bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating Alleged Drinking After Driving – The Hip-Flask Defence
Authors: Iffland R , Jones A W
Published: February 2010

The second part of this review describes the principles and practice of forensic congener analysis as an alternative way to evaluate claims of drinking alcohol after driving. Congener analysis was developed, perfected and practised in Germany as a way to evaluate hip-flask defences. This kind of defence challenge arises frequently when the drunk driving suspect is not apprehended at the wheel and especially after hit-and-run incidents. Besides ethanol and water, alcoholic beverages contain trace amounts of many other low-molecular substances, known collectively as the congeners, which impart the characteristic smell and taste to the drink. Importantly, the congener profile can be used to identify a particular kind of alcoholic beverage. Forensic congener analysis entails making a qualitative and quantitative analysis of ethanol, methanol, n-propanol and the isomers of butanol in blood and urine from the apprehended driver and comparing the results with the known congener profile of the alcoholic beverage allegedly consumed after driving. Interpreting the results of congener analysis requires knowledge about the absorption, distribution and elimination pattern of the congener alcohols, including their oxidation and conjugation reactions, and any metabolic interactions with ethanol. Complications arise if drinks with widely different congener profiles are consumed or if the same beverage was ingested both before and after driving. Despite these limitations, congener analysis can furnish compelling evidence to challenge or support claims of drinking alcohol after driving.
The Use of Section 136 of the Mental Health Act 1983 in a Family of Rural English Police Forces
Authors: Greenberg Neil , Haines Niki
Published: February 2010

Section 136 of the Mental Health Act 1983 is used by police officers to detain persons who they feel might be suffering with mental disorder until a formal Mental Health Act assessment can be undertaken. Previous studies have shown that the outcomes of these assessments result in remarkably different rates of subsequent hospital admissions. Within a rural setting it has also been shown that the rate of use of Section 136 varies considerably. This study examines the use of Section 136 within a family of eight police forces that have been matched to ensure that they cover similar populations. The results show that there are considerable variations in the use of Section 136, with the Devon and Cornwall region using the section over two and a half times the mean for the group. Possible reasons for this discrepancy are discussed.
Probation Orders with Conditions of Psychiatric Treatment: A descriptive study
Authors: Richardson T , McInnes R , Davies S
Published: February 2010

Although probation orders with conditions for psychiatric treatment (POPTs) have been in existence for many years there is very little literature relating to their use and almost none from a psychiatric perspective. All patients who were subject to, or had recently completed, a POPT in Leicestershire were identified and information on them collected from psychiatric and probation records. Of 33 POPTs identified, psychiatric information was found for 31 and probation for 23. The most striking feature of the sample was its great heterogeneity in terms of psychiatric diagnoses and index offences. Worryingly, a number of serious offences did not lead to charges or convictions and there was evidence of poor communication between and within agencies, particularly psychiatric services. Our recommendations for improvement mirror those of other studies in the area, namely, better training of the staff from the multiple agencies involved, improved communication, better documentation and ongoing audit to prevent the situation continuing.
1. The Myth of Child Rape as a Cure for HIV/AIDS in Transkei
Authors: Meel B L
Published: February 2010

South Africa has one of the highest cases of HIV/AIDS infection in Africa, and Transkei, a former black homeland, now a part of the Eastern Cape Province, is one locality with a large number of HIV/AIDS sufferers. The unemployment level is very high and crime, including child rape, is very common. This report presents the case of a victim of rape, a nine-year old female child who was brought to the Umtata General Hospital, a victim of the mistaken belief that sex with a virgin will cure an HIV-infected person or AIDS sufferer of his illness. The alleged rapist was an HIV-positive uncle of the child. The myth of the `HIV/AIDS virgin cure' is prevalent in the community. The history, physical examination and laboratory investigations of this case are given. A conclusion is drawn and preventive methods are suggested.
Multiple Contacts with Diversion at the Point of Arrest
Authors: Riordan Sharon , Wix Stuart , Haque M Sayeed , Humphreys Martin
Published: February 2010

A diversion at the point of arrest (DAPA) scheme was set up in five police stations in South Birmingham in 1992. In a study of all referrals made over a four-year period a sub group of multiple contact individuals was identified. During that time four hundred and ninety-two contacts were recorded in total, of which 130 were made by 58 individuals. The latter group was generally no different from the single contact group but did have a tendency to be younger. This research highlights the need for a re-evaluation of service provision and associated education of police officers and relevant mental health care professionals.
Psychiatric Treatment in Prison: A missed opportunity?
Authors: Smith S S , Baxter V J , Humphreys M S
Published: February 2010

National Health Service Executive guidelines require psychiatric services to maintain links with prisoners previously subject to the Care Programme Approach (CPA) and to participate in discharge planning. We are unaware of previous studies assessing the involvement of general psychiatric services with patients in prison or prisoners' perceptions of their needs.

Consecutive referrals to a prison psychiatric liaison service over a three-month period were screened for previous psychiatric contact. Half of those interviewed reported previous psychiatric contact. Two-thirds were in contact with services at the time of detention. One-third believed services knew of their imprisonment. Ninety-three per cent believed they would require psychiatric support after release.

