bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Suicide Mortality in the Deprived Region of Epirus (North-West Greece) During the Period 1998-2002
Authors: Vougiouklakis Theodore , Boumba Vassiliki A , Mitselou Antigony , Peschos Dimitrios , Gerontopoulos Kyriakos
Published: February 2010

This study determines the risk factors associated with suicide rates and the investigation of time trends in the deprived region of Epirus, north-west Greece, which is considered to be one of the least developed prefectures of the EU. Data selected demonstrated: (1) a mean age-standardized suicide rate per year of 4.00/100,000 for males, 1.29/100,000 for females and 2.65/100,000 for the total population; (2) a significant rising trend of male suicides in the 35-44 and 65-74 age groups; (3) a low female suicide rate in <35 years age group and a relatively stable rate in the other age groups; (4) a significantly higher suicide rate in men than in women from both urban and rural areas and in older men from rural areas; (5) higher rates of suicide among widowed men and unmarried women; (6) the use of predominantly violent suicide methods, especially self-shooting, hanging and drowning; (7) a significant peak in the total suicide rate in the spring and summer months and a decreased rate in September; and (8) three out of four of the suicide victims had consumed alcohol and/or other drugs before the act. Data reported here shows some remarkable trends compared to previous reports on suicide in Greece and other countries, probably due to cultural and life style characteristics of the study population.
2. Usefulness of Post-Mortem Ophthalmological Endoscopy During Forensic Autopsy
Authors: Tsujinaka Masatake , Akaza Kayoko , Nagai Atsushi , Nakamura Isao , Bunai Yasuo
Published: February 2010

Post-mortem intraocular findings in two autopsy cases with traumatic intracranial haemorrhage were obtained using an ophthalmological endoscope. The endoscopy results clearly revealed the presence of intraocular haemorrhages and papilledema caused by intracranial haemorrhage. Post-mortem ophthalmological endoscopy offers several benefits. First, post-mortem intraocular findings can be directly observed in corpses with post-mortem clouding of the cornea. Secondly, the endoscopy only requires a 0.9 mm incision in the sclera and does not require the removal of the eye from the corpse, a procedure that should be avoided for ethical and cosmetic reasons. Thus, post-mortem opthalmological endoscopy is a useful method for obtaining intraocular findings in autopsies.
Diaphragmatic Pathology: A cause of clinically unexplained death in the perinatal/paediatric age group
Authors: Sundararajan S , Ostojic N S , Rushton D I , Cox P M , Acland P
Published: February 2010

Sudden unexpected death in infancy and childhood requires a `full' post-mortem investigation. Guidance from the Royal College of Pathologists recommends sampling of all the major organs. However, the diaphragm does not feature in this or in most lists of routine histology. Our aim is to emphasize the importance of sampling the diaphragm for histological examination during autopsy. We describe three autopsy cases of clinically unexplained death in the perinatal and paediatric age group that showed significant pathology of the diaphragm. In Case 1, a previously healthy five-year-old girl collapsed suddenly and died four days later. In Case 2, an eight-month-old infant had repeated episodes of respiratory arrest that culminated in death. Autopsy demonstrated a predominantly diaphragmatic myositis. In Case 3 a female neonate had a respiratory arrest three days after birth and died less than a month later. Autopsy showed multiple large calcified necrotic fibres in the diaphragm.

The diaphragm is seldom sampled at autopsy. In the first two cases a predominantly diaphragmatic myositis was either the direct or underlying cause of death. In the third case long-standing diaphragmatic pathology of uncertain cause may have contributed to the original respiratory arrest.

Had the diaphragm not been examined histologically, the cause of death would have remained unascertained in these cases. In cases of sudden death in infancy and childhood, failure to reach a diagnosis may lead to undue suspicion falling upon the child's carers. This underscores the need for full histology at post-mortem in child deaths, including diaphragmatic sampling.
A Postgraduate Sexual Assault Forensic Medicine Program: Sexual assault medicine from scratch
Authors: Parekh Vanita , Currie Marian , Brown Cassandra Beaumont
Published: February 2010

A government-funded service to provide forensic and medical care to survivors of sexual assault was established in the Australian Capital Territory (ACT) in 2001. Doctors employed by the service lacked the specific skills required to care comprehensively for survivors.

Our aim was to develop, implement and evaluate a sexual assault medical education program.

It consisted of an `in-house' education program, and external university course and incorporated team-building, networking activities and protocol development. Core elements were: forensic evidence collection, assessment and management of injuries, prevention of sexually transmissible infections and pregnancy, counselling and emotional support. Participant satisfaction and knowledge acquisition were evaluated using a semi-structured interview and a questionnaire.

Seven doctors participated in a 16-session program conducted by the director and nurse coordinator with help from local forensic, legal and medical experts. All doctors successfully completed the Certificate in Forensic Medicine, and reported satisfaction with the program and their increased knowledge, particularly associated with collection of forensic evidence and court procedures. A compete set of protocols was developed and cohesive networks established.

