Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE MARCH 1999 ISSUE THE POISON SLEUTHS DEATH BY DIESEL FUMES -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a old man today. What has happened to him? Please tell me." "Good morning Tarun. The name of this old man is Shyam. He was a big industrialist and was about 83 years old. His dead body was found today morning at about 9 am in his Ford saloon car. This car was parked in his garage. I may tell you that this car was fitted with a diesel engine." "So how do you think he has died?" "That is what I have to find out. But police has a suspect with them, and they think that he has killed Shyam. Well, let me begin from the beginning. Shyam had a business associate Sohan Lal. Both Sohan and Shyam had been working together for quite some time. However lately they had fallen out over some monetary matter. Sohan is a relatively young man - only about 48 years old. The police has interrogated many persons who knew both of them, and all of them have told the police that Sohan did not have good relations with Shyam. The things had deteriorated to such an extent that on one occasion, Sohan had even threatened Shyam with dire consequences." "Oh, I see. It does appear that Sohan has a hand in Shyam's killing." "Shyam Lal lives alone in his big mansion. His wife died about two years back and his only son is settled in Netherlands. He comes to India only occasionally. Rarely a guest comes to his house to spend a night with him. So for all practical purposes Shyam Lal lives alone in his house. Shyam Lal used to remain quite depressed after his wife's death, and it appears he had lost all will to live, especially as his only son had also left him. Two days before, i.e. on Saturday evening Sohan invited Shyam Lal for dinner. He came to Shyam Lal's house in his own car, parked it at his house and from there both of them drove to a 5-star hotel in Shyam Lal's car. It was somewhat surprising to Shyam, but he thought that probably Sohan wanted to settle matters with him, and so accepted his invitation. They had their dinner and returned quite late - at about 12 midnight. We know these details because the police has made thorough inquiries from the hotel staff. Shyam Lal was not seen on whole of Sunday, and on Monday morning, i.e. today his dead body has been found in the garage in his car. So the presumption is that Shyam Lal died just after his return from the hotel. I have made some preliminary examination of the dead body, and from the various changes seen in the body, I am also of the view that Shyam Lal died somewhere around 1 am on Sunday morning, i.e. just about one hour after return from the hotel." "So what do you conclude from all this?" "Well, the police has come up with an interesting story. According to them, Sohan mixed some poison in his food surreptitiously when they were having dinner together. He came with Shyam Lal back to his house. There he left him, collected his own car from his residence, and drove away. Shyam Lal was already feeling weak from the effect of the poison Sohan had given him. He wanted to get some rest. But just as we was parking his car in his garage, he fainted and dropped dead within his car. His body was only discovered today." "So what are they waiting for? They must immediately arrest Sohan." "They have already done that. But Sohan is swearing he didn't mix any poison in Shyam's food. He says that he did want to patch up things with Shyam, and for this purpose he had invited him for dinner. But from the talks it appeared to him that Shyam was reluctant to his proposal. They had talks for about 2 hours after which Sohan came back to Shyam's house, bade him good bye and went to his own house. He does not know what happened to Shyam Lal after that. However the police are reluctant to believe his version. They are holding him, and interrogating him more severely, so he could come out with the truth." "What do you think doctor?" "Tarun, a forensic pathologist goes only by the evidence that he has with him. I am a forensic pathologist and I won't form any theories merely from the details of circumstances. From the circumstances, it does appear that Sohan has a hand in the death, but I would make my deductions only from the hard scientific facts that I have seen for myself. I went to Shyam's house and made some preliminary observations. The first thing that struck me when I was examining the car was that, a hose pipe was connected to the interior of the car from the exhaust..." "Sorry to interrupt you doctor, but how is this observation important?" "Tarun. It is a common method of committing suicide. Carbon monoxide is known to emit from all car exhausts. Many persons - especially in the western countries- close themselves in a garage along with their car, run the engine of the car and simply wait there till the level of carbon monoxide rises enough to kill them. The attraction of this method among suicides is that it is a very painless death, and all persons wanting to commit suicide want a painless death. A hosepipe going to the interior of the car from the exhaust means an arrangement had been made to let the carbon monoxide come inside the car." "But doctor, these days most cars are fitted with catalytic converters. I believe such an advanced car as the Ford saloon, in which Shyam Lal's body was found must definitely be fitted with a catalytic converter." "You are right Tarun. Catalytic converters convert carbon monoxide to relatively non-toxic carbon dioxide. This has not only enabled the carbon monoxide levels in the atmosphere to go down, but also reduced the risk of suicides substantially. Now anyone who makes this arrangement for the purpose of committing suicide is likely to fail. The reason is that carbon dioxide is not as deadly as carbon monoxide. In fact, if you read medical literature, you will find many instances of failed suicides because of these catalytic converters." "Oh, I see." "Tarun, with the coming of new vehicles on the Indian roads, there is now an apparent progressive increase in diesel-driven motor vehicles in all forms of road transportation. Diesel is a commonly used vehicle now and it is believed to be safer than petrol as diesel fumes contain substantially less carbon monoxide. However their emissions are still potentially toxic. Diesel engines emit more than twice the amount of sulphur dioxide than that contained in petrol emissions. They also emit 14 times the amount of black smoke, i.e. particulate materials, than of petrol engines. Diesel emissions also contain marginally more nitrogen dioxide than petrol. Petrol, as I told you earlier, however creates more carbon monoxide - 28 times to be exact- than diesel." "Oh, I see. So if someone wants to commit suicide in the manner you just described, probably he is better off with a petrol engine than with diesel engine?" "You are right Tarun. The reason is obvious. Petrol engines create substantially more carbon monoxide. Of course only those petrol engines would do so, which are not fitted with catalytic converters. I must however tell you that both fuels cause acute toxicity if substantial quantities of their emissions are inhaled. However the mode of toxicity would be different. Whereas petrol engines cause death by carbon-monoxide poisoning, diesel fumes cause death by blocking the air passages with soot and other material in the emissions. The absorption of toxic materials in the latter case is increased owing to the blockage of tiny lung alveoli by the soot