Few patients received input from general psychiatric services during imprisonment despite a high level of perceived need. Improved liaison would help facilitate both care in prison and discharge planning in the spirit of CPA and the government directive.
Accidental Fatal Hypothermia in Elderly People with Alzheimer's Disease
Authors: Kibayashi Kazuhiko , Shojo Hideki
Published: February 2010

We report two forensic autopsy cases of fatal accidental hypothermia in an 89-year-old woman and a 76-year-old man who were found dead and unclothed. In both cases, Alzheimer's disease (AD) was diagnosed by neuropathological examination. Wandering due to AD was determined as the cause of these accidents. Although paradoxical undressing in hypothermic victims is known to occur as a result of cold exposure, in our patients, undressing was attributed to dementia due to AD before they became hypothermic. These cases indicate that neuropathological examination is crucial to determining the cause of such accidents and that undressing is not always the result of hypothermia in elderly victims.
Psychiatrists' Knowledge of the Human Rights Act and its Relevance to Mental Health Practice: A questionnaire survey
Authors: Passmore Kirsty , Leung Wai-Ching
Published: February 2010

The recent implementation of the Human Rights Act 1998 has important implications for UK psychiatric practice but previous studies have demonstrated that psychiatrists generally have poor knowledge of mental health law. The aims of this study were to assess psychiatrists' knowledge of the Human Rights Act and to examine whether knowledge is related to seniority or experience. Questionnaires were sent to 154 psychiatrists in the Northern Region, testing both their factual knowledge of the Human Rights Act and their ability to apply it to clinical scenarios. Ninety-six psychiatrists responded and they demonstrated good overall knowledge and ability to apply the Human Rights Act. However, half of the respondents were not aware that the Act only imposes a duty on public authorities and that a lack of active treatment in itself does not constitute a breach of the Act. Specialist registrars and consultants scored significantly higher than SHOs but there was no significant difference between the specialist registrars and consultants. The scores of psychiatrists who had detained at least one patient under the Mental Health Act 1983 over the last six months were significantly higher than those who had not. The implications of these findings are discussed. There is still a need for further training on relevant aspects of the Human Rights Act.
Suicide Trends In Singapore: Two decades down the road
Authors: Ng David Wei Liang , Lau Gilbert
Published: February 2010

In this study, recent trends in the incidence and methods of suicide in Singapore, over the period 1991-2000, were compared with the results of a previous study covering the period 1975-1984 (Tan, 1986). The present study included a total of 3,834 suicidal deaths reported to the coroner and investigated by the Centre for Forensic Medicine of the Health Sciences Authority. The results showed that the crude suicide rate had stabilised over the last decade and that the rate was highest among elderly males. The three most common methods employed were falls from a height (69.3%), hanging (20.7%) and poisoning (5.5%).

Comparison of the results of both studies showed that the crude suicide rate had stabilised over the last two decades. However, there was an increase in the suicide rates among males, as compared with the previous study, and a marginal decrease in suicide rates among females over this time. There was also an appreciable change in the methods of suicide employed, in that there was an increase in the proportion of deaths due to falls from a height and corresponding reductions in the proportions of deaths by hanging and poisoning.
Women's Rights in Pakistan: A forensic perspective
Authors: Hadi Sibte
Published: February 2010

Pakistan is a large and an important West Asian country which came into being in the name of Islam and therefore Islamic tenets remain the core of its constitution. The laws of the state have to conform to Islamic law so that they can have a positive impact on the society. Unfortunately, in Pakistan today not all men enjoy the rights and facilities to which they are entitled and women are doubly disadvantaged by poverty and gender.

With their own political agendas, various governments have promulgated laws which affect the society in various ways. The laws which directly influence women's rights merit mention, as women comprise more than 50% of the population of Pakistan and are still kept on the sidelines by the male dominant society. The Muslim Family Law Ordinance, 1961, and the Hudood Ordinance, 1979 were both promulgated by military dictators with different visions. The former codified the rights of women bestowed by Islamic law; the latter repealed laws for sexual offences according to the injunctions of Islam and had a negative impact.

Both laws need the assistance of forensic medicine as age estimation and medical examinations are necessary if they are to be followed in the right perspective. However, a legal need for an examination by an expert in forensic medicine is sadly lacking in both laws. This has happened due to lack of training of forensic physicians and therefore a lack of research in important areas of forensic medicine in the country. This paper examines these laws and the interaction they have with forensic medicine and proposes that the laws need revision in accordance with modern science, incorporating forensic sciences as well as the injunctions of Islam.
The Mental Health Act 1983 Section 5(2): Clinical application and predictors of outcome
Authors: Dearman Samuel P , Waheed Waquas
Published: February 2010