We have designed an effective education program for doctors working in the field of sexual assault and offer it as a template to other health professionals working in this area.
Patients with Affective Disorders Admitted to Maximum Secure Care (1999-2003)
Authors: White T
Published: February 2010

The State Hospital, Carstairs, is a special secure psychiatric facility for Scotland and Northern Ireland. This study describes the background, illness and offence (where appropriate) characteristics of 25 patients admitted between 1999 and 2003 with a diagnosis of any affective disorder.

Patients were, on average, 37 years old and had a lengthy history of psychiatric contact. Patients with an affective disorder were more likely to be admitted under civil proceedings, following a transfer from hospital, as opposed to being admitted under criminal procedure. Sixty per cent were discharged to prison, court or local hospitals within one year of their admission to special secure care.

Significant violence during an episode of mania or hypomania (even in the presence of psychotic symptoms) appears rare. Recurrent unipolar depression resistant to first and second line treatments in women, and lithium withdrawal mania in male bipolar patients were the most common clinical problems. Treatments aimed at reducing co-morbid substance misuse, and improving compliance with mood stabilisers, appear important in managing this patient group.
Is There a Need for Elderly Forensic Psychiatric Services?
Authors: Nnatu I O , Mahomed F , Shah A
Published: February 2010

The population of the elderly in most developed nations is on the increase. Furthermore, the prevalence of mental disorder amongst elderly offenders is high. The true extent of `elderly' crime is unknown because much of it goes undetected and unreported. This leads to a failure to detect mental illness in such offenders. Court diversion schemes may improve recognition of mental illness but these schemes usually tend to deal with the more severe crimes. This may result in an overestimation of the amount of serious crime committed by the elderly and a failure to detect mental illness amongst those who commit less serious crimes. Efforts to service this hidden morbidity call for multi-agency collaboration. Improved detection and reporting of crimes is essential if mental health difficulties in the elderly are not to go unnoticed. The needs of elderly mentally-disordered offenders are complex and fall within the expertise of old age and forensic psychiatry, without being adequately met by either one. Therefore, consideration should be given to the development of a tertiary specialist forensic old-age psychiatry service.
Dowry – A Deep-Rooted Cause of Violence Against Women in India
Authors: Sharma B R , Harish D , Gupta Manisha , Singh Virendar Pal
Published: February 2010

The world has entered the new millenium but it is a harsh reality that the woman in India has long been ill-treated in our male-dominated society. She is deprived of her independent identity and is looked upon as a commodity. She is not only robbed of her dignity and pride by way of seduction by the men outside, but also may become a victim of cruelty by her saviours, within the four walls of her own house. However, her trauma does not end here, it may even go to the extent of forcing her to commit suicide or she may be burnt to death for various reasons, including that of dowry. This type of violence transgresses the boundaries of caste, class, region or religion and is prevalent in almost all societies in India.

The system of dowry is a social practice which on its own has claimed the lives of scores of women – both young and old, and has made life a virtual hell for many more. Unfortunately, education among women has not produced a reformative effect on their social outlook, nor encouraged any change in them conducive to social upliftment. Those parents who prefer not to take dowry for their well-qualified and settled male children, are in fact considered `strange' by the society and doubts about `the respectability of the groom's family' are usually raised. The present study makes an in-depth review of the dowry system in India and analyses the reasons which have demonized dowry into its present commercialized and institutionalized form.
1. An Uncommon Case of Zoophilia
Authors: Bhatia Manjeet Singh , Srivastava Shruti , Sharma Sumeet
Published: February 2010

Humans show a wide array of sexual preferences and behaviour. Zoophilia, or bestiality, consists of sexual intercourse by a human being with a lower animal. There is a paucity of literature on zoophilia. We describe a rare case of preferential zoophilia involving multiple animals. The perpetrator developed this habit only during episodes of depression. It is recommended that due to the apparent common occurrence of this condition, questions exploring a topic which appears to be routinely ignored should be included in the psychiatric interview.
3. Sudden Death Due to Pulmonary Thromboembolism After Car Driving
Authors: Hitosugi Masahito , Yufu Tetsuo , Kido Masahito , Yokoyama Tomoko , Nagai Toshiaki , Tokudome Shogo , Joh Kensuke
Published: February 2010

An autopsy case of sudden death due to pulmonary thromboembolism after a car trip is reported. A 56-year-old Japanese man with hypertension and atrial fibrillation suddenly died immediately after having driven for two and a half hours. At autopsy, the pulmonary arteries were found to be filled with dark-red, coiling thrombi consisting of fibrin and red blood cells. In the dilated right popliteal vein, a thrombus consisting of fibroblasts, a large number of collagen fibres, and newly formed capillaries was attached to the vessel wall. The cause of death was determined to be pulmonary embolism due to the thrombus of the right popliteal vein. Two and a half hours of prolonged sitting while driving a car encouraged thrombus formation. We believe that this case, the first autopsy case of fatal pulmonary thromboembolism after a car trip to be reported, highlights the importance of predicting venous thrombosis of the leg or fatal venous thromboembolism after a car trip.
Taking Chances: Risk assessment and management in a risk obsessed society
Authors: Prins Herschel
Published: February 2010

Two earlier contributions to this journal on the topic of `dangerous behaviour' are updated in the light of recent theoretical and practical developments in the assessment and management of risk in criminal justice and psychiatry. Such assessment and management need to be viewed against the background of current over-preoccupation with avoiding the hazards of daily living.

