifica under excessive uptake of aluminum in contaminated habitats.

Murderer who spread table salt over his victim's corpse unintentionally preserved it from putrefaction

Adipocere is medico-legally exigent post-mortem change alternative to putrefaction. Sprinkling table salt over corpse to hasten disintegration and keep carnivores and nibblers off is a feature of ritualistic burial. We describe an unusual murder concealment wherein assailant put quantum of table salt over and around dead body while burying in jungle to hasten disintegration. Unexpected adipocere involving table salt preserved the body and firearm injuries. A mystifying thanatological aspect was the basic fact of table salt osmotically drawing even intrinsic body water needed for adipocere in non-damp conditions. It exceptionally formed in a week, and in a shallow grave, its formation in such conditions being very unusual and unreported.

Fatal monocrotophos poisoning by cutaneous absorption while sleeping: A remarkable case study

Organophosphate poisoning is a continued menace associated with high morbidity and mortality in both resource-crunched developing and developed countries. Cases have been described of deliberate self-poisoning which has higher mortality than accidental exposure. Fatal poisoning by accidental dermal absorption is rarely reported for monocrotophos. Authors detail fatal accidental monocrotophos poisoning in adult female by dermal exposure while sleeping. Pesticide was detected in post-mortem blood and skin by chromatography and spectroscopy. Extraction along with review of literature for monocrotophos poisoning is adjuncted in this study.

Access to Round Window Niche via Posterior Tympanotomy and Impact of Drilling Its Overhangs: A Cadaveric Descriptive Study

We intended to study the morphological parameters of round window region and assess the gain in exposure achieved by drilling the round window niche overhang. The Exposure of the round window membrane (RWM) is of prime importance to carry out atraumatic electrode insertion for cochlear implantation. The anatomy of round window has been a subject of considerable debate in literature. Fifty-one Formalin preserved adult cadaveric temporal bones were micro-dissected to carry out an 'optimal' posterior tympanotomy to expose the round window region. The bony overhangs of round window niche (RWN) were next drilled to achieve maximal possible exposure the RWM without violating the annulus of the same. The exposure was classified as per St Thomas' Hospital classification. The round window could not be visualized in 3 bones (5.9%). The commonest morphology of RWN was dome shaped, found in 18 (37.5%) and that of the RWM was oval shaped, found in 14 (29.2%) bones. Pre drilling 41 bones had a > 50% exposure of RWM while post drilling > 50% exposure could be achieved in all the bones except the 3 bones in which RWN could not be visualized to begin with. The drilling of the RWN overhangs exposed RWM in entirety in 91.7% of bones with a visible morphology of RWN pre drilling. RWN and RWM exhibit varied morphology. Drilling of the round window niche overhangs can considerably enhance the exposure of RWM.

Homicide concealed strangulation after bobbing reins in sexually sadistic homicide

This case of sexually motivated homicide combined the perpetrator's obliteration of his victim's identity along with his attempt at concealment of the corpse and sexual gratification following ligature strangulation of a young unidentified female from a minority Indian state. Sexual bondage was evident with characteristic body tying in a typical posture to fuel the killer's sexual arousal and gratification before, during and then after strangling his victim with a scarf. The victim's body was left in a sack packed with vegetables and transported from the crime site and found abandoned in a park.

Homicidal methanol poisoning in filicide-suicide

Most methanol poisonings are accidental. We present a rare case of filicide-suicide, where a youth was killed by methanol poisoning and his parents then committed suicide by jumping in front of a running train. The father's suicide note explains the crime.

Rare gripping object in electrocution: Cadaveric spasm at its best

Cadaveric spasm causes instantaneous rigor without preceding post-mortem flaccidity. The precise pathophysiological basis of this phenomenon is still unknown. We report a case of accidental electrocution where the deceased was found dead with a metallic water supply pipe of a motor booster pump firmly gripped in his hand. In this report, we review the literature and consider the mechanisms that may cause this phenomenon.