particles. These soot particles effectively plug the alveoli, thus "holding back" the toxic fumes within the alveoli. This greatly enhances the absorption of toxic substances. Thus although diesel fumes do not contain much carbon monoxide, they can still be very harmful." "Doctor, have you found any evidence that Shyam Lal died of diesel fumes?" "Tarun when I examined Shyam's heart, I found that the coronary arteries - the arteries that supply the muscles of the heart - were blocked to a great extent. However the amount of blocking was not sufficient to cause death, so I looked at other organs for more clues. The interesting finding was that the windpipe (trachea) and the bronchi were thickly covered with soot. The lungs were very much congested, which meant that they had been exposed to some irritating substance like diesel fumes. But what clinched the diagnosis in favour of death by diesel fumes was the fact that there were thick beads of black oily sticky material in the smaller bronchi. When I cut the lungs and pressed the cut ends, these thick beads of oily materials could be expressed. These beads were nothing but toxic material -including some diesel fuel- in the lungs. To see if the blood had any carbon monoxide in it, I did a toxicological analysis of the blood too, and found that there was less than 5% saturation with carbon monoxide. This indicates that there wasn't a substantial amount of carbon monoxide in the fumes that Shyam Lal inhaled. It is almost sure that Shyam Lal died of diesel fumes." "Oh, that is interesting. So would you reconstruct the events for me doctor?" "Sure. On Saturday evening, the talks between Shyam Lal and Sohan failed and this sent Shyam Lal again into a bout of depression, which he was already suffering from. He came back to his house and probably decided to take his own life. He had already lived a full life, his wife was no more there and his son was living far away from him. On that day, probably he lost all will to live. He was an educated man. He had read about deaths by carbon monoxide. I personally feel that he intended death by carbon monoxide. But it was a diesel engine, which does not emit carbon monoxide. He ultimately died of diesel fumes. Come let us tell the police that Sohan is innocent and they should release him." "Very clever indeed. This was a most interesting discussion doctor. Without your masterly deduction, police could have unnecessarily went on harassing Sohan. People might have thought, it was a case of killing by Sohan. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about death by arsine gas. "

Frequently asked questions General What is an electronic journal? An electronic journal is a scholarly publication made available exclusively in digital format, accessible via the Internet. Unlike traditional print journals, it leverages the flexibility and speed of the web, allowing for immediate global dissemination, interactive content, and multimedia integration. Why is your journal titled Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology? Wouldn’t a simpler title, such as Internet Journal of Forensic Medicine and Toxicology, be more appropriate? The journal bears my name to clearly identify the editorial leadership and maintain accountability for content quality. This practice ensures transparency and reflects the personal commitment behind the journal’s establishment and ongoing standards. It is a deliberate choice to build trust and credibility in an era of proliferating online publications. But isn't it somewhat unusual for a journal to be named after its editor? Indeed, it is unconventional. However, the name reflects the pioneering nature of this project—an initiative deeply driven by a single individual’s expertise and passion for forensic sciences. It symbolizes responsibility and personal stewardship over the journal’s integrity and quality. What is the frequency of publication of this journal? The journal publishes biannually, issuing two comprehensive editions per year, each presenting the latest advances and research in forensic medicine and toxicology. How many electronic journals currently exist on the internet? There are numerous electronic journals available online—approximately a dozen that I have personally accessed and linked on our homepage. However, Anil Aggrawal’s Internet Journal of Forensic Medicine and Toxicology remains a pioneering publication as India’s first true electronic journal across all disciplines and the world’s inaugural electronic journal dedicated to forensic medicine . This landmark journal was launched on February 25, 2000. Are the papers published in this journal peer-reviewed? Who are the editors? Yes. All submissions undergo a rigorous peer-review process before publication. The journal is guided by an International Board of Editors , comprising at least two subject-matter experts from each continent. For a full list of editors and their affiliations, please refer to the International Board of Editors page on our website. Can I cite articles from this journal in my book or academic papers? If so, how? Absolutely. Citing electronic journal articles is now standard academic practice. You are encouraged to reference our papers in your scholarly work. Detailed citation guidelines are available on the Instructions for Authors page. Do electronic journals simply act as repositories for papers rejected by traditional print journals? Not at all. The academic landscape has evolved significantly. Electronic journals are now widely respected, and many researchers specifically choose to submit to them. All papers published in this journal have been written and submitted exclusively for consideration here. Moreover, our journal has a distinct editorial scope and mission that sets it apart from conventional print journals. As outlined on our Home page, we embrace the unique capabilities of digital publishing—such as multimedia integration and broader accessibility—making it a purposeful and independent platform, not a fallback option.

OUR VALUED CONTRIBUTORS The following contributors have been kind enough to submit forensic quotes to this ever growing page of Forensic Quotes and Aphorisms. Contributor Clemency, E. Crippin, James (Jamie) Duxbury, Mike Signal45@aol.com Garrison Jr., Dean H. Jain, Vivek Kovac, Peter Porter, Harold J. Rikhari, R.D. Fernando, Gyan Category in which contributed General, Philosophical Witticisms Expert testimony General Autopsy Witticisms Witticisms Arson and fire investigation Forensic science and forensic medicine Autopsy, Autopsy risks, forensic pathologists E-Mail clemency@innocent.com jcrippin@rmi.net MDuxbury@aol.com Signal45@aol.com Gunhand@aol.com vivek@wilnetonline.net kovac@crick.fmed.uniba.sk haroldp@mail.gov.nf.ca rdrikhari@hotmail.com ssu.management-dcc@btinternet.com gyan_f@hotmail.com You may have enjoyed the quotes by these contributors, as well as other quotes appearing on these pages. May be you know more forensic quotes which are funny, hilarious, educative, instructive, stunning, pithy,.....you know what. You know what kinds will impress your colleagues. Click the button to contribute your own forensic quotes. All quotes which are found suitable would be put on the web with suitable credits. If you want, a link can be inserted so the readers can directly contact you via E-mail too. If you are not sure, whether a particular quote appears on these pages or not, send the quote just the same to me, and I will check it for you. I want to contribute my own forensic quotes too!