`Never predict anything, particularly the future'

(Statement attributed to Sam Goldwyn, Film Producer)
Alcohol Discovered in the Urine after Death: Ante-mortem ingestion or post-mortem artefact?
Authors: Cullen S A , Mayes R W
Published: February 2010

A study was undertaken of blood and urine alcohol levels in 44 cases where the bodies had been immersed in water, following accidents, for at least one day after death. In no case was there any ante-mortem evidence of ingested alcohol. In 15 cases there was a raised urine alcohol. The average urine-to-blood alcohol ratio in these cases was 0.56:1. This is dramatically less that that seen after ingestion. It is suggested that the alcohol, following its initial post-mortem production in the abdomen, enters the urine by diffusion from surrounding tissues. The presence of alcohol in the urine from bodies that have not been recovered and examined until several days after death cannot always be taken to indicate ante-mortem ingestion. Urine-to-blood alcohol ratios of less than 1:1 are strongly suggestive of post-mortem production.
The Regional Commission for Medical Accidents and Nosocomial Infections set up by French Law
Authors: Bartoli C , Piercecchi-Marti M D , Pelissier-Alicot A L , Cianfarani F , Leonetti G.
Published: February 2010

The regional commission for conciliation and compensation for medical accidents, iatrogenic diseases and nosocomial infections (commission régionale de conciliation et d'indemnisation des accidents médicaux, affections iatrogènes et infections nosocomiales, CRCI) offers victims of such events the possibility of obtaining compensation without recourse to legal proceedings.

We suggest various points of view about this commission set up by the French law no. 2002-303 of 4 March 2002: the composition, role and competence of the CRCI; the place of the expert's report; the opinion pronounced by the CRCI and its outcome, the compensation of victims and, finally, interaction with other procedures.
Characteristics of Perpetrators of Homicide in Independent Inquiries
Authors: McGrath Melissa , Oyebode Femi
Published: February 2010

An independent inquiry has been mandatory for all homicides committed by persons in contact with mental health services in England and Wales since 1994. The aim of this study is to provide a detailed description of the characteristics of the perpetrators of homicides covered by the independent inquiries between 1994 and 2002. Ninety-seven published inquiry reports were collected for analysis. Descriptive case data regarding the perpetrator was manually abstracted from each report using a structured questionnaire. Ninety-nine individuals committed 109 homicides. Most perpetrators of homicide were male, with a diagnosis of schizophrenia or other psychotic illness. Victims are most likely to be a family member or an acquaintance. Psychotic symptoms as well as alcohol or substance misuse were found to be present at the time of homicide. Comparisons with the National Confidential Inquiry into Suicides and Homicide by People with a Mental Illness suggest that independent inquiries appear to focus on high profile cases. Patient characteristics can be used to inform risk assessments that may improve current prediction of violence in mentally ill persons.
Vulnerable Victims of Sexual Assault
Authors: Sahu Geeta , Mohanty Sachidananda , Dash Jyotin Kumar
Published: February 2010

Sexual assault is one of the heinous crimes of present day society. Although it has always been evident, in recent times there has been a steady increase in the rate of sexual assault cases. The aim of this study was to identify the groups most at risk. Therefore it includes only cases of sex offences and sex offences with kidnapping. Information was obtained by interviewing the victims and accompanying persons, and from records submitted by the investigating officers. Our study reveals sexual assault commonly occurs among the age group of 16-19 years (60.8%), mostly at night (53.23%), inside the house (87%) and usually by a close acquaintance (61%). The majority of the victims were unmarried (84.7%), lived in rural areas (65.2%), were unemployed (93.5%), of less educated or illiterate groups (88%) and found to be mentally fit (97%). The victims were mostly drawn from low socio-economic groups.
1. Fatal Acute Hepatitis in Infectious Mononucleosis in a Forensic Setting
Authors: Sauvageau Anny , Racette Stéphanie
Published: February 2010

Mononucleosis is generally considered a benign, self-limited disease. However, though uncommon, fatal complications are sometimes encountered. Deaths from liver failure, splenic rupture, respiratory obstruction, neurological complications, secondary infections and bleeding complications have been described. In the forensic setting, there are a few reports of sudden and unexplained deaths from splenic rupture and upper airway obstruction. We report here the first case of sudden and unexplained death from acute hepatitis in infectious mononucleosis presenting as a suspicious death.
4. Cerebral Venous Thrombosis in Pregnancy
Authors: Yadav Jayanthi , Arora Arneet , Dubey B P
Published: February 2010

Sudden unexpected death in many instances comes with stimulating or interesting findings, often in contrast to the history provided.