Upper Gastrointestinal Bleeding in Aluminium Phosphide Poisoning

Aluminium phosphide is one of the most common poisons used for suicide in an agricultural country like India. Death is usually due to myocarditis which occurs within few hours of ingestion. There are many late complications reported in medical literature, however toxic effects on the gastrointestinal system, particularly corrosive action leading to massive haemorrhage is rarely reported. A 30 year old male developed upper gastrointestinal bleeding on the second day after consumption of aluminium phosphide. An exploratory laprotomy was done followed by adhesinolysis, gastrostomy closure with feeding jejunostomy and drainage. He died after eight days of ingestion. The autopsy findings of this rarely reported case along with review of literature on corrosive action of Aluminium Phosphide is discussed.

Fatal ovarian hyperstimulation syndrome in an anonymous egg donor

Ovarian hyperstimulation syndrome is a rare, but potentially life-threatening iatrogenic disorder arising from ovulation induction or ovarian hyperstimulation for assisted reproduction techniques. We report a case of a 26-year-old multiparous woman, an anonymous egg donor, who died a few hours after undergoing a procedure to donate eggs at an in vitro fertilization clinic. Her husband alleged that medical negligence had led to her death. The autopsy confirmed death due to ovarian hyperstimulation syndrome. We know of no previous descriptions of fatal ovarian hyperstimulation syndrome in an anonymous egg donor in medico-legal literature.

Ingestion of safety razor blade and delayed hanging in a complex suicide

Ingestion of a foreign body is mostly accidental in children and intentional in prisoners to achieve hospitalization; however, use of this method of suicide is rare. We report a case where the victim first ingested a safety razor blade, but failed to die and then hanged himself, but failed again and finally succumbed to the complications on the sixth day. He had also attempted suicide by inflicting multiple incised wounds on his neck four days before the safety blade ingestion, but none were fatal.

Suicidal asphyxiation by carbon monoxide within a polythene bag

Suicide by inhalation of carbon monoxide is not uncommon and usually involves car exhausts or burning charcoal or defective boilers. We report a case of a 25-year-old man, who committed suicide by inhaling carbon monoxide gas inside a polythene bag in a bathroom. The open carbon monoxide cylinder found inside the polythene bag was purchased online by the deceased a few days earlier. He had stated that the gas would be used for his experiment on the environment. A suicide note recovered from his trouser pocket revealed his intention for a painless death.

Cardiac rupture delayed for a week in an asymptomatic child following blunt trauma

A two-year-old child was hit by a car outside his home and was immediately taken to hospital. There were no external injuries present over the body except two small abrasions on the occipital region of head. A computed tomography scan of the head was performed which revealed no cranio-cerebral injury. He was discharged from the hospital within few hours apparently well. The child was absolutely asymptomatic for a week, after which he suddenly died while playing at home. Autopsy revealed left ventricular free wall rupture and pericardial haematoma. This case report discusses the rare incidence of delayed cardiac rupture due to blunt trauma resulting in haemorrhagic tamponade in an asymptomatic child.

Medico-legal autopsy of abandoned foetuses and newborns in India

Foeticide and the abandonment of newborns are important, albeit frequently neglected, issues. Concealment of childbirth is often seen in the setting of unwanted pregnancy which has been recognised as one of the most important factors in both cases. This study highlights the medico-legal autopsy findings of 238 abandoned foetuses and newborns over a period of 17 years (1996-2012) from the region of South Delhi, India. There was no sex predilection. The majority of the cases were full term. Nearly 35% of the foetuses were still born, about 29% were live born and the remainder were non-viable. Among the live born, death by homicide was more common than a natural death and most were left by the roadside. The abandoning and killing of newborns needs urgent attention, and strict measures are needed to save thousands of innocent lives.

