case report diabetic artefacts in forensic practice o.p. murty mbbs md (professor) * forensic...
TRANSCRIPT
![Page 1: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/1.jpg)
Case Report
Diabetic artefacts in forensic practiceO.P. Murty MBBS MD (Professor) *Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450
Present by.Cap.Sudhunsa Suebsaman
![Page 2: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/2.jpg)
Diabetic artefacts in forensic practice... A case is presented where confusion arose ab
out 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.
![Page 3: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/3.jpg)
Electrical injuries - Electrical injuries can cause multiorgan
dysfunction and a variety of burns and traumatic
injuries
1.Cardiovascular : arrhythmia, asystole
![Page 4: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/4.jpg)
Electrical injuries
Respiratory: respiratory arrest Musculoskeletal: compartment syndrom ENT/head: perforated tympanic membranes,
facial burn,
![Page 5: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/5.jpg)
Electrical injuries Skin: A variety of burns and thermal injuries
occurs from electricity that affect the skin and soft tissues
![Page 6: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/6.jpg)
Electrical injuriesHigh-voltage electrothermal burns:
- Contact point
![Page 7: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/7.jpg)
Electrical injuries
High-voltage electrothermal burns
- Ground point
![Page 8: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/8.jpg)
Electrical injuries Low-voltage burns:
erythema to full-thickness burns.
![Page 9: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/9.jpg)
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.
![Page 10: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/10.jpg)
Diabetes mellitus Complications :1. Microangiopathy
- Diabetic cardiomyopathy : heart failure
- Diabetic nephropathy : kidney failure
- Diabetic neuropathy : muscle weakness due to neuropathy , DM foot ,Sensory neuropathy
![Page 11: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/11.jpg)
Diabetes mellitus Stroke : mainly the ischemic type Diabetic retinopathy : Vision loss , Blindness Peripheral vascular disease,
- periungual erythema
![Page 12: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/12.jpg)
Diabetes mellitus Dermopathy
- Spontaneous Blisters in Diabetes
![Page 13: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/13.jpg)
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.
![Page 14: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/14.jpg)
Fig. 2. Place of fall in the cell where he sustained fracture of skull in occipital areaafter stroke, CVA.
Fig. 1. Solitary-confinement cell
![Page 15: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/15.jpg)
External examination
Fig. 3. Middle occipital areas showed abraded bruise near cut hair.
![Page 16: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/16.jpg)
External examination
Fig. 11. Hand showing necrotic nail bed areas.
Fig. 15. Finger nail beds are clean without any ischemic effect.
![Page 17: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/17.jpg)
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 necroticulcerative lesion ; little finger nail also showing small eroded ulcerative lesion.
![Page 18: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/18.jpg)
External examination
Fig. 13. Foot showing reddish areas (A and B).
![Page 19: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/19.jpg)
External examination
Fig. 14. Shows early erythematic blister like appearances in toes except the greattoe
Fig. 16. Foot of other side in clean.
![Page 20: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/20.jpg)
Internal examination
Central nervous system
Fig. 3. Middle occipital areas showed abraded bruise near cut hair.
![Page 21: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/21.jpg)
Internal examination
Fig. 6. Suturing of fracture line with craniotomy holes.
Central nervous system
Fig. 4. Blood in occitpal and tempero-parietal area of scalp, exaggerated bycraniotomy wound
![Page 22: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/22.jpg)
Internal examination
Fig. 7. Under surface of brain with contusion haemorrhages. Atherosclerosis of vessels also visible.
Fig. 8. Necrotic brain tissue after CVA.
![Page 23: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/23.jpg)
Internal examination Cardiovascular system
Fig. 10. Advance atherosclerosis in descending and abdominal aorta
![Page 24: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/24.jpg)
Discussion In our study the lesions seen in the finger bed
s 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.
![Page 25: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/25.jpg)
Discussion
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.
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.
Artefacts
![Page 26: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/26.jpg)
DiscussionArtefacts
Electrical injuries Ground point
Fig. 14. Shows early erythematic blister like appearances in toes except the greattoe
![Page 27: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/27.jpg)
Discussion In this particular case skin lesions were not se
en 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.
![Page 28: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/28.jpg)
Discussion The lesions over the skin of hand and feet wer
e probably due ischemic effects because of poor neuro-muscular and vascular control as a result of cerebral ischemia
Spontaneous Blisters in Diabetes periungual erythema
![Page 29: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/29.jpg)
Discussion
Opinion: death was due to cerebral hypoxia consequent to brain infarction and head injury
(a) Cranio-cerebral injuryDue to (b) Fall from standing heightDue to (c) Brain infarction
![Page 30: Case Report Diabetic artefacts in forensic practice O.P. Murty MBBS MD (Professor) * Forensic Medicine, Faculty of Medicine, UITM, Malaysia 40450 Present](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649e195503460f94b0641a/html5/thumbnails/30.jpg)
Do you have any question ?
Thank you.....Ka