This study examined trends and influences of variables in the 100 most recent applications of Section 5(2) of the Mental Health Act 1983 in a major teaching hospital in England. Case notes, section-forms, log-books and computerised records were scrutinised. Sixty-four per cent of the cases were converted to Section 2(28%) or Section 3(36%), the remainder were rescinded or lapsed. No demographic, illness characteristic or grade of doctor significantly effected conversion or lapse rate of Section 5(2). The clinical implications of a high rate of non-conversion of Section 5(2) is clear. Non-psychotic patients may be less likely to be regarded for further Sections when detained under Section 5(4) before detention under Section 5(2), yet no single factor determines the outcome of emergency detention.
Depression, Homicide and Diminished Responsibility: New Scottish directions
Authors: Collins Philip , White Thomas
Published: February 2010

In a recent Scottish Appeal Court opinion ( Kim Louise Scarsbrook or Galbraith v. Her Majesty's Advocate, 2001) it was successfully argued by the appellant that her conviction of murder was unsound inter-alia on the basis of overly restrictive pre-existing definitions of diminished responsibility in Scottish law resulting in unduly narrow directions being given by the trial judge to the jury in her case. We felt it timely to present a revised overview of the defence of diminished responsibility in Scotland and to consider the issues surrounding its applicability in cases of clinical depression. The psychiatric literature regarding depression and homicide is reviewed.
Gender-Related Traumatic Deaths in Transkei: Incidence and causes
Authors: Meel B L
Published: February 2010

This study is unique in that it strives to unfold, perhaps for the first time, the problem of female mortality due to trauma in the Transkei region of the Eastern Cape Province of South Africa. This study was carried out in the Umtata and Ngqeleni magisterial districts which have a combined population of about 400,000. Most of the people have very few resources and have historically relied on money repatriated by migrant workers.

The objective was to establish the incidence and the causes of deaths due to gender-related trauma and to formulate recommendations which could probably help prevent or reduce these deaths. The study reviewed cases of female traumatic death during the period January 1993 to December 1999 that were brought to the mortuary in Umtata General Hospital (UGH). There were 1,054 (23%) traumatic deaths recorded in females between 1993 and 1999. Of these 486 (28%) were related to motor vehicle collisions, 219 (18%) due to gunshot injuries, 152 (19%) due to stab wounds and 139 (21%) as a result of blunt trauma. The male to female ratio was 3.3:1 in traumatic deaths. In homicides the male: female ratio was 4.4:1, gunshot 4.5:1, stab 4.2:1 and blunt injuries 3.7:1. In motor vehicle collisions (MVC's) the ratio was 2.5:1.

There is an increasing incidence of traumatic deaths in women. Gun shot injuries are the commonest among traumatic deaths in females. This article recommends stricter measures to protect women in the form of legislation. Social uplifting and economic support should be carried out as part of the process of social change. In this case educating the entire community is necessary to safeguard women and their future survival.
Suicides in Northern India: Causes, methods used and prevention
Authors: Sharma B R , Sharma Vivek , Harish Dasari , Vij Krishan
Published: February 2010

Suicide patterns and rates differ in various populations and cultures. It has been reported that developing countries have lower suicide rates, possibly because of a lower level of environmental stress but the Indians have a very high suicide rate (Elfawal, 1999). The choice of method used to commit suicide depends on availability of means, knowledge about lethal effectiveness, and the victim's motivation and intent. The present work was designed to investigate the different methods of self-destruction, the age and gender susceptibility to suicide, the groups particularly affected and the underlying motivating factor for such an extreme step among the North Indians. Various suggestions relating to decreasing the tensions of the modern mechanical life-style, educating the public in general and the availability, use and storage of agrochemicals have been put forward. Marriage counselling and the concept of family planning are also advocated.
Ascertaining Capacity to Consent: A survey of approaches used by psychiatrists
Authors: Shah Ajit , Mukherjee Sujoy
Published: February 2010

Doctors are increasingly criticised for imposing treatment without adequate consent. Approaches used by psychiatrists (of all grades and in all subspecialities) to assess capacity to consent in a large west London psychiatric trust were surveyed with a questionnaire. The questionnaire consisted of two case-vignettes and a series of seven questions (six with forced choice yes/no answers and one with an open-ended answer). The responding psychiatrists' assessment of capacity and that judged by the research psychiatrist were compared. There was no relationship between age, sex, duration of experience in psychiatry, grade and speciality, and (i) the respondents' assessment of capacity and (ii) the research psychiatrist's assessment of capacity. The kappa concordance between the responding psychiatrists' assessment of capacity and that judged by the research psychiatrist was 0.17 (P=0.067) and 0.12 (P>0.05) for vignettes 1 and 2 respectively. Individual psychiatrists appear to variably interpret and apply the criteria for assessment of capacity to consent.
A Study of the Investigation of Death (Coroner System) in Sri Lanka
Authors: Fernando R
Published: February 2010