Sulphuric acid marketed in water bottle in India: A cause for fatal accidental poisoning in an adult

Corrosive acid ingestion is a rare but serious health hazard with fatal complications. Cases of suicidal and accidental acid ingestion have been documented in the scientific literature. Accidental acid poisoning due to a mistaken identity of the bottle containing sulphuric acid is a matter of grave concern especially in a household set-up. We hereby report a fatal case of accidental sulphuric acid ingestion in an adult, who unsuspectingly swallowed about 50 ml of 'toilet-cleaner' at his residence. The bottle containing the acid was recently purchased from a local vendor and placed with water bottles in the kitchen. The autopsy and toxicological findings of this case are discussed in this paper with discussion of medico-legal issues on the sale and use of such corrosive acids in illegal bottles and its subsequent health hazards in India.

Suicide notes and cadaveric organ donation

A suicide note is an important tool for medico-legal investigation on the manner and circumstances surrounding the death. It can also act as a facilitator for organ donation when the victim expresses their wish to do so. This article cites four examples, where the victims had specifically mentioned a "last wish" to donate their organs. The importance of such "expressed consent" in suicide notes is discussed. Such observations are not found in available scientific literature and are of importance in countries where there is a long waiting list for organ recipients and a very large number of suicidal deaths.

Suicide by injecting lispro insulin with an intravenous cannula

Suicide by injecting insulin is not uncommon both in diabetic and non-diabetic people. The victim usually uses an insulin syringe or a traditional syringe attached to a needle for the injection of insulin, of either animal or synthetic origin. We report a case of suicide by a non-diabetic physician by injecting lispro insulin through an intravenous cannula. To the best of our knowledge, the use of an intravenous cannula for the injection of insulin for suicide is unusual and is rarely reported in the medico-legal literature.

Triple hanging in filicide-suicide: an unusual case report

Filicide-suicide is a special category of homicide-suicide event where the victim(s) are children and the perpetrator is one of the parents or both. It is not extensively documented or adequately defined in literature. In developed countries, shooting is a common method of homicide and suicide. Uses of knives, blunt objects, strangulation, poisoning and drowning are other methods frequently employed by the perpetrator. Homicide by hanging in filicide-suicide is rarely reported in forensic literature. We present a rare case of filicide-suicide, where the mother killed both her children by hanging them one by one from a ceiling fan in the same room and later committed suicide by hanging in another room.

Medico-legal autopsy of 1355 unclaimed dead bodies brought to a tertiary care hospital in Delhi, India (2006-2012)

In India, it is estimated that about 13 million people are homeless. As these individuals have no close acquaintances, in the event of death, their bodies remain unclaimed. These unclaimed corpses pose a major challenge for the local law enforcement agencies in identification and thus become an obstacle in solving the cases of missing persons. We sought to review the autopsy characteristics and causes of death in the unclaimed/unidentified bodies autopsied at the All India Institute of Medical Sciences (AIIMS) from 2006 to 2012. Among the total of 11,786 cases autopsied during the year 2006 to 2012, 1335 (11%) were unclaimed. Most of the cases were males (91%) with a male-to-female ratio of 9:1. Mean age of the cohort was 43 years (range, 1-85 years). Natural events were the foremost cause of death and were more commonly seen in males. While accidental, suicidal and homicidal modes were common in younger age groups; natural manner of death predominated in the elderly. Most of the cases were found dead on the roadside. This paper also compares with the previous study in the same set-up during the time period 2001 to 2005. The authors believe that knowledge about the existing healthcare facilities need to be reinforced and their utilisation promoted.

Fatal hemothorax due to homicidal blunt trauma to carotid artery in the neck

A 30-year-old man was found dead in a pool of blood inside his office room in the morning. Autopsy revealed a small contusion at the lower anterior part of neck, laceration on the left common carotid artery, hemothorax and a laceration over the nose with underlying fracture. On investigation, it was found that on the previous night the victim had been assaulted by his domestic help with an iron rod over head and neck. The blunt trauma to the neck resulted in laceration on the left common carotid artery and subsequently bled, causing fatal hemothorax. The authors report this case owing to the rarity of such patterns of injury leading to fatal outcomes, which may be overlooked due to the simple nature of external injuries.