Two cases of sudden death in pregnant females with central venous thrombosis are described, because of their rarity. The incidence, etiological factors, predisposing conditions and the ethical and legal questions arising from such deaths are discussed.
Redeveloping Secure Psychiatric Services for Women
Authors: Thomas Stuart D M , Dolan Mairead , Shaw Jenny , Thomas Samantha , Thornicroft Graham , Leese Morven
Published: February 2010

Historically, a substantial proportion of women have been unduly detained in conditions of high security in England due to the lack of suitable alternative facilities. There have been no studies that have comprehensively examined the individual needs of these women in relation to their placement needs.

A cross sectional survey was undertaken of the individual and placement needs of all females detained in the three high security psychiatric hospitals (HSPHs) in England on 18th October 1999. Whilst there are clearly differences in accommodation needs among the women, those requiring lower secure services are significantly less likely to have needs in relation to violence (OR 0.29, 95% CI 0.14-0.62) and drugs (OR 0.29, 95% CI 0.12-0.67) when length of stay is taken into account. They also have lower security, treatment and dependency needs than women still requiring HSPH treatment.

A significant reorganisation of services is required. There is a need to gain further understanding of the relationships between traumatic histories, clinical presentation and antisocial behaviour and how these impact on assessed risk, treatment and care needs and outcome. The special needs of these women should be considered a priority when developing treatment and care packages.
Underlying Factors for the Rapid Increase of Suicide in Mie Prefecture, Japan
Authors: Inoue Ken , Abe Shuntaro , Okazaki Yuji , Fukunaga Tatsushige
Published: February 2010

The number of suicides in Japan increased from about 22,000 per year during the period 1988 to 1997 to over 30,000 since 1998. The number of suicides has also been increasing in Mie Prefecture. In the present study we examined the incidence and the circumstances for all suicidal cases during the seven-year period, 1996-2002, that were reported to Mie Prefectural Police Headquarters.

In Mie Prefecture, the number of suicides per year averaged 421 cases: from a minimum of 319 in 1997 to a maximum of 501 in 1998. The most frequent month for suicides was July, while the lowest number occurred in February. Suicide was most common in the 50-59 year age group in men, and in the 70-79 year group in women. Regarding the means of suicide, hanging was the most frequent (61.6%) in both sexes. Psychiatric disorders were the most serious causative factors in all generations, accounting for 23.8% in general but being especially prevalent in the younger generation of people under 39 years. Further reasons for suicide were economic problems for the 40-64 age-group in men and suffering from illness for the elderly age-groups in both sexes. In order to prevent suicide, urgent strategies for effective medical treatments and improved working circumstances are required.
Suicides in Trakya Region, Turkey, from 1984 to 2004
Authors: AZMAK ALI DERYA
Published: February 2010

The aim of this study is to investigate some features of suicide cases in Trakya region, Turkey. During the 21-year period from January 1984 to September 2004, there were 137 suicide cases autopsied by the Department of Forensic Medicine, Trakya University. Suicides comprised 16.1% of all forensic autopsies. Twenty-seven per cent of the cases were aged between 21 and 30 years and the mean age was 39.7 years. Males constituted 78.1% of the cases. The most frequent method of suicide was hanging (40.1%), followed by firearms, and poisoning. Overall, suicide rates in males showed an increase in the last five years. Most of the suicides occurred in the winter months.

In conclusion, since suicides present a major public health problem, detection and prevention methods must be developed for high-risk groups.
Amphetamines as Potential Inducers of Fatalities: A review in the district of Ghent from 1976-2004
Authors: DE LETTER ELS A , PIETTE MICHEL H A , LAMBERT WILLY E , CORDONNIER JAN A C M
Published: February 2010

Abuse of amphetamine (AMP) and its derivatives, such as 3,4-methylenedioxymethamphetamine (MDMA, ‘Ecstasy’), 3,4-methylenedioxyethylamphetamine (MDEA, MDE), and 3,4-methylenedioxyamphetamine (MDA) is an important public issue. Fatalities following ingestion of these substances are not infrequent in current forensic practice. The aim of this study was twofold. Firstly, considering the wide range of blood levels reported in fatalities, to provide insight into the interpretation of a quantified blood level and, secondly, to examine and discuss possible causes, mechanisms and manners of death.