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE OCTOBER 1999 ISSUE THE POISON SLEUTHS DEATH BY VITAMIN A -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young man today. What happened to him? Please tell me.” “Good morning Tarun. The name of this 24 year old man is Ramlal, and he died in the hospital today morning. He was admitted to the hospital about two days back, with complaints of throbbing headache, pain in the stomach, diarrhoea, vomiting, irritability, dizziness, muscular weakness and cramps. Some peculiar symptoms, which confused most doctors at the hospital was that his skin was peeling off from many parts of the body, his hair were falling and that he had an irresistible desire to sleep. Doctors were trying to figure out what his illness was, but in the meantime he expired.” “Seems like a most strange illness to me doctor. But since you have said that his hair were falling, I can surmise that he might be suffering from Thallium poisoning.” “Tarun, I do remember having told you that hair start falling in thallium poisoning, but look at his other symptoms too. All the symptoms taken together are pointing towards only one direction - I can think of nothing but one poison, with which Ramlal must have been poisoned. It remains to be seen who gave him this poison.” “Doctor please tell me which is that poison. I am getting curious.” “Tarun, somebody has given Ramlal a dangerously high dose of Vitamin A, and probably that is why he has died.” “Vitamin A! Come on doctor. You are being preposterous. We all know that Vitamin A is an essential vitamin, which must be regularly taken to stay healthy. How can such a nutrient prove toxic?” “This is the paradox. Vitamin A acts as a double edged sword. Before saying anything, let me clarify a few basic concepts about Vitamin A. The term “Vitamin A” covers two chemicals - a true pre-formed vitamin known as retinol, and a pro-vitamin beta-carotene. A pro-vitamin is a substance which gets converted into the proper vitamin in the body. In human beings, some beta-carotene gets converted into Vitamin A in the intestinal mucosa, while the most gets converted in the liver. Vitamin A is usually measured in International Units or I.U. One I.U. of Vitamin A is equal to about 0.3 micrograms of retinol, which as you now know is the true Vitamin A. I must also tell you that one microgram of beta-carotene (which is the pro-vitamin) gets converted to about 0.167 micrograms of true vitamin A or retinol. Another way of saying this is that the “retinol equivalent” of one microgram of beta-carotene is 0.167.” “Oh, yes, I am understanding it. What is the daily requirement of Vitamin A, and what is its toxic dose?” “Normal daily requirement of Vitamin A for an adult is about 3000 I.U. per day. In pregnancy and lactation, it increases to about 4000 I.U. per day. Vitamin A capsules available in the market provide a little more than this amount. For instance Adexolin, a commonly available capsule of Vitamin A contains about 5000 I.U. of vitamin A. You must remember that Vitamin A and D are not soluble in water so if someone takes more quantities of these vitamins than required, there is no way they can be excreted. They generally are stored in the liver. On the other hand Vitamins B and C are water soluble vitamins. If someone takes enormous quantities of Vitamin B and C, they would be excreted in urine.” “Oh, I see. So this means Vitamin A can act as a poison too?” “Oh yes. Certainly. This is a fact which most people do not know. The medical condition which results from an intake of excessive amounts of Vitamin A is known as Hypervitaminosis A. About one million I.U. of vitamin A are very toxic to human beings, and about 3 million I.U. may prove fatal, as they have in the case of Ramlal. To put it another way, about a year’s requirement of Vitamin A if taken as a single dose may prove toxic, and about three years’ requirement taken as a single dose may kill a human being. Well, we do say often that ‘too much of a good thing can be bad’. Nowhere does this maxim prove truer than in the case of Vitamin A.” “Doctor, you are repeatedly saying that Ramlal died of Vitamin A poisoning, but how could he have got poisoned. You tell me that an average capsule of Vitamin A available in the market provides about 5000 I.U. of vitamin A, and also that about 3 million I.U. are fatal. This means that someone with an intent to kill his enemy has to administer as many as 600 capsules of Vitamin A to his enemy. How is that possible?” “Tarun, I did not tell you a very interesting fact. Most polar animals such as polar bears have dangerously high levels of Vitamin A in their liver. In fact there have been cases, where polar explorers have died of Vitamin A poisoning, because they ate the livers of animals residing in those regions.” “Really? That’s an interesting fact. How does such dangerous amounts of Vitamin A reach their liver?” “Vitamin A originates in marine algae, and then passes up the food chain to reach the large carnivorous animals. Toxic levels of Vitamin A may accumulate in the livers of a wide range of creatures such as Polar bears, seals, porpoises, dolphins, sharks, whales, Arctic foxes and huskies. Even a small meal of southern Australian seal liver, say 80 g, may produce illness in man. I may tell you that several foods are recommended as good sources of Vitamin A. Most of them contain well below the toxic levels of vitamin A, but one - Halibut liver oil - contains dangerously high amounts of Vitamin A, as you can see from the accompanying table. Source of Vitamin A Vitamin A content in International Units (I.U.) per gram of food Ox liver 550 Cod liver oil 600 Halibut liver oil 30,000 Table 1: Vitamin A content of some commonly recommended foods rich in Vitamin A In contrast look at the vitamin A contents of the livers of some common animals living in the polar regions in the following table. For comparison, I have also given the vitamin A content of the human liver. As you can see, most animals, especially the