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Case Report Diabetic artefacts in forensic practice. O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present by.Cap.Sudhunsa Suebsaman. Diabetic artefacts in forensic practice.

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case report diabetic artefacts in forensic practice

Case ReportDiabetic artefacts in forensic practice

O.P. Murty MBBS MD (Professor) *

Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450

Present by.Cap.Sudhunsa Suebsaman

diabetic artefacts in forensic practice
Diabetic artefacts in forensic practice...
  • A case is presented where confusion arose about skin lesions and whether they were diabetic or electricalin origin. The deceased was a known diabetic and hypertensive man.

A middle-aged person in early fifties was found unconscious in the cell and judicial autopsy was performed.He was facing trial for capital punishment of being allegedly involved in drug trafficking and money laundering. He had few marks over his fingers and foot which were considered to be electric marks produced in electric torture.

electrical injuries
Electrical injuries

- Electrical injuries can cause multiorgan

dysfunction and a variety of burns and traumatic

injuries

1.Cardiovascular : arrhythmia, asystole

electrical injuries1
Electrical injuries
  • Respiratory: respiratory arrest
  • Musculoskeletal: compartment syndrom
  • ENT/head: perforated tympanic membranes, facial burn,
electrical injuries2
Electrical injuries
  • Skin: A variety of burns and thermal injuries occurs from electricity that affect the skin and soft tissues
electrical injuries3
Electrical injuries

High-voltage electrothermal burns:

- Contact point

electrical injuries4
Electrical injuries

High-voltage electrothermal burns

- Ground point

electrical injuries5
Electrical injuries
  • Low-voltage burns:

erythema to full-thickness burns.

diabetes mellitus
Diabetes mellitus
  • Is a condition in which the body either does not produce enough, or does not properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy. This causes glucose to accumulate in the blood (hyperglycemia), leading to various potential complications.
diabetes mellitus complications
Diabetes mellitusComplications :

1. Microangiopathy

- Diabetic cardiomyopathy : heart failure

-Diabetic nephropathy : kidney failure

- Diabetic neuropathy :muscle weakness due to neuropathy , DM foot ,Sensory neuropathy

diabetes mellitus1
Diabetes mellitus
  • Stroke : mainly the ischemic type
  • Diabetic retinopathy : Vision loss , Blindness
  • Peripheral vascular disease,

- periungual erythema

diabetes mellitus2
Diabetes mellitus
  • Dermopathy

- Spontaneous Blisters in Diabetes

case summary
Case summary
  • The deceased was a middle-aged under trial and was lodged in state jail. He was a known diabetic and hypertensive man. He had fallen on the floor inside the room in prison and became unconscious.He was taken to prison hospital and from there immediately taken to district hospital. CT scan showed, fracture of skull bones, extradural haemorrhage,subdural Haemorrhage, cerebral oedema,brain infarction on right side. He underwent craniotomy twice for drainage of blood which had collected due to stroke and head injury.
slide14

Fig. 1. Solitary-confinement cell

Fig. 2. Place of fall in the cell where he sustained fracture of skull in occipital area

after stroke, CVA.

external examination
External examination

Fig. 3. Middle occipital areas showed abraded bruise near cut hair.

external examination1
External examination

Fig. 11. Hand showing necrotic nail bed areas.

Fig. 15. Finger nail beds are clean without any ischemic effect.

external examination2
External examination

Fig. 12. Enlarged and close-view of above areas. Blackish discoloration of nail beds,right index finger with a large blackish-blue area ; ring finer just showing early appearance of start of discolorations ; ring finger showing eroded necrotic

ulcerative lesion ; little finger nail also showing small eroded ulcerative lesion.

external examination3
External examination

Fig. 13. Foot showing reddish areas (A and B).

external examination4
External examination

Fig. 14. Shows early erythematic blister like appearances in toes except the great

toe

Fig. 16. Foot of other side in clean.

internal examination
Internal examination
  • Central nervous system

Fig. 3. Middle occipital areas showed abraded bruise near cut hair.

internal examination1
Internal examination

Central nervous system

Fig. 4. Blood in occitpal and tempero-parietal area of scalp, exaggerated by

craniotomy wound

Fig. 6. Suturing of fracture line with craniotomy holes.

internal examination2
Internal examination

Fig. 7. Under surface of brain with contusion haemorrhages. Atherosclerosis of vessels also visible.

Fig. 8. Necrotic brain tissue after CVA.

internal examination3
Internal examination
  • Cardiovascular system

Fig. 10. Advance atherosclerosis in descending and abdominal aorta

discussion
Discussion
  • In our study the lesions seen in the finger beds and soles could be due to diabetes in this deceased. But main concern is as how to deny allegations in this case of whether he was tortured electrically in the prison as lesions are closely simulating the finer electric points which are seen in the victims tortured in the jail.
discussion1
Discussion

Artefacts

Fig. 12. Enlarged and close-view of above areas. Blackish discoloration of nail beds,right index finger with a large blackish-blue area ; ring finer just showing early appearance of start of discolorations ; ring finger showing eroded necrotic ulcerative lesion ; little finger nail also showing small eroded ulcerative lesion.

Fig 21. Finger of a patient with diabetes mellitus demonstrating erythema of the proximal nail fold. This erythema is associated with dilatation of the superficial vascular plexus.

discussion2
Discussion

Artefacts

Electrical injuries Ground point

Fig. 14. Shows early erythematic blister like appearances in toes except the great

toe

discussion3
Discussion
  • In this particular case skin lesions were not seen when he was admitted in the hospital. He remained in coma for few days and after that he developed chest infection.The lesions were noticed only just two day prior to his death.
  • His autopsy report mentioned that he was a case of accidental fall after stroke from a standing height in the solitary confinement prison cell.
discussion4
Discussion
  • The lesions over the skin of hand and feet were probably due ischemic effects because of poor neuro-muscular and vascular control as a result of cerebral ischemia

Spontaneous Blistersin Diabetes

periungual erythema

discussion5
Discussion
  • Opinion: death was due to cerebral hypoxia consequent to brain infarction and head injury

(a) Cranio-cerebral injury

Due to

(b) Fall from standing height

Due to

(c) Brain infarction