All the medico-legal files between January 1976 and December 2004 were skimmed through to investigate whether amphetamine and/or derivatives were involved in the fatal outcome. Particularly, in addition to overdose cases due to or including amphetamines, all amphetamines-related fatalities were examined. In addition to AMP, MDMA, MDEA, and MDA, two other amphetamine derivatives, namely 4-methylthioamphetamine (4-MTA) and para-methoxyamphetamine (PMA) were considered.

In 34 fatalities, amphetamines were involved and the majority were men, under the age of 25 years. A wide range of blood levels was found: e.g. MDMA blood concentrations in cases of ‘pure’ intoxication were found between 0.27 and 13.51 μg/ml. The age and sex distribution as well as the broad range of quantified amphetamines blood levels were in line with those reported in the literature. In our study group, ‘pure’ intoxications with amphetamines, polydrug overdoses, and the combination of amphetamines use and polytrauma were the most prominent causes of death. Considering the manner of death in these fatalities, unintentional overdoses were most frequent, though suicides, traffic accidents, and criminal offences associated with amphetamines use also accounted for significant percentages. Acute to subacute cardiopulmonary failure was the most frequent mechanism of death, followed by (poly)trauma, mechanical asphyxia, and hyperthermia, respectively.

In conclusion, although amphetamines-related fatalities are only a fraction of the total number of fatalities studied at our Department, their contribution to current forensic practice has been increasing during the last few years. As there is still considerable debate as to what level of amphetamines can be toxic or even potentially lethal, it is strongly advisable to interpret the anatomo-pathological findings and the toxicological results together in arriving at a conclusion. This guideline is important in view of the different possible mechanisms of death which implicate quite different survival times following intake of amphetamine and/or its derivatives (e.g. cardiopulmonary complications, hyperthermia).
Assessing Decision-Making Capacity: A survey of psychiatrists' knowledge
Authors: HILL SIMON A , MATHER GREGORY I , JAMES ADRIAN J B
Published: February 2010

We aimed to survey the knowledge of psychiatrists on the assessment of decision-making capacity. Ninety-two psychiatrists of all grades and three other doctors attending a regional conference were marked on their verbal response to the question ‘What are the key elements in the assessment of a patient's capacity?’

On average, participants mentioned three out of the five elements in testing decision-making capacity. Scores were negatively correlated with age (Pearson's coefficient 0.275, sig 0.007). Section 12 status and grade had no impact on knowledge.

Most psychiatrists of all grades have a reasonable knowledge of assessing decision-making capacity. Over a third of participants mentioned two or fewer of the five points, suggesting inadequate knowledge. Assessing decision-making capacity needs to be emphasised in training throughout psychiatrists' careers- not just at the start.
Firearms Accidents in Northern India (1980-2000)
Authors: SINGH B P
Published: February 2010

This paper investigates firearms accidents from the last two decades (1980-2000), with information received from the three North Indian states, Chandigarh, Delhi and Himachal Pradesh and from the military and paramilitary organisations working in the region. In this study 139 cases were analysed for evaluation of various parameters such as type of accident, type of firearm used, age, sex, occupation and caste of victim, day of the week and the season in which the accident occurred, place of incident and location of wound. Information was extracted from the case histories and First Information Reports (FIR), and also from autopsy and injury reports. The accidents were self-inflicted in nine cases while another person fired the weapon in 130 cases. Most accidents occurred during hunting or from mishandling the firearm. Gun cleaning accidents rarely occurred and few cases were due to technical defects of the firearm. Shotguns and rifles caused most of the accidents. Shotgun accidents occurred mostly in rural areas whereas the cases involving rifles and handguns were from urban areas.

Victims were predominantly male with a mean age of 26 and 30 years for males and females respectively. Victims' occupations were principally agricultural followed by service class and housewives. The most aggressive community was the Kshatriya caste. Most of the accidents occurred during the winter season and on days between Sunday and Tuesday. Accident locations were most commonly the forest, the fields or the home. The chest and head were the most common anatomical sites of injury. All accidental cases were the result of only one firing. It is important to mention that, based on these findings, firearm accidents could be reduced significantly if firearm holders were better trained regarding the handling and safety aspects of their guns, particularly farmers to whom firearm licences are granted specifically for the protection of crops.
Prosecuting Psychiatric Inpatients – Where is the Thin Blue Line?
Authors: BROWN ADRIAN R
Published: February 2010

Violence by psychiatric inpatients is under-reported and the involvement of the police is limited. No research has specifically investigated the views of the police force in this area. Ten senior police officers were interviewed using a semi-structured format to elucidate their views. A thematic analysis of the results highlighted training needs, and concerns around the public interest and evidential tests where the mentally ill are concerned. However, there was also a clear willingness to attend incidents and support the individuals involved. Possible sources of bias are considered. Issues of policy for psychiatric hospitals are noted as are victim-related factors.
Diabetic Ketoacidosis – A possible Complicating Factor in Deaths associated with Drug Overdose
Authors: BYARD R W , RICHES K J , KOSTAKIS C , FELGATE H E
Published: February 2010