polar bear have very high amounts of Vitamin A in their livers. Common Name Zoological Name Vitamin A content of the liver in International Units (I.U.) per gm of specimen Weddel Seal Leptonychotes weddelli 444 Man Homo sapiens 575 Southern Elephant Seal Mirounga leonina 1,160 Antarctic huskies Canis familaris 10,570 Arctic bearded seal Erignathus barbatus 12,000-14,000 Polar bear Thalaractos maritimus 24,000-35,000 Table 2: Vitamin A content of the livers of some common animals living in polar regions - compared with that in humans “Oh, these two tables are real eye openers. Doctor, you were telling me that some polar explorers have actually died of Vitamin A poisoning. Could you tell me that story in detail please? I am getting curious.” “Oh sure. The story starts in January 1912, when a three man party of explorers from the Australasian Antarctic Expedition started their expedition to explore Antarctica. The team was led by Douglas Mawson, and the other two members were Lt. B.E.S. Ninnis and Xavier Mertz, a Swiss scientist. Disaster struck on December 14, 1912, when Ninnis fell into a very deep pit and died. With him also went precious food supplies. With most of their food gone, Mawson and Mertz decided to return to their base at Commonwealth Bay, which is at the shores of Antarctica. From here they could take the ship back to their country. But Commonwealth Bay was about 315 miles from where they were stationed. Covering that distance in the inhospitable surroundings of Antarctica would have taken them weeks, and they had only 10 days’ food left with them. They had six huskies with them. Huskies, as you know are Eskimo dogs, used as ponies in Antarctic region. They knew that sooner or later they would have to eat those dogs to remain alive.” “Oh, it was really terrible. But the story is getting interesting. What happened then?” “They did kill the huskies and ate their flesh, but the flesh was stringy and they could not eat it. In contrast to flesh, they found the liver softer and easier to eat so they took generous quantities of liver. Mertz was a near vegetarian; he could not eat the stringy flesh, so he took more liver than Mawson. Little did he realize that he was taking fatal amounts of Vitamin A in this form. On New Year’s Eve, Mertz began to feel ill. Next day he complained of stomach pains. Few days later both men began displaying typical symptoms of Vitamin A poisoning, although Mawson was affected less. Their skin was falling off their bodies in strips and their hair was dropping out in handfuls. A week later, Mertz fell into a delirious sleep - a sleep from which he never woke. As far as we know, he was the first case of death due to overdose of Vitamin A. Mawson survived, and ultimately did return to Commonwealth Bay." Note by the Editor There are counterclaims insisting that the death of Xavier Mertz and the suffering of Douglas Mawson was not due to overdose of Vitamin A. For more on this, please click here “This is certainly a most interesting incident doctor.” “So I was telling you about the vitamin A content of polar animals. With the amounts I told you, you can see that really very little quantities of livers of these animals are required to kill a human being. For instance, it would require about 30 to 90 g of the liver of a polar bear, 80 to 240 g of the liver of bearded seal and 100 to 300 g of the liver of Antarctic Husky to kill a human being. You may think that the livers of these animals are not commonly available. That is true, but Halibut liver oil also contains almost the same amounts of Vitamin A as that of the liver of Polar Bear. About 30 to 90 g of Halibut liver oil could thus prove fatal to a human being, and this is commonly available with the chemists. It is not very difficult for someone to coax another to drink this amount, especially when Halibut Liver Oil is commonly considered to be a health food.” “So you think someone coaxed Ramlal into drinking this amount of Halibut liver oil?” “This is exactly what has happened. I have made inquiries, and found that Suresh a person working in the same factory as Ramlal held a grudge against him. Suresh was an educated person - he held a first division in chemistry in college- and yet Ramlal, probably due to his hard work, rose to a higher position than him in the factory. He held another grudge against him, that Rekha, a co-worker whom he loved and wanted to marry was attracted more towards Ramlal.” “Oh, I see. But how did he coax Ramlal to drink a fatal amount of Halibut liver oil?” “Ramlal thought that he was not strong enough, and before marriage he could do with some more nutritious foods. Suresh knew about health foods well, and one day he took his advice. Suresh saw his chance and advised him to contact him the next day. Next day he handed him a bottle of Halibut liver oil and asked him to drink copious amounts from there. He told him that it acted as a good aphrodisiac and would serve him well before marriage. Poor Ramlal believed him, and drank almost the whole bottle, which contained 100 g of oil in one go. This is how he died.” “This is all very well doctor, but how are you going to prove in a court of law that Ramlal died of Vitamin A poisoning?” “Tarun, I have examined the vitamin A content of Ramlal’s liver and it is more than 40,000 I.U. per g. As you know, a human being should have at the most about 600 I.U. of Vitamin A per g of liver. This proves beyond doubt that Ramlal had Vitamin A poisoning. Added to this is the hospital record which gives us the typical symptoms of vitamin A poisoning. I don’t think the court would have any hesitation awarding sentence to Suresh. Come, let us tell the police to arrest Suresh.” "That was very clever of you doctor. Without your clever deduction - especially your noticing the peculiar symptoms of Ramlal at the time of his death- everybody would have thought he died of some mysterious natural disease. This was a most interesting discussion doctor. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Cicutoxin."