Sri Lanka (Ceylon) inherited the `coroner system' of investigating death in the early nineteenth century. Unlike in England and Wales, the coroner system in Sri Lanka did not change much in the last century. This study, the first of its kind, was performed for a period of three months in 1995 to analyse the causes and circumstances of deaths reported for inquest, and the number of autopsies performed. Of the 868 cases reported to the Inquirer, the circumstances were not determined in 94 cases at the initial inquest proceedings. Of the other 774 cases, 454 (58.7%) were natural deaths. Autopsies were performed on 44.5% of natural deaths, 58.2% of accidental deaths, 96% of road traffic accidents, 44.9 % of suicides and 81.6% of homicides. Coronary heart disease was the leading cause of natural death (33.9%). Head injuries were responsible for 31.8% of accidental deaths while burns accounted for 24.5% of accidental deaths and 46.3% of suicides. There were 38 cases (4.9%) of homicide of which autopsies were performed in 31. There is an urgent need to reform the century-old laws relating to inquest procedures in the country.
The Cresta Run: A uniquely evolving tradition
Authors: OGILVIE-HARDY E T
Published: February 2010

The Cresta Run is a unique toboggan run and exists in only one place in the world, namely, St. Moritz, Switzerland. The height of the resort is over 6,000 feet (1828 metres). Therefore there is a diminution of oxygen content in the air. Normally it takes from three to seven days for a person from lower habitat altitudes, visiting the resort, to become fully acclimatized if they are to be involved in energetic competitive sport. The age and fitness of the toboggan rider is a factor.

The Cresta Run takes place each year and has, since its inception under the auspices of the St Moritz Tobogganing Club, been built from virgin snow to a formula determined by a brilliant 22-year-old Swiss geometrician, Peter Bonorand, who devised the first Run in 1884. Using his exceptional mathematical knowledge to determine a course from St. Moritz to Celerina, he drew up plans and drawings for the first Cresta Run. The Run therefore is constructed to a known formula and it is significant that in over 115 years the times on the Run have only improved on average by a few tenths of a second progressively each year despite improvements to riding equipment.

Since the Run's inception in 1885 there has always been an element of danger, but accidents have invariably occurred on the section of the Run that comprises the competition course between the start line and the finish line. During the past few seasons, an increasing number of accidents have taken place after the finish line. The problem is short-term blackout while riding (Reader, 1978). There is now a need to investigate what changes have been made or have evolved to cause this. However, certain immutable facts have remained constant and these must be identified and then considered in the context of recent changes as a result of improvements in equipment. Considerable improvements have been made over the past 25 years to safety helmets. These are the result of different materials, their suitability and ease of manufacture, particularly with regard to the full-face type helmet. The full-face helmet could be a significant contributing factor to the problem of accidents, particularly after the finish line, on the Cresta Run.
First Ever Admission to Medium Security
Authors: HARDWICK ELIZABETH , GRAY DOUGLAS , HUMPHREYS MARTIN
Published: February 2010

This paper describes the characteristics of a group of patients admitted to a Medium Security Unit over the course of a ten-year period who had never previously had any form of psychiatric inpatient care. We used a computerised data base to gain detailed information. The control group was made up of patients admitted to the same hospital over the study period who had been psychiatric inpatients before but not in medium secure conditions. We found that the patients from the first ever admission group were generally older and that the numbers had increased over the ten-year period. Their average length of stay was shorter. The most common diagnosis for all patients was schizophrenia. The findings suggest that there is a place for secure provision in the treatment of first episode psychosis, especially if the initial contact is through a penal institution.
1. Left Aortic Arch with Right-Sided Descending Aorta Associated with Sudden Neonatal Death
Authors: PAMPIN J BLANCO , RIVERO A GARCIA , TAMAYO N MORTE , FONSECA R HINOJAL
Published: February 2010

We present the case of a 26-day-old female in whom left aortic arch with right-sided descending aorta occurred. The previously healthy newborn baby was found dead on her bed. This anomaly is very uncommon and its clinical presentation as sudden death is also exceptional with only a few cases having been reported in the literature. The pathological findings and embryological origins of this malformation, so-called ‘circumflex aorta’ are discussed. The pertinent literature is reviewed.
The Criminal Careers of Arsonists
Authors: SOOTHILL KEITH , ACKERLEY ELIZABETH , FRANCIS BRIAN
Published: February 2010

This paper replicates a 1973 study of the criminal careers of arsonists (Soothill and Pope, 1973). It compares the original series of those convicted at the high court of arson in England and Wales in 1951 (n=74) with three new series of all those convicted in any court in England and Wales in 1963-5 (n=1352), in 1980-1 (n=5584) and in 2000-1 (n=3335).