Two cases are described where diabetic ketoacidosis was found in conjunction with significant levels of prescription drugs. Case 1: A 45-year-old woman with a history of insulin-dependent diabetes mellitus was found to have Armanni-Ebstein nephropathy characteristic of hyperglycaemia with a vitreous humour glucose level of 63.1 mmol/L and a β-hydroxybutyrate level of 14.25 mmol/L. Ancillary toxicological evaluation revealed a lethal level of sertraline (2.5 mg/L), with an elevated level of methadone (0.23 mg/L). Death was due to diabetic ketoacidosis complicating mixed drug toxicity. Case 2: A 27-year-old man with a history of insulin-dependent diabetes mellitus was found to have Armanni-Ebstein nephropathy with a vitreous humour glucose level of 51.7 mmol/L and a β-hydroxybutyrate level of 18.6 mmol/L. Ancillary toxicological evaluation revealed a potentially lethal level of methadone of 0.39 mg/L. Death was attributed to diabetic ketoacidosis complicating methadone toxicity.

These cases demonstrate a situation where drug toxicity led to diabetic ketoacidosis resulting in death most likely from a combination of factors. Measuring vitreous humour glucose and β-hydroxybutyrate levels is important in individuals with histories, or scene evidence, of insulin-dependent diabetes mellitus, in addition to toxicological screening when there is evidence of possible drug taking. It appears that drug intoxication in both cases had impaired the ability to administer insulin, resulting in the development over time of diabetic ketoacidotic states. Lethal mechanisms were, therefore, more complex than simple drug toxicity or diabetic ketoacidosis in isolation.
The Applicability of DNA Techniques in Investigations of Hospital Malpractices
Authors: GIROTI RAJIV
Published: February 2010

DNA analysis has been used successfully in a number of parentage cases and for the purposes of identification. However DNA typing is still not generally integrated efficiently into hospital systems in India. I report here the use of DNA evidence in a parentage dispute that arose as a result of a bizarre sequence of events in a maternity ward of General Hospital, Chandigarh, India. The changing standards of hospital practice and social attitudes such as gender bias are likely to augment medico-legal problems in India. There is good reason for DNA profiling methods to be introduced into the hospitals.
Uneventful Recovery from Suicidal Hanging
Authors: KODIKARA SARATHCHANDRA
Published: February 2010

Although hanging accounts for a considerable number of suicidal deaths in Sri Lanka, on rare occasions the victims survive. A few cases have been reported in the literature where victims survived after varying periods of unconsciousness. It has been observed that death does not necessarily result from hanging, provided the victim is brought down promptly and resuscitated actively and vigorously. This paper focuses on an unusual case of a 39-year-old male who survived after resuscitation, without any adverse neurological outcome, after a suicide attempt by hanging.
Alleged Dowry Death: A study of homicidal burns
Authors: SHAHA KUSA KUMAR , MOHANTHY SACHINDANANDA
Published: February 2010

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.
Using the Inflammatory Cell Infiltrate to Estimate the Age of Human Burn Wounds: A review and immunohistochemical study
Authors: TARRAN SARAH , LANGLOIS NEIL E I , DZIEWULSKI PETER , SZTYNDA TAMARA
Published: February 2010

The burn wound healing process, which is reviewed in this paper, has features that differ from the healing of incised cutaneous wounds. This study used immunohistochemical staining and cell counting to examine the inflammatory cell response in biopsy samples of burn wounds from live human subjects obtained at six hours until 23 days after injury in order to determine how the age of a burn could be estimated. Acute inflammatory cells predominated in samples taken six hours to two days after injury. However, neutrophils were often minimal in early samples or could be present late. Elevated numbers of macrophages tended to be encountered from days 2 to 20, but it was not uncommon to observe a minimal or absent macrophage response. Unexpectedly, there was no trend in the number of lymphocytes. A small study was also made of burn wound samples that had been obtained at post-mortem examination of subjects that died in a fire or up to 77 days after injury from fire. This revealed a similar trend of neutrophil and macrophage accumulation. Additionally, it appeared that an increase in the number of lymphocytes occurred late, from 35 days. In conclusion: If neutrophils predominate, the wound is probably less than a couple of days old. When macrophages are abundant the wound is probably a few days to weeks old. However, as expected from the review of the literature, the inflammatory cell infiltrate may be low or absent in burn wounds, which can render determination of the age of burn wounds difficult.
Fatal Electrocution in Adults — A 30-Year Study
Authors: WICK REGULA , GILBERT JOHN D , SIMPSON ELLIE , BYARD ROGER W.
Published: February 2010

A retrospective study was undertaken of all cases of death in adults (>16 years) due to electrocution which were autopsied at Forensic Science SA, Adelaide, Australia, over a 30-year period from 1973 to 2002. A total of 96 cases were identified with 87 males (91%) (mean age = 41.6 years; range 17 to 86 years) and nine females (9%) (mean age = 49.2 years; range 20 to 76 years). Deaths were due to accidents in 66 cases (69%; M:F = 63:3), suicides in 28 cases (29%; M:F = 24:4) and homicides in two cases (2%). Both homicide victims were females, with females accounting for only 5% of the accidents and 14% of suicides. The number of accidental deaths increased until the early 1990s and then declined, whereas suicidal electrocutions were only found in the last 20 years of the study.