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Main Page > Vol-27 No.- 1 > Paper 1(you are here) [Epub ahead] Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 27, Number 1, January - June 2026 Received: Accepted: Ref: Tsranchev I , Timonov P , Yancheva S , Hadzhieva K , Gudelova T , Sotirova M , Fasova A , Dzhambazova E , Uchikov P. Posttraumatic Ischemic Brain Stroke After Sharp Neck Injury: A Case Report Based on Autopsy . Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology [serial online], ---- ; Vol. 27, No. 1 (January - June 2026): [about 6 p]. Available from: https://www.anilaggrawal.com/forensic-medicine-and-toxicology/vol-027-no-001/27-01-paper001 . Published : -----, (Accessed: ---) Email- Ivan Tsranchev Pavel Timonov Stela Yancheva Kristina Hadzhieva Teodora Gudelova Mirena Sotirova Antoaneta Fasova Elizabet Dzhambazova Petar Uchikov Posttraumatic Ischemic Brain Stroke After Sharp Neck Injury: A Case Report Based on Autopsy Abstract Neck injuries usually are emergency medical conditions which require special medical attention. Several complications following neck trauma could be fatal, if they are not correctly treated and diagnosed. Present case is of a 56-year- old male patient sustained sharp neck trauma, who was immediately admitted for hospital treatment, with following surgical reconstruction of the left carotid artery. Two days after the surgical intervention, the patient showed clinical signs of coma and sudden respiratory and cardiac failure, resulting in a lethal outcome. Autopsy and microscopic findings revealed a life-threatening post-traumatic complication following such type of trauma. In each case of sharp or blunt neck trauma, the diagnosis “post-traumatic ischaemic brain stroke” must be ruled out as a possible serious complication by a detailed examination, including laboratory, ultrasonography, contrast angiography and various specific imaging methods. All these medical actions as standard medical algorithm can save the patient’s life. Keywords: neck injury, posttraumatic brain stroke, sharp force trauma, fatal outcome, medico-legal case Introduction In routine forensic practice, various types of trauma can contribute to neck injuries, potentially leading to severe consequences or even a fatal outcome for the patient. Death could be directly attributed to the source of the injury or as a result of a complication following such a neck injury [1]. One possible cause of death can be a post-traumatic ischaemic brain stroke after blunt or sharp neck trauma involving blood vessels in the neck, which supply the brain with blood, which in turn can be a reason for blood clots and/or emboli, causing critical cerebrovascular blood flow blockage and death of brain tissue. In these emergency cases, if such an injury to the arteries can be diagnosed at the time after the trauma, a patient could be treated with different types of anti-clotting medications to prevent thrombosis and potential stroke formation, thus saving the patient's life. Case Presenntation A 56-year-old male patient after excessive alcohol consumption fell to the floor in a bar and injured his neck on pieces of a broken glass. Immediately after, he was transported by emergency medics to the University Hospital "St George", Plovdiv, Bulgaria. After a detailed emergency room assessment, he was transferred to the Department of Vascular Surgery with the diagnosis of an "incised wound in the neck region with severance of the left carotid artery." An emergency reconstruction of the vessel wall was performed. Two days after the surgical intervention, the patient presented with clinical signs of coma and sudden respiratory and cardiac failure, resulting in a lethal outcome. After death, the body was transferred to the Department of Forensic Medicine for routine forensic examination. During the examination of the cadaver in the autopsy room, it was observed that on the frontal surface of the neck, in its upper third, just below the tip of the chin and slightly to the left, a slit-shaped incised wound was found, which had been surgically treated and stitched with 4 sutures. The length of the wound was 5cm. The edges of the wound were relatively clean and smooth; the edges were sharp. On the left half of the frontal surface of the neck, in the upper, middle and lower thirds, a large zigzag wound was found, stitched with 15 sutures. The length of the wound was 17 cm. The edges of the wound were also relatively smooth and clean, slightly congested, with scattered necrotic areas (Fig. 1). The wound was additionally assessed by performing several deep surgical cuts. A slit-shaped wound, 1 cm long and treated with one stitch, was found 2 cm to the left of the zigzag wound in the middle third of the neck. Fig.1 showing the neck region represented with a zigzag wound Fig.2 showing the left common carotid artery and inserted prosthesis inside with a greyish-reddish dense thrombus The skin in the neck area was carefully dissected, and the zigzag wound was examined in depth. The muscles in the left half of the neck were diffusely blood-soaked with a dark reddish colour. The middle third of the sternocleidomastoid muscle had impaired integrity and had undergone surgical suturing. The muscle was dissected, and the left carotid artery was reached. It was found that a 2.5 cm long section from the common carotid artery to the carotid sinus was replaced by an artificial Dacron-type prosthesis. The left common carotid artery was opened during the autopsy, and at the upper end of the inserted prosthesis, a greyish-reddish dense thrombus was found inside, adhered to the prosthesis-vessel transition (Fig. 2). The thrombus occluded the lumen of the carotid artery by about 90%. Along the course of the external carotid artery at its beginning, two transverse tears in its intima with lengths of 0.2 and 0.4 cm were found. There was a tear in the wall of the left jugular vein at the level of the described carotid artery prosthesis. The tear is sutured. Its length was 0.5 cm. During the internal examination of the cadaver, all soft tissues forming the scalp were intact, with a moist surface and a pale pink colour. The bones of the cranium were intact. The dura mater was pearly in colour and had a smooth surface. The cerebral gyri were smoothed, and the sulci were narrowed. In the left parieto-temporal region, there was a section of the cerebral cortex, sunken