The profile of convicted arsonists has significantly shifted over the years, with an increasing proportion of females and a rise in the average age of both males and females. Previous convictions for violence and criminal damage (including arson) are much more evident in the later series. The proportion of medical disposals has declined, while the 1:2 ratio for custodial/non-custodial sentences has remained constant. With a 20-year follow-up the proportion reconvicted for arson has more than doubled – from 4.5% in the 1951 series to 10.7% for the 1980-1 series. The indications are that the situation in relation to arson has deteriorated significantly over the past forty years.
In Search of the Boston Strangler: Genetic evidence from the exhumation of Mary Sullivan
Authors: FORAN DAVID R , STARRS JAMES E
Published: February 2010

The Boston Strangler was one of the United States' most notorious serial killers, raping and strangling with decorative ligatures thirteen woman in Boston during the early 1960s. Albert DeSalvo, never a suspect in the slayings, confessed in prison (where he was later murdered) to being the Boston Strangler, and the investigation largely ended. Mary Sullivan was the last victim of the Boston Strangler, found sexually assaulted and strangled in her Boston apartment in 1964. Recently, a team of forensic scientists undertook the exhumation and subsequent scientific analysis of Mary Sullivan's remains, in hope of finding consistencies or inconsistencies between DeSalvo's confessed description of the murder and any evidence left behind. Included in these analyses was extensive DNA testing of all UV fluorescent material associated with the body. The large majority of results were negative, however, fluorescent material located on the underwear and entwined in her pubic hair generated two human mitochondrial DNA sequences. Neither of these matched the victim nor members of the forensic team who worked on the evidence. Most importantly, neither DNA sequence could have originated from Albert DeSalvo.
Anatomical Variations in Termination of the Axillary Artery and its Clinical Implications
Authors: PANDEY S K , GANGOPADHYAY A N , TRIPATHI S K , SHUKLA V K
Published: February 2010

Variations in the termination of the axillary artery (AA) were observed in 51 out of 356 axilla during routine dissections. The incidence of variation was higher on the right axilla in 17.42% cases (CI: 11.60-22.51) than the left axilla 11.24% cases (CI: 6.46-15.55) and was found to be 12.33% in male and 40.63% in female cadavers. The variations were divided into four groups. The first group showed that the terminal end of the AA divided into lateral and medial divisions in 6.16% (CI: 2.21-9.82) male and in 15.63% (CI: 2.76-25.25) female cadavers. The second group variation showed that the terminal end of the axillary artery divided into deep and superficial divisions in 2.74% (CI: 0.10-5.27) male and in 6.25% (CI: -1.87-13.13) female cadavers. The third group showed that the terminal end of the AA divided into three branches in 2.74% (CI: 0.10-5.27) male and in 6.25% (CI: -1.87-13.13) female cadavers. The fourth group showed the tapering of the terminal end of AA in 0.68% (CI: -0.63-1.99) male and 12.50% (CI: 0.97-21.46) female cadavers. The variable origin of the circumflex humeral, subscapular and profunda brachii arteries was also observed. These variations in the terminal end of the axillary artery are not only of significant clinical importance to orthopaedic and reconstructive surgeons but also have very significant medico-legal implications.
1. Dissection of the Vertebral Artery During a Basketball Game
Authors: GIORGIO F DE , VETRUGNO G , MERCURIO D DE , PASCALI V L , RAINIO J , CARBONE A , FERNANDEZ E
Published: February 2010

Dissection of the vertebral artery represents a significant potential cause of strokes among young and middle-aged people. We present a case of dissection of the vertebral artery observed at the forensic autopsy of a professional basketball player who was suddenly taken ill during a practice game and died seven days after the event. A medico-legal autopsy was performed in order to establish an essential causal relationship between arterial dissection and basketball activity. No preceding trauma possibly contributing to the dissection was discovered. The histology of the arterial wall did not show specific alterations in the adventitia, the muscular layer, or the intima. In addition, the toxicological examination excluded any effects of drugs of abuse.

We describe macroscopic and microscopic findings in the autopsy, and discuss possible mechanisms of the arterial rupture as well as the autopsy procedure in similar cases.
2. An Unusual Russell's Viper Bite Mark
Authors: WANKHEDE ASHESH GUNWANTRAO
Published: February 2010

A case of Russell's viper bite is presented with four fang marks in a single bite. The distance between each fang mark is greater than that noted between fang marks to date. This particular presentation of a snake bite mark is observed for the first time.
Fatal Poisoning in Jamaica: A coroner's autopsy study from the University Hospital of the West Indies
Authors: ESCOFFERY CARLOS T , SHIRLEY SUZANNE E
Published: February 2010

This study reviewed cases of fatal poisoning in a coroner's autopsy series at the University Hospital of the West Indies and represented the first such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed over the 20-year period January 1980 to December 1999 were reviewed retrospectively; 22 (1.0%) cases were identified and relevant clinical and pathological data analysed.

There were 13 males and nine females (M:F ratio 1.4:1) with an age range of 2- 69 years (mean ± SD = 27 ± 16.1 years). The 20-29 year group was most commonly affected and five patients (22.7%) were children (<18 years of age). Pesticides (herbicides/insecticides) were implicated in nine (41%) cases: paraquat was the most common, found in six (27%) cases. Prescription drugs were the next most prevalent group with six (27%) cases, followed by anti-psychotic drugs in four (18%) cases. Cocaine and ackee were each implicated in two (9%) cases.