Most deaths (N = 80; 83%) were due to low voltage circuits (<1000 volts), with deaths due to high voltages occurring in 15 cases (16%). One death was due to lightning (1%). While suicides were evenly distributed throughout the year, most accidental deaths occurred in late spring and summer (N = 42; 64%) with the lowest number of accidental deaths occurring in winter and early spring. This report demonstrates a significantly higher rate of electrocution deaths among males, with a summer predominance of accidental deaths, most likely due to increased outdoor activities in better weather. The reduction in cases over the last decade of the study may be a reflection of the success of workplace and domestic safety campaigns. Female electrocution suicides and electrocution homicides were rare events.
An Audit of a Specialist Old Age Psychiatry Liaison Service to a Medium and a High Secure Forensic Psychiatry Unit
Authors: SHAH AJIT
Published: February 2010

The elderly prison population is increasing and there is a significant amount of unidentified psychiatric morbidity among elderly prisoners. A sizeable number of elderly subjects are referred to regional forensic units. These units are able to provide advice but are reluctant to admit frail, physically ill and vulnerable elderly into their unit because the ward environment is considered inappropriate for them. A sizeable number of inpatients in medium and high secure units are elderly.

This paper is an exploratory audit of referrals from a medium and high secure forensic psychiatry unit to a specialist consultation-only liaison old age psychiatry service, which was specifically developed to service the forensic unit. The demographic and clinical characteristics of the patients seen by this specialist service were similar to elderly inpatients in medium and high secure units. All referrals were judged to be appropriate and new management advice was provided in all cases. Main reasons for referral included diagnostic advice, placement advice and treatment advice. Establishing a diagnosis of dementia was considered important because Alzheimer's disease and Lewy body dementia can be treated with cholinesterase inhibitors. Placement advice was the most difficult to provide because of paucity of residential and nursing homes able and willing to accept patients with a forensic history.

There is a need for a comprehensive model of specialist forensic old age psychiatry service at a regional or supraregional level. A consensus needs to be reached on the exact configuration of such a service.
The International Criminal Tribunal for the former Yugoslavia (ICTY) and the Forensic Pathologist: Ethical considerations
Authors: DE LA GRANDMAISON G LORIN , DURIGON M , MOUTEL G , HERVE C
Published: February 2010

Since 1991, war crimes in the former Yugoslavia have been the subject of several international medico-legal investigations of mass graves within the framework of inquiries led by the International Criminal Tribunal for the former Yugoslavia (ICTY). Forensic pathologists involved in the ICTY missions could be subjected to ethical tensions due to the difficulties of the missions, the emergent conflicts between forensic scientists of the investigating teams and the original nature of the ICTY proceedings.

In order to study the nature of such ethical tensions, we sent a questionnaire to 65 forensic pathologists who have been involved in the ICTY missions. The rate of response was 38%. The majority of forensic pathologists questioned (n=18) did not know how the medico-legal data was exploited by the ICTY. Three of them have been subjected to pressures. Three of them were aware of mass grave sites knowingly not investigated by the ICTY. Fifteen considered that the ICTY respected the elementary rules of the law and four of them questioned the impartiality of the justice led by the ICTY.

Two conflicting types of ethics can be drawn from these results: conviction ethics, which are shared by most of the forensic pathologists questioned, and responsibility ethics. In the former, the forensic pathologist completely agrees with the need for an international war crimes tribunal, even if such justice can be challenged regarding the respect of human rights and impartiality. In the latter, he or she needs to conduct him or herself in ways that do not infringe impartiality. As medical deontology duty requires impartiality ethics, discursive ethics are needed to ease ethical tensions and to suggest ethical guidelines. Alternatives to international justice, through a truth and reconciliation commission and by way of humanitarian missions combining victims' identification with forensic investigations for historical purposes, could be considered.
The Role of Drugs and Alcohol in Rape
Authors: HORVATH MIRANDA A H , BROWN JENNIFER
Published: February 2010