below the level of the surrounding brain tissue, with a pale greyish-yellowish colour, sized 4cm by 3.5 cm. We fixed the brain in a 10% formaldehyde solution for 48 hours before conducting a detailed examination. The cerebral vessels at the base of the brain were well developed without malformations. A detailed examination revealed a hard, greyish-reddish thrombus occulting the left middle cerebral artery. Consecutive sections of the brain were made. In the left parieto-temporal region of the brain, a large area of softening with a livid-greyish colour was found, with peripheral reddish haemorrhages (infarction) around it. The border between the grey and white brain matter was obliterated (Fig. 3). This area measured approximately 8 cm x 7 cm as dimensions on the surface of the left cerebral hemisphere with depth measured 7 cm in the left cerebral hemisphere. The left middle cerebral ventricle narrowed, and the left cingulate gyrus (gyrus cinguli) was shifted to the right. In the hypothalamus in the left cerebral hemisphere, a dark reddish round haemorrhage measuring 0.5 cm x 0.5 cm was also found. A similar haemorrhage was found in the basal nuclei of the left hemisphere, measuring 1 cm x 0.5 cm. Along the course of the brainstem (pons and medulla oblongata), numerous dark reddish haemorrhages measuring from punctate to 0.5 cm in diameter were found. In cross-section, the cerebellum was clear and normally developed. Fig.3 showing the infarction of brain matter over the left cerebral hemisphere Samples from brain matter were taken, and further microscopic examination was performed with H-E staining under Primo Star Zeiss microscopes with enlargements of 10x, 40x, and 100x. The detailed microscopic examination showed haemorrhages, oedema and multiple massive punctate haemorrhages in the left frontal cortex with multiple massive punctate haemorrhages in the left parietal cortex (Fig. 4), in combination with hyperaemia of blood vessels in the arachnoid layer. Additional microscopic findings were stated during this examination as follows: corpus callosum – mild oedema, hypothalamus – massive punctate haemorrhages and mild oedema, pons – areas with haemorrhages and severe oedema, medulla oblongata – severe oedema, cerebellum – oedema, cortex – mild oedema 2. Carotid artery vessel wall – part of a vessel with mixed thrombus (fig. 5). Other samples from internal organs showed no significant pathologic changes. Fig. 4 showing multiple haemorrhages and oedema in the left frontal and left parietal cortex. H-E staining. Fig.5 showing the carotid artery vessel wall – part of a vessel with mixed thrombus. H-E staining Discussion Ischaemic strokes resulting from carotid artery thrombosis following open and closed head and neck trauma have been recognised with increasing frequency recently, and these cases involve not only adults but even children [2-6]. They can lead to life-threatening consequences or even a fatal outcome if they are not diagnosed correctly [7-10]. Ischaemic strokes resulting from carotid artery thrombosis are observed in both blunt and sharp injuries, such as in the case report described above. Carotid artery thrombosis is a rare but potentially devastating complication that can follow even reconstructive surgery of any major traumatised blood vessel of the neck region [11, 12]. The non-traumatic genesis of carotid artery thrombosis, which can lead to ischemic stroke, should also be considered in such cases. The most common cause of non-traumatic carotid artery thrombosis is atherosclerosis [13]. In the presence of an unstable atherosclerotic plaque or an ulcerated atherosclerotic plaque, the endothelium of the arteries is compromised. In these cases, coagulation factors are activated, which predisposes to the formation of thrombi. In our case report during the autopsy, no atherosclerosis of the carotid arteries was detected. Other factors, of a non-traumatic nature, also predispose to the formation of thrombi in the body, such as obesity, pregnancy, smoking, arterial hypertension, and hyperlipidemia. Our case lacks previous patient history on whether the patient had any of the above-listed diseases based on medical documentation, and no pathological changes or malformations of the vessels in the brain were identified during the autopsy and on microscopy. Other causes of ischemic stroke are emboli. Most often, emboli form in the heart in the area of a post-infarction aneurysm, in the left auricle of the heart in patients with ventricular fibrillation, and in patients with bacterial endocarditis. No such conditions were found in our case report. Taking certain medications, such as oral contraceptives, can cause blood clots to form in women. Different mechanisms can cause traumatic internal carotid artery thrombosis, including direct traumatic force delivered to the neck, the head, or the oral cavity, resulting in trauma to the soft tissues or even to the cranial bones, other possible mechanisms are whiplash trauma, seatbelt trauma or even procedures in the neck region [14]. Studies have shown that factors significantly increasing the risk of developing carotid thrombosis due to carotid artery injuries include non-penetrating head injury, basilar fractures of the skull, facial fracture, cervical spinal fractures and thoracic injuries [15], with the non-penetrating head injury being the most common single associated injury. In the literature is suggested that combined injuries to the upper part of the body /head and neck injuries especially skull and spinal fractures and combined injuries to the head and chest/ increase the risk of damage to the carotid arteries. In our case the patient did not sustain any other trauma, except to the neck. In this case, we concluded that the cause of death is an ischaemic brain stroke caused by vascular injury resulting from sharp force trauma to the neck. He sustained a reconstructive operation on the traumatised section of the common carotid artery, which was replaced with an artificial Dacron-type prosthesis, despite additional anticoagulation therapy. During the autopsy, a thrombus was found adhered to the prosthesis-vessel transition. The macroscopical and histological examinations determined ischaemic brain stroke.These results imply that the carotid artery damage location is where the thrombus originated. It is therefore very likely that the thrombus formed as a result