The manner of death was suicidal in 14 (64%) cases and accidental in eight (36%) cases. Seven patients had documented psychiatric illnesses, six of whom committed suicide. Autopsy findings were largely non-specific. The relatively small number of cases was consistent with the low incidence of fatal poisoning in Jamaica.
Homicide and Affective Disorder
Authors: WHITE T
Published: February 2010

The background, offence characteristics and psychiatric diagnosis were reviewed of 115 referrals of offenders charged with homicide made by procurators fiscal to the State Hospital, Carstairs, Scotland's only special secure hospital. A retrospective case-note review was performed using a structured questionnaire. A higher percentage of mental illness and substance misuse (11% and 40%) was recorded than that reported by Gillies in 1976. The results are discussed in the context of comparable studies and, in particular, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and the Discussion Paper on Insanity and Diminished Responsibility published by the Scottish Law Commission.
3. A Fatal Impaling Injury in a Road Traffic Accident
Authors: RAUTJI R , GIRDHAR S , LALWANI S , DOGRA T D
Published: February 2010

A 17-year old, thin-built male was sitting in a bus on the right side of the rear seat. The same side of the bus accidentally hit some iron rods, meant for construction work, projecting from the tail end of a small truck. The incident happened when the bus driver tried to manoeuvre the bus towards the left side of the truck, standing at a red traffic light intersection. One of the iron-rods entered the bus through the glass window next to which the victim had been sitting and penetrated his chest cavity from the side, lacerating both the lungs and exiting through the left shoulder blade. The individual died on his way to hospital.
Homicidal and Dyadic Falls From a Height: Rarities in Singapore
Authors: LAU G
Published: February 2010

A review of homicidal falls from a height, over a ten-year-period (1991-2000), demonstrated the rarity of such deaths in Singapore, despite the high frequency of fatal falls from a height that prevails in the city-state. During that time, there were four cases (involving five individuals) of pure homicide and nine episodes (involving 19 individuals) of dyadic death involving vertical deceleration from a considerable height in the approximate range of 17-31 m (6-11 floors) and 17-50 m (6-18 floors), respectively. The index cases were gleaned from a total of 533 homicides and 3,963 fatal falls from a height. Hence, the corresponding ten-year prevalence rates of homicidal falls were 0.9% in terms of all homicidal deaths and 0.1% in relation to all fatal falls, and 3.6% and 0.5% for dyadic falls, respectively.

The majority of victims were children, with almost equal numbers of males and females, aged between two months and six years for pure homicides and between 20 months and 13 years for homicide-suicides. Over a third (9/24) of these subjects attained the maximum Injury Severity Score (ISS) of 75. With respect to the dyadic deaths, the majority of the perpetrators (6/9) were females, comprising four mothers and two live-in maids. It would appear that strained or broken relationships, probable or actual mental illness, or a combination of both factors, had largely predisposed them to these tragic events which may, potentially, carry diplomatic implications when foreign nationals are involved.
Victims of Falls From a Height Surviving to Hospital Admission in Two Singapore Hospitals
Authors: ONG ADRIAN , IAU PHILLIP T C , YEO ALLEN WY , KOH M P , LAU GILBERT
Published: February 2010

Falls from a height are a common problem in Singapore. However, there has been no analysis of the injury patterns and outcomes of patients who survived initial resuscitation after falls from a height in Singapore. One hundred and thirty-nine patients admitted over a two-and-a-half year period after falls of greater than one storey were studied. The higher the fall, the greater the likelihood of hypotension and neurological injury. The length of stay in hospital, the number of operative procedures and mortality also correlated with the height of the fall. The overall mortality rate was 11% but rose to 47% among patients who were hypotensive on admission. About half of the deaths were due to head injury with haemorrhage being the second most common cause. The majority of patients who fell from five or more storeys did so intentionally, and had more severe torso and extremity injuries compared with those who fell accidentally. These findings suggest that efforts in injury prevention and aggressive evaluation and treatment of fall victims arriving alive at the hospital continue to be important.
Psychotropic Prescriptions and Elderly Suicide Rates
Authors: LODHI LUBBABA MAHMOOD , SHAH AJIT
Published: February 2010

Suicide rates in the elderly have declined in recent years in several countries including England and Wales. There have also been major changes in prescribing patterns of psychotropics in many countries during recent years. This study examined the association between a trend of decline in suicide rates in the elderly in England and Wales and changes in the prescribing of psychotropics for the period 1985 to 1996.

Data on suicide rates was ascertained from the annual mortality statistics for the years 1985 to 1996. Data on the prescriptions of psychotropics was ascertained from the Statistic Division (SD1E) at the Department of Health. Spearman's rank correlation coefficient (rho) was used to examine the relationship between the prescription of psychotropics and suicide rates.

The main findings of this study were: (i) a highly significant negative correlation between the prescription of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) and elderly suicide rates; (ii) a significant positive correlation between the prescription of monoamine oxidase inhibitors (MAOIs) and elderly suicide rates; (iii) a highly significant negative correlation between the prescription of antimanics and antipsychotics and elderly suicide rates; (iv) a highly significant positive correlation between the prescription of hypnotics, anxiolytics and barbiturates and elderly suicide rates; and, (v) a significant negative correlation between the prescription of analgesics and elderly suicide rates.