Alcohol and drugs have been inextricably linked with sexual assault. Media coverage has increasingly highlighted the health risks facing intoxicated women and more recently identified the risk of rape as an additional hazard. Using a sample of rape cases reported to the police between 1999 and 2004, this paper establishes that rapes involving intoxicants (alcohol and/or drugs) are distinguishable from those which do not. Further analysis discovered that the identity of the intoxicated parties (i.e. men, women, neither or both) is important in differentiating rapes. Results report differences by location of assault, victim offender relationship, victim and offender characteristics and offence behaviours. A consistent finding from the analysis is that the victim's state of sobriety or inebriation appears more significant than that of the offender. The implications for crime prevention and directions for future research are discussed.
Accidental Strangulation of a Mentally Retarded Patient by a Clothing Collar
Authors: HITOSUGI MASAHITO , YOKOYAMA TOMOKO , KIDO MASAHITO , KAWATO HITOSHI , MATSUSHIMA KAZUMI , NAGAI TOSHIAKI , TOKUDOME SHOGO
Published: February 2010

A 40-year-old mentally retarded woman died of accidental strangulation in a nursing home. She was found in a kneeling position with her hands on her knees and the collar of her clothing compressing the front and sides of the neck. Before the accident, a nurse had dressed the patient in one-piece overall-style pyjamas put on back to front so that she could not remove the garment herself. The post-mortem findings and reconstruction of the scene of death suggested that the patient had been strangled by the collar of her backward-facing clothing while in a kneeling position. Because patients with psychiatric illnesses may have a limited ability to recognize or communicate symptoms of physical danger, they must be closely monitored by knowledgeable medical and nursing staff. This case highlights the importance of preventing the accidental deaths of mentally retarded patients in nursing homes.
Suicide by Combined Insulin and Glipizide Overdose in a Non-Insulin Dependent Diabetes Mellitus Physician
Authors: RAO NAGESHKUMAR G , MENEZES RITESH G , NAGESH K R , KAMATH GANESH S
Published: February 2010

A case of self-injected insulin intoxication with an oral hypoglycaemic agent glipizide overdose in a type-II/non-insulin dependent diabetes mellitus (NIDDM) individual, a physician by profession, is presented with a review of the literature. The case demonstrates the need for thorough scene investigation, perusal of clinical details and complete autopsy to certify the death caused by combined insulin and glipizide overdose, and the manner of death. A meticulous search in the English literature reveals that hardly any fatal cases of combined insulin and glipizide overdose have been reported, with almost no cases from India, thus making this case report relevant and unique.
Fatal Heat Injury Incident in a Private Home for Elderly People
Authors: OHSHIMA TOHRU
Published: February 2010

This report presents a case in which an 84-year-old elderly female resident of a private home for the aged was fatally injured by a young male member of staff. The deceased suffered from senile dementia, and died from heat shock due to prolonged exposure to an electric fan heater. The heater had been placed immediately in front of the woman's body for approximately 2.5 hours, and the deceased could not escape from the heat by herself. Major autopsy findings were marked second degree burns (predominantly) and smaller areas of first degree burns observed on the anterior body surface (chiefly the face, lower abdomen, forearm and thigh). The burns area exceeded one-third of the entire body surface. Only a small amount of dark red blood (36 g) remained in the heart cavity: this was fluid but remarkably condensed. Petechial bleeding was observed in areas such as the palpebral conjunctivae and renal pelvic mucosae.

This case generated great public attention as the assailant, who had been employed exclusively for three nights' duty per week, had been regarded as very diligent and kind; inflicting such a lethal injury appeared out of character. Several important issues related to managing residential care facilities for the elderly (in particular, the stress associated with night duty caring for the aged with senile dementia, and the mental health care of the staff themselves) were disclosed and are discussed herein from a medico-legal viewpoint.
Euthanasia and Assisted Suicide: Comparison of legal aspects in Switzerland and other countries
Authors: BURKHARDT S , LA HARPE R , HARDING T-W. , SOBEL J
Published: February 2010

The purpose of this paper is to present the legal aspects associated with assisted suicide in Switzerland and compare them with those in other countries. Like euthanasia, assisted suicide is a subject that induces much discussion in many countries. While the law is very liberal in some countries, such as Belgium and the Netherlands (where both euthanasia and assisted suicide take place), these practices are very controversial in other countries, such as France, where they remain taboo subjects.

In the United States of America, the laws concerning assisted suicide can differ greatly from one state to another. For example, in Oregon, assisted suicide is allowed if applied by a medical doctor; in others, this act is illegal. In Canada, it is punishable according to the Criminal Code.

In Switzerland euthanasia is punishable by law. However, the penal code does not condemn assisted suicide, whether carried out by a medical doctor or another person, provided it is not carried out through selfish motives. The application of these practices has become simplified in recent years and societies for the right to die with dignity based on this principle have come into being (Exit and Dignitas).

In the French- and German-speaking parts of Switzerland the association Exit assists individuals living in Switzerland with serious progressive and incurable disease in their engagement to end their life. The association Dignitas, in the German-speaking part of Switzerland, also undertakes – in the same circumstances – to assist individuals coming from foreign countries. Dignitas welcomes several such individuals every year, especially from Germany, where a similar approach does not currently exist.