E-suicide note: A newer trend and its medico-legal implications in India

Rapid advancements of information and communication technology in the form of electronic mails, mobile phones, social networking sites, etc have an increasing impact on people's day to day life. It has been observed that these readily available applications are used frequently to express suicidal intentions. There are many studies on conventional handwritten suicide notes but suicide note in electronic format is an emerging issue and an under-researched phenomena. The authors have termed it as "E-suicide note" and discuss its medico-legal implications in India with examples from their observations.

Suicide note on the palm: three case reports and discussion of medico-legal aspects

Suicide notes are usually written by the victim on paper or readily accessible things such as notebooks, walls or mirrors. Though writing may be found on the body of the deceased, suicide notes in a structured manner written on the palm have not been reported in forensic literature. In all the three cases presented here, we found a handwritten note on the palm of the deceased at the time of autopsy. The victims had written a brief note in their own handwriting, citing the reasons for ending their lives. The suicide note in one case also mentioned details regarding the custody of the victim's children to be given to her mother. Since we have not found similar cases in the literature, we present and discuss our three cases herein.

Suicide pact by drowning with bound wrists: a case of medico-legal importance

Suicide pacts are uncommon and mainly committed by male-female pairs in a consortial relationship. The victims frequently choose methods such as hanging, poisoning, using a firearm, etc; however, a case of a suicide pact by drowning is rare in forensic literature. We report a case where a male and a female, both young adults, in a relationship of adopted "brother of convenience" were found drowned in a river. The victims were bound together at their wrists which helped with our conclusion this was a suicide pact. The medico-legal importance of wrist binding in drowning cases is also discussed in this article.

Antitubercular drug-induced violent suicide of a hospitalised patient

We present a case where a young adult male, on treatment for multidrug-resistance tuberculosis (MDR-TB), developed drug-induced psychosis. The psychiatric symptoms were ascribed to the anti-TB drug and were duly withdrawn by the treating doctors and supplemented with other drugs. However, the victim continued to have psychiatric symptoms and committed suicide in the hospital. He ended his life in a violent manner by stabbing and cutting himself with a kitchen knife. The case is briefly reported in this paper with a discussion on anti-TB drug-induced psychiatric effects leading to suicide.

Ice pick death: a case report and discussion of the injury pattern

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.

Cut wrists, electrocution and subsequent drowning in a water drum: an unusual combination of methods in complex suicide

A 25-year-old male was found dead in a water drum inside the bathroom of his house one morning. Autopsy revealed a fatal right wrist cut, superficial cuts on middle phalanx of left index finger and features of ante mortem drowning. Investigation revealed the victim was an alcoholic and was depressed due to financial problems. On the previous night, under the influence of alcohol, he first tried to commit suicide by cutting wrist with razor blades, but death was not immediate. He then attempted electrocuting himself by touching a live wire, inside the bathroom, which failed and finally he drowned in a water drum. The victim had left a message, written with his blood on the floor of the room, reflecting his suicidal intentions. In complex suicide, many bizarre methods are used, but this combination of methods is unusual and not found in available forensic literature.

Sudden death in advanced abdominal pregnancy: a case report and discussion of the related medicolegal issues

We report sudden unexpected death in a 35-year-old woman with pregnancy of seven months duration. There was an allegation by the parents of the woman that she was subjected to an assault prior to death. Autopsy examination showed an abdominal pregnancy with a dead fetus, ruptured gestational sac, massive haemorrhage and secondary placental attachment. During her antenatal check-ups, she had persistently complained of abdominal pain and loose stools, but the diagnosis of abdominal pregnancy was missed clinically and on ultrasound scan. In this paper we discuss the diagnostic difficulties and medicolegal issues in such cases.