of an intimal tear in the carotid artery caused by the sharp force trauma. The patient died three days later, with clinical signs of coma and sudden respiratory and cardiac failure. In summary, for patients admitted for treatment as a result of neck trauma caused by a sharp object, it is important to monitor them, especially in the first few days, for the appearance of neurological symptoms [16]. It is known that in the early stages of development of an ischaemic stroke of the brain, changes may not be visualised with standard imaging techniques like a CT scan. Therefore, numerous tests have been developed that can provide an early evaluation of a neurological condition, such as the MMSE (mini mental state examination) or Folstein test, the Hodkin-son abbreviated mental test score. Highly sensitive imaging methods have also been developed, such as diffusion-weighted magnetic resonance imaging (DWI or DW-MRI), which is highly sensitive to the changes occurring in the lesion and revealing subclinical neurological changes. These imaging-specific methods could be used in combination with specific biochemical markers, proving the diagnosis [17]. CT angiography is also a highly sensitive and informative imaging method which could be in helpful use for the correct diagnosis. Conclusion Different diagnostic methods, clinical assessing tests and biochemical markers could be used in cases of sharp force neck trauma to diagnose this type of life-threatening post-traumatic complication in trauma patients. In each case of sharp or blunt neck trauma, the diagnosis “post-traumatic ischaemic brain stroke” must be ruled out as a possible serious complication. A detailed examination, including laboratory, ultrasonography, contrast angiography and various specific imaging methods with the rich patient’s history, periodic neurologic consultation and physical examination, must be performed as a standard algorithm for medical action in such types of clinical cases. That could prevent fatal complications and can save a patient’s life. References 1. Tawil I, Stein DM, Mirvis SE, Scalea TM. Posttraumatic cerebral infarction: incidence, outcome, and risk factors. J Trauma. 2008 Apr;64(4):849-53. doi: 10.1097/TA.0b013e318160c08a. PMID: 18404047 2. Yılmaz S, Pekdemir M, Sarısoy HT, Yaka E. Post-traumatic cerebral infarction: a rare complication in a pediatric patient after mild head injury. Ulus Travma Acil Cerrahi Derg. 2011 Mar;17(2):186-8. PMID: 21644101. 3. Chaturvedi S, Sohrab S, Tselis A. Carotid stent thrombosis: report of 2 fatal cases. Stroke. 2001 Nov;32(11):2700-2. PMID: 11692038. 4. Moulakakis KG, Kakisis J, Tsivgoulis G, Zymvragoudakis V, Spiliopoulos S, Lazaris A, Sfyroeras GS, Mylonas SN, Vasdekis SN, Geroulakos G, Brountzos EN. Acute Early Carotid Stent Thrombosis: A Case Series. Ann Vasc Surg. 2017 Nov;45:69-78. doi: 10.1016/j.avsg.2017.04.039. Epub 2017 May 5. PMID: 2848362 5. Caldwell HW, Hadden FC. Carotid artery thrombosis; report of eight cases due to trauma. Ann Intern Med. 1948 Jun;28(6):1132-42. doi: 10.7326/0003-4819-28-6-1132. PMID: 18864120 6. Hockaday TD. Traumatic thrombosis of the internal carotid artery. J Neurol Neurosurg Psychiatry. 1959 Aug;22(3):229-31. doi: 10.1136/jnnp.22.3.229. PMID: 14402209; PMCID: PMC497379 7. Schneider RC, Lemmen LJ. Traumatic internal carotid artery thrombosis secondary to nonpenetrating injuries to the neck; a problem in the differential diagnosis of craniocerebral trauma. J Neurosurg. 1952 Sep; 9(5): 495-507. doi: 10.3171/jns.1952.9.5.0495. PMID: 12981571. 8. Moulakakis KG, Mylonas SN, Lazaris A, Tsivgoulis G, Kakisis J, Sfyroeras GS, Antonopoulos CN, Brountzos EN, Vasdekis SN. Acute Carotid Stent Thrombosis: A Comprehensive Review. Vasc Endovascular Surg. 2016 Oct;50(7):511-521. doi: 10.1177/1538574416665986. Epub 2016 Sep 19. PMID: 27645027 9. Julia C. Schmidt, Dih-Dih Huang, Andrew M. Fleming, Valerie Brockman, Elizabeth A. Hennessy, Louis J. Magnotti, Thomas Schroeppel, Kim McFann, Landon D. Hamilton, Julie A. Dunn, Missed blunt cerebrovascular injuries using current screening criteria — The time for liberalised screening is now. Injury, Volume 54, Issue 5, 2023, Pages 1342-1348, ISSN 0020-1383, https://doi.org/10.1016/j.injury.2023.02.019 10. Macdonald S. Brain injury secondary to carotid intervention. J Endovasc Ther. 2007 Apr;14(2):219-31. doi: 10.1177/152660280701400215. PMID: 17488181. 11. Setacci C, de Donato G, Setacci F, Chisci E, Cappelli A, Pieraccini M, Castriota F, Cremonesi A. Surgical management of acute carotid thrombosis after carotid stenting: a report of three cases. J Vasc Surg. 2005 Nov; 42(5):993-6. doi: 10.1016/j.jvs.2005.06.031. PMID: 16275459. 12. Iancu A, Grosz C, Lazar A. Acute carotid stent thrombosis: review of the literature and long-term follow-up. Cardiovasc Revasc Med. 2010 Apr-Jun; 11(2):110-3. doi: 10.1016/j.carrev.2009.02.008. PMID: 20347802.] 13. Torvik A, Svindland A, Lindboe CF. Pathogenesis of carotid thrombosis. Stroke. 1989 Nov; 20(11): 1477-83. doi: 10.1161/01.str.20.11.1477. PMID: 2815181. 14. Karnecki K, Jankowski Z, Kaliszan M. Direct penetrating and indirect neck trauma as a cause of internal carotid artery thrombosis and secondary ischaemic stroke. J Thromb Thrombolysis. 2014 Oct; 38(3): 409-15. doi: 10.1007/s11239-014-1077-2. PMID: 24748050; PMCID: PMC4143597. 15. Hayakawa A, Sano R, Takahashi Y, Fukuda H, Okawa T, Kubo R, Takei H, Komatsu T, Tokue H, Sawada Y, Oshima K, Horioka K, Kominato Y. Post-traumatic cerebral infarction caused by thrombus in the middle cerebral artery. J Forensic Leg Med. 2023 Jan; 93:102474. doi: 10.1016/j.jflm.2022.102474. Epub 2022 Dec 24. PMID: 36577210 16. Fisher M, Paganini-Hill A, Martin A, Cosgrove M, Toole JF, Barnett HJ, Norris J. Carotid plaque pathology: thrombosis, ulceration, and stroke pathogenesis. Stroke. 2005 Feb;36(2):253-7. doi: 10.1161/01.STR.0000152336.71224.21. Epub 2005 Jan 13. Erratum in: Stroke. 2005 Oct; 36(10): 2330. 17. Capoccia L, Speziale F, Gazzetti M, Mariani P, Rizzo A, Mansour W, Sbarigia E, Fiorani P. Comparative study on carotid revascularisation (endarterectomy vs stenting) using markers of cellular brain injury, neuropsychometric tests, and diffusion-weighted magnetic resonance imaging. J Vasc Surg. 2010 Mar; 51(3):584-91, 591.e1-3; discussion 592. doi: 10.1016/j.jvs.2009.10.079. Epub 2010 Jan 4. PMID: 20045614 *Corresponding author and requests for clarifications and further details:

