Manas R Sahu

Abstract

Baclofen is a synthetic derivative of GABA and is used as a muscle relaxant or antispasmodic agent. It is used in the management of various muscle spasticity resulting from conditions such as cerebral palsy, spinal cord injuries, and stroke. The reported potential adverse effects following overdose are marked impairment in consciousness, acute kidney injury, seizures, coma, and respiratory failure. Since there is no specific antidote available to treat baclofen toxicity, the mainstay of management remains supportive treatment. Herein we describe a case of baclofen overdose in a 62-years-old male who consumed 15 tablets of 25 mg tablets of baclofen (375 mg) and died due to multiorgan failure after 5 days of poisoning. Although many reports in the published medical literature describe the clinical manifestations and the management of baclofen toxicity, only a few reports presented the fatality in baclofen overdose. Furthermore, no report documented the death following lethal multiorgan failure resulting from baclofen overdose, and from India to the best of our knowledge.   Keywords: Baclofen, Multiorgan failure, Toxicology, Poison, Hemodialysis, Autopsy, Overdose.

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Abstract

Death from natural diseases prior to or after entering the water is relatively rare but does occur. These underlying natural diseases lead to the incapacitation of the water victims and culminate in accidental or unintentional drownings. People who are unaware or ignorant of their disease status, living in rural areas with nearby open water sources, and belonging to economically backward communities in developing countries are more vulnerable to these unintentional drownings and pose a substantial challenge in determining the cause of death. Here we present a 45-year-old, underweight woman who brought a history of drowning in a pond near her house where she regularly took a bath. The history from the relatives and crime scene investigation was unremarkable. Thalamic hemorrhage, intraventricular hemorrhage, triple vessel atherosclerosis of the heart, and left ventricular hypertrophy suggestive of undiagnosed hypertension were discerned only after the autopsy, besides profound findings of drowning. This report highlights the significance of a meticulous autopsy to explain the cause of death in unwitnessed open water drownings, thus benefitting the bystanders and investigating team.   Keywords: Drowning, Intraventricular hemorrhage, Thalamic hemorrhage, Hypertension, Forensic pathology

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Abstract

Background: The age determination of an individual is indispensable in various civil and criminal cases. The sternum is one of the key bones for age estimation beyond 25 years. Many studies were done in the past on age determination from the sternum had variable and inconclusive results. Further, the region-specific research on the sternum for age determination is lacking from the eastern Indian population. Objective: The present study was done to examine the sternum for its fusion status along each segment, mesosternum-xiphisternal (MXJ) junction, and manubrium-sternal (MSJ) joint by direct inspection. Materials and Methods: This cross-sectional, observational study was conducted in the mortuary of a tertiary health care center in ABC. 102 sterna were collected from known corpses during autopsy which included 73 males and 29 females aged between 6 years to 85 years. Results: The earliest complete fusion of manubrium with the body was observed to be 17 years in females and 24 years in males. Whereas the maximum number of cases of complete fusion was observed among 51-60 years of age irrespective of the sexes, indicative of a very limited role of the sternum in estimating the age. Conclusions: The fusion of each segment of mesosternum has utility in determining age beyond 20 years and the xiphisternal joint remains reliable corroborative evidence for the age beyond 40 years.   Keywords: Age estimation, Mesosternum, Manubrium, Xiphisternum, Fusion of bones.

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