A trend of decline in suicide rates in the elderly in England and Wales for 1985 to 1996 and changes in the prescribing of psychotropics were significantly associated. The results of this study suggest that prescription patterns of psychotropics may be an important factor contributing to the recent decline in suicide rates in the elderly in England and Wales but this effect should be viewed in the context of other health and social factors.
Organ Transplantation Programme: An overview of the present situation
Authors: SHARMA B R , HARISH D
Published: February 2010

An ever-increasing demand for organs for transplantation has failed to keep pace with their availability. Social, religious and legal restrictions on the one hand and technological developments on the other have further worsened the existing shortage of organs. A correct definition of the ‘moment of death’, a more humane approach in breaking the news of death to relatives and de-linking the request for donation from the announcement of death may all go a long way in enhancing organ donation and procurement for needy patients. In India, the Transplantation of Human Organs Act was passed in 1994 to regulate the removal of organs from the living as well as the dead. However, it has certain fallacies. This paper reviews the various criteria in use to define the ‘moment of death’ around the world and with reference both to the Transplantation of Human Organs Act 1994 and the urgent need for organ retrieval in the present day paucity of donors.
1. A Fatal Case of Hepatic Failure Possibly Induced by Nitrosofenfluramine
Authors: LAU GILBERT , LO DANNY S T , YAO Y J , LEONG H T , CHAN CHENG LENG , CHU SWEE SENG
Published: February 2010

A 42-year-old female developed fulminant hepatic failure after having ingested an undetermined quantity of a herbal product over a period of approximately four months prior to the onset of her illness. Clinically, the cause of liver failure was assessed to be drug-induced and she eventually underwent total hepatectomy, with porto-caval shunting, in anticipation of a living-unrelated liver transplant. Unfortunately, her condition deteriorated and she died less than 48 hours postoperatively, approximately three weeks post-admission. An autopsy showed that the subject was deeply jaundiced and severely obese (BMI: 47.1 kgm-2), with evidence of diffuse haemorrhage, including the presence of 1.35 l of blood in the peritoneal cavity.

The liver had been removed and was later recovered as a formalin-fixed specimen which was markedly contracted, comprising multiple micronodules interspersed with extensive areas of dense fibrotic tissue. Histologically, there was massive necrosis of the hepatic parenchyma, such that the residual hepatocytes were disposed as nodules displaying variable cellular regeneration and ballooning degeneration, attended by florid ductal proliferation and mixed inflammatory infiltrates. Infective, autoimmune, metabolic, vascular, neoplastic and most other natural causes of massive hepatocellular necrosis were effectively excluded.

Analysis of the post-mortem blood samples yielded fluconazole, metronidazole, frusemide, lignocaine and tramadol, (therapeutic agents administered to the patient during her last illness). Subsequent analysis of the residual capsules revealed that they were adulterated by fenfluramine, N-nitrosofenfluramine (1.3-1.6 mg per capsule), nicotinamide (13.3-15.6 mg per capsule) and thyroid extract. None of the herbal ingredients is currently known to be hepatotoxic and much the same applies to fenfluramine, nicotinamide (except when taken in mega-doses) and thyroid extract. However, as nitrosamines are known to be variably hepatotoxic, it would be reasonable to surmise that, in the absence of a more plausible cause of liver damage, N-nitrosofenfluramine was the likely cause of massive hepatocellular necrosis in this instance.
3. A Fatal Case of Poisoning by Lidocaine Overdosage – Analysis of Lidocaine in Formalin-Fixed Tissues
Authors: KUDO KEIKO , NISHIDA NAOKI , KIYOSHIMA AKIKO , IKEDA NORIAKI
Published: February 2010

The death of a 76-year-old man with heart disease as a result of the injection of an excessive dose of lidocaine is presented. The patient was given 5 ml of 10% lidocaine hydrochloride (500 mg) intravenously instead of 2.5 ml of 2% lidocaine hydrochloride (50 mg) in order to treat repeated paroxysmal ventricular arrhythmia. Immediately following the injection the patient had tonic clonic seizures and complete cardiopulmonary arrest followed. Although resuscitation attempts once successfully restarted his pulse and spontaneous respiration, the patient died on the eighth day after the injection.