Accidental carbon monoxide poisoning during yagya for faith healing--a case report

A 20-year-old female and a 45-year-old male were found lying dead on the floor with frothand vomitus stain present over mouth, nose and face in a closed room. An earthen bowl with incomplete burnt woods, flowers, food materials, agarbati, etc, was also found lying near the body of the two deceased. The cause of death, established by autopsy and toxicological examination was carbon monoxide poisoning in both victims. The source of carbon monoxide was incomplete burnt woods used for yagya during puja (a faith healing practice) for bearing children.

A psychological profile of a serial killer: a case report

Serial killers have always fascinated society. A serial killer is typically defined as a perpetrator who murders three or more people over a period of time. Most reported cases of serial killers come from the United States and Canada. In India, there are few reported cases. We present, to the best of our knowledge, the first Indian case in the literature. The present case is of a 28-year-old man, Surinder Koli. The Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delphi handled the forensic study. We present a most unique psychological investigation into the mind of a serial killer.

Fatal accidental fall from height in infants and children: a study from South Delhi

One hundred and seventy-four deaths of infants and children due to accidental fall from height received from South Delhi for autopsy were studied during the 10-year period from January 1998 to December 2007 at the All India Institute of Medical Sciences, New Delhi. Data were analysed with regard to age, sex, location of fall, height of fall, pattern of injury, cause of death and seasonal variation. These cases represented approximately 22.56% of all deaths due to a fall from height and 1.31% of all medicolegal autopsies conducted during the period. There were 106 male (60.9%) and 68 female (39.1%) victims. Age-specific rate of fall showed that the highest rate was in toddlers (39.65%), followed by 26.43% each in preschool children and school-going children and the least in infants (7.47%). The head and face was the most frequently injured body region (93.67%) and the skull was the commonest bone fractured (59.19%). The most common cause of death was head injury (84.48%). Major fall sites in decreasing order of frequency were rooftop (38.50%), balcony (24.13%), household furniture (21.26%), staircase (6.89%), window (4.59%), wall (1.72%), rickshaw/bicycle (1.15%) and tree (0.57%). Most fatalities due to a fall from height were reported in the rainy season.

An unusual fatal construction site injury in India: a case report

A 35-year-old male, employed at a construction site, accidentally injured himself when an iron rod, which he was handing up from the ground floor to a fellow worker standing on the first floor, fell backwards. It pierced his suprascapular fossa on the right side, damaging great vessels and the tricuspid valve, and entered the pericardial cavity after puncturing the posterior wall of the right ventricle. The iron rod was taken out by fellow workers at the site and the injured man was immediately taken to a nearby clinic where he was resuscitated and the wound was stitched. He was later transferred to a tertiary care hospital where he died about an hour after admission. Though many bizarre injuries have been reported at construction sites, a fatal injury of this nature deserves a mention in the forensic literature.

Patterns of injury seen in deaths from accidental falls down a staircase: a study from South Delhi

The present study is a retrospective analysis of 92 cases of death from an accidental fall down a staircase, which were autopsied at the All India Institute of Medical Sciences, New Delhi, India, during a ten-year period from 1996 to 2005. The cases were analysed with regard to age, sex, location, cause of death and pattern of injury. Males (62, 67.39%) outnumbered females (30, 32.61%). The commonest age group involved was 31-40 years (28.26%) followed by 21-30 years (18.47%) and 51-60 years (14.13%). The lowest number of cases (4.34%) was in the 11-20 years age group. All deaths were accidental in nature. The most common cause of death was head injury (80.43%) followed by haemorrhagic shock resulting from intra-abdominal and intra-thoracic visceral injuries (9.78%) and injury to the neck (4.34%). The parietal and temporal bones were those most frequently fractured in head injury cases. Cerebral oedema (n = 56, 70.88%), followed by subdural haematoma (n = 34, 43.03%) were the two most common intra-cranial injuries. Two females were accidentally hanged while descending stairs. The majority of accidents happened at home (n = 90, 97.82%). Alcohol was detected in ten cases (17.54%). Fatalities from falls down a staircase were most often reported in the rainy season.