Karthik Krishna

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.

DECT evaluation of noncalcified coronary artery plaque

PURPOSE Composition of the coronary artery plaque is known to have critical role in heart attack. While calcified plaque can easily be diagnosed by conventional CT, it fails to distinguish between fibrous and lipid rich plaques. In the present paper, the authors discuss the experimental techniques and obtain a numerical algorithm by which the electron density (ρ(e)) and the effective atomic number (Z(eff)) can be obtained from the dual energy computed tomography (DECT) data. The idea is to use this inversion method to characterize and distinguish between the lipid and fibrous coronary artery plaques. METHODS For the purpose of calibration of the CT machine, the authors prepare aqueous samples whose calculated values of (ρ(e), Z(eff)) lie in the range of (2.65 × 10(23) ≤ ρ(e) ≤ 3.64 × 10(23)/cm(3)) and (6.80 ≤ Z(eff) ≤ 8.90). The authors fill the phantom with these known samples and experimentally determine HU(V1) and HU(V2), with V1,V2 = 100 and 140 kVp, for the same pixels and thus determine the coefficients of inversion that allow us to determine (ρ(e), Z(eff)) from the DECT data. The HU(100) and HU(140) for the coronary artery plaque are obtained by filling the channel of the coronary artery with a viscous solution of methyl cellulose in water, containing 2% contrast. These (ρ(e), Z(eff)) values of the coronary artery plaque are used for their characterization on the basis of theoretical models of atomic compositions of the plaque materials. These results are compared with histopathological report. RESULTS The authors find that the calibration gives ρ(e) with an accuracy of ±3.5% while Z(eff) is found within ±1% of the actual value, the confidence being 95%. The HU(100) and HU(140) are found to be considerably different for the same plaque at the same position and there is a linear trend between these two HU values. It is noted that pure lipid type plaques are practically nonexistent, and microcalcification, as observed in histopathology, has to be taken into account to explain the nature of the observed (ρ(e), Z(eff)) data. This also enables us to judge the composition of the plaque in terms of basic model which considers the plaque to be composed of fibres, lipids, and microcalcification. CONCLUSIONS This simple and reliable method has the potential as an effective modality to investigate the composition of noncalcified coronary artery plaques and thus help in their characterization. In this inversion method, (ρ(e), Z(eff)) of the scanned sample can be found by eliminating the effects of the CT machine and also by ensuring that the determination of the two unknowns (ρ(e), Ze(ff)) does not interfere with each other and the nature of the plaque can be identified in terms of a three component model.

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.

A Case of Accidental Fatal Aluminum Phosphide Poisoning Involving Humans and Dogs

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.

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.

Sudden Death due to Uterine Rupture in a Primigravida with Placenta Accreta in Unscarred Uterus: An Autopsy Report

Spontaneous rupture of uterus during pregnancy is a known complication of placenta accreta. Some of the known risk factors for the trophoblastic invasion of the uterine wall leading to placenta accreta during pregnancy are multi-parity, previously scarred uterus, etc. The clinical management of such cases is found in scientific literature; however sudden death due to uterine rupture as a complication of placenta accreta, in a primigravida is not reported till date. We encountered a case, where a 27 year old primigravida, at 29th week of gestation who had no known risk factors, succumbed to death, due to spontaneous uterine rupture. The diagnosis of placenta accreta in this case could be made, only during the autopsy. The clinical presentation and the autopsy findings are discussed in this paper, with a note on diagnostic difficulties, especially in the developing countries.

Sudden death due to ruptured pseudoaneurysm of femoral artery in injected drug abusers - report of four cases at autopsy and review of literature

Pseudoaneurysm in injected drug abusers occurs due to traumatic damage by the repeated injections and infections. It most commonly involves the femoral artery that requires intensive management. When medical attention is delayed, the victim is prone to have massive bleeding from the ruptured artery, resulting in death. Although pseudoaneurysms in injected drug abusers are known, there is paucity of autopsy study on sudden deaths due to its rupture. We report four such cases with different presentations of the pseudoaneurysm that had ruptured spontaneously. The paper highlights the case history and autopsy findings of these cases with review of literature of this catastrophic event in injected drug abusers.

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 fathers 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.

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.

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.