Toxicological examinations were carried out on the tissues obtained at the time of autopsy and which had been fixed in formalin solution for 40 days, and lidocaine was detected in each tissue examined. The concentrations were (ng/g or ml): parietal lobe, 308.0; occipital lobe, 208.7; temporal lobe, 318.0; frontal lobe, 223.2; cerebellum 200.9; pons 285.7; liver, 109.5; kidney 52.2; skeletal muscle 127.0; and formalin solution 8.4. In an experiment on rats we determined the concentration changes of lidocaine in formalin fixed tissues. The concentrations of lidocaine in these tissues significantly decreased to 1/3-1/4 from the original. This data shows that the cause of death was poisoning by lidocaine overdose.
Neonaticidal Mothers: Are more boys killed?
Authors: MARLEAU JACQUES D , DUBÉ MYRIAM , LÉVEILLÉE SUZANNE
Published: February 2010

Neonaticide refers to the homicide of a newborn of less than 24 hours old. Recently, certain authors have reported that only boys were victims (Dubé, 1998; Haapasalo and Petäjä, 1999). The aim of this study was to determine whether the proportion of male/female victims identified in the literature varied significantly from the official proportions of males/females at birth in countries of the Western World. Two types of study were taken into account to identify the victims' sex, namely, those presenting case reports and those presenting case series. A total of 420 neonaticides were included in our analyses. The majority of newborn victims were male (58.3%). However, there was no significant difference compared with the percentage of male births (51.4%). Based on the data collected, results indicate overall that a child's sex is not a significant factor associated with neonaticide.
1. An Autopsy Case of Fatal Arrhythmia Induced by Injuries of the Atrioventricular Conduction System: A case report
Authors: INOUE HIROMASA , IKEDA NORIAKI , TSUJI AKIKO , KUDO KEIKO , NISHIDA NAOKI
Published: February 2010

A 65-year-old woman died three days after being involved in a traffic accident, following an episode of ventricular fibrillation. She was diagnosed as having suffered cardiac contusion, liver contusion, mediastinal hematoma and rib fracture on admission. Her electrocardiogram showed complete right bundle branch block, complete atrioventricular block, and right axis deviation. Aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase and creatine kinase-MB were found to be elevated on biochemical blood analysis. These findings recovered and her condition appeared to improve daily. At autopsy, epicardial and intramyocardial haemorrhage were macroscopically seen in the posterior wall of the bilateral ventricles. On microscopic examination, there was evidence of fresh haemorrhage and coagulative necrosis with inflammatory reaction in the ordinary myocardium and adipose tissue around the atrioventricular node, which had spread to the proximal portion of the His' bundle. It is considered that these findings caused ventricular fibrillation to occur, and that the cause of death in this case was myocardial contusion due to blunt thoracic injury. This case would indicate that myocardium nearby atrioventricular junction is vulnerable to external force. Moreover, it would seem that fatal arrhythmia occasionally occurs during the follow-up stage, despite the lack of any significant clinical findings.
2. Accidental Strangulation: A case report
Authors: GUPTA B D , JANI C B , DATTA R G
Published: February 2010

Accidental strangulation, though reported, is uncommon. We report a case of an unusual accidental strangulation in which the floating end of the ‘saree’ of the pillion rider of a two-wheeler motorcycle got entangled in the moving rear wheel and constricted her neck. To our knowledge this is the first case of its type involving a two-wheeler motorcycle. Comments are also given on traditional Indian wear and safety measures required in two-wheelers to prevent such incidents.
Fingerprint Evidence in England and Wales – The Revised Standard
Authors: Leadbetter Martin J
Published: February 2010

Evidence of personal identity, often based solely on the comparison of a single finger impression, or fragment of an impression, has been accepted by courts of law at all levels in England and Wales since 1901, when the fingerprint system of identification was first adopted by police forces. Fingerprint identification is used by police forces world-wide, not only for the identification of latent fingermarks left at crime scenes, but also as the basis for ensuring accuracy in the criminal record system. For more than a century fingerprint evidence has been shown without doubt to be the best form of personal identification yet devised and millions of comparisons and subsequent identifications have been effected world-wide without any flaw in the system having been detected.

From 1953-2001 it was the usual practice in England and Wales for the police to proffer fingerprint evidence showing 16 common matching characteristics, or features in agreement, between the two impressions being compared. In 1996 the Association of Chief Police Officers (ACPO) commissioned a review of the existing methods of presenting fingerprint evidence before the courts and on 11 June 2001 a new standard of fingerprint evidence was adopted by the police forces of England and Wales.

This paper describes how the new standard was developed and implemented and why it was considered necessary to move away from the existing 16-point standard.
Self-Inflicted Burns Fatalities in Manipal, India
Authors: Mohanty Manoj Kumar , Arun M , Monteiro Francis N P , Palimar Vikram
Published: February 2010

Death due to burns is an important public health problem. Suicide by burning is uncommon in the Western world compared with Asian countries. This study presents retrospective research carried out in the tertiary care teaching hospital of Kasturba Medical College, Manipal, Southern India, between January 1993 to December 2003 (11years). Out of a total of 343 burns deaths during the above-mentioned period, 39 were victims of suicide. The majority of deaths (46.1%) occurred in the 21-30 years age group, with a preponderance of the female sex (79.5%). Most of the victims belonged to the Hindu religion and the incident occurred mostly during the daytime. In the overwhelming majority of cases, the incident occurred at home (97.4%). In all cases kerosene was the accelerant and flame was the causative agent. In more than fifty per cent of cases, the total body surface area (TBSA) involved was more than 80%. Dowry demands and harassment were the reasons for committng suicide in 12 cases. More stringent laws and empowering female independence, both mentally and economically, will reduce suicidal burns in young women.