Anil Aggrawal's Internet Journal of Book Reviews Aims and Objectives This journal has been started by Dr Anil Aggrawal, Professor of Forensic Medicine at the Maulana Azad Medical College, New Delhi - 110002. Dr. Aggrawal is quite keen to interact with people who are interested in books. Dr. Aggrawal adores books and literally thrives on them. Though being a medical doctor specializing in forensic medicine, he loves books on all subjects encompassing such diverse ranges from astronomy and zoology to paleontology, history, occult science, philosophy, mathematics, and classical literature, et al. His penchant for books was conceived quite early in life. Even as a three year old he always pined for books instead of toys-as his siblings did. There is a legend about the Greek mathematician and engineer Archimedes (ca. 287 B.C. - ca. 212 B.C.). When Roman armies sacked Syracuse in 212 B.C. he was busy studying a geometrical figure made in sand. When a Roman soldier commanded him to come along, he motioned to him imperiously, "Don't disturb my circles". The soldier felt so insulted that he killed Archimedes on the spot! In a similar situation Dr. Aggrawal would probably say, "Don't disturb my books!" Writers and thinkers have always been his idols. Some of the people who have inspired him are (i)Lord Buddha (he remains first on his list) (ii)Albert Einstein (iii)Robert James Fischer (The only American who has been an official World Chess Champion) and (iv)Isaac Asimov (he wrote close to 500 books, and is reputed to be the only author to have published books in all ten categories of the Dewey Decimal System! Oh, well, we all know it's not true, but he has really written so widely, it seems cruel to challenge this statement.) Aggrawal is no Asimov, but like him, he loves writing books. He has written nine books so far (till 2006 end). Four of them are quiz books, which reflect his morbid passion for quizzes. The books, in order they were published are (i) 1000 Crime Quiz (published 30 March 1992) (ii)1000 Love & Sex Quiz (published 13 August 1992) (iii) Some Common Ailments (Published 27 January 1993)(iv)The Book of Medicine (Published 5 February 1994) (v)Narcotic Drugs (Published on 2 May 1995) (vi) 1000 Biology Quiz (Published on 29 August 1995) (vii)Modern Diagnostics (Published on 8 March 2001) (viii) Health Quiz Book (Published on 5 August 2002) (ix) Self Assessment and review of Forensic Medicine and Toxicology (the first book related to his profession). And since we all love statistics, here is a detailed statistics of these books. Here they are: Book Statistics Book 1000 Crime Quiz 1000 Love & Sex Quiz Some common Ailments The Book Of Medicine Narcotic Drugs 1000 Biology Quiz Modern diagnostics Health Quiz Book Self assessment and review of Forensic Medicine & Toxicology Started On 1.2.91 1.6.91 1.6.91 Nov 92 1.1.93 6.1.92 1995 Feb 2002 2005 Completed On 31.5.91 5.1.92 28.11.91 Jan 93 9.5.94 17..3.93 1995 July 2002 2006 Submitted On 31.5.91 7.1.92 28.11.91 15.1.93 9.5.94 19.3.93 1996 July 2002 April 2006 Published March 1992 Aug 1992 Jan 1993 Frb 1994 May 1995 Aug 1995 March 2001 Aug 2002 May 2006 Publisher Rupa Rupa NBT Rupa NBT Rupa NBT Ocean Books PeePee Cost 30 30 25 30 46 80 80 200 295 (Books published till 2007 end) N.B. 1. NBT stands for National Book Trust, India. 2. Dates mentioned are in this format: day/month/year. 3. The cost is in Indian Rupees. 4. Some Common Ailments has been translated in Assamiya, Bangla, Hindi, Kannada, Konkani, Marathi, Nepalese, Oriya, Punjabi, Telugu and Urdu (Total 12 languages). 5. Narcotic Drugs has been translated in Assamiya, Bangla, Hindi, Punjabi and Urdu (Total 6 languages). 6. Health Quiz Book has been translated in Hindi (Total 2 languages). Why is Dr. Aggrawal interested in writing book reviews? Whenever he reads a book he tries to discover its strong points. There is a subconscious effort on his part perhaps, to incorporate those points in his own writings. He then wants to share his findings with everyone. In the year 2000, he started an Internet Journal of Forensic Medicine and Toxicology, and out of his sheer interest in books, he included a book review section to it. The unprecedented popularity of the review section took him by complete surprise. He received books from authors and publishers in thousands. And they belonged to all subjects-not only forensic medicine and toxicology, which he had intended at the inception of the above journal. With time he and his group realized that they must conjure another journal devoted solely to Book Reviews for books of all genre. In this all-new journal they would accommodate all kinds of books, and hence the present Anil Aggrawal's Internet Journal of Book Reviews. Dr. Aggrawal fondly cites the examples of many regular journals (not devoted to book reviews), which have come out with issues especially devoted to book reviews. One pertinent example is Archives of Sexual Behavior, which came out with an issue (Volume 28, Number 5 / October, 1999, pages 377-467) especially devoted to book reviews in 1999. -Puneet Setia Journal Associate

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| Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Paper/Thesis/Dissertation Submission GUIDELINES A ll papers can be submitted electronically (by E-mail, floppy, magneto-optical disk, zip drive, tape drive or CD). If you are comfortable with sending just a typed manuscript, this is also acceptable (please include your E-mail ID in the covering letter). The submitted material must come along with the submission letter. This is a signed statement on official letterhead, which must state the following: SUBMISSION LETTER 1. 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I/we also understand that if requested by the reviewers for cross-checking facts stated in the paper, I/we would be able to send a pdf/scan/photocopy of the paper. 4. The article contains no libellous or other unlawful statements and does not contain any materials that violate any personal or proprietary rights of any other person or entity. In case, any legal action is instituted because of any statement(s) made by me in the paper, I will be completely responsible for it, and the journal would carry absolutely no liability in that matter. 5. I/we hereby acknowledge Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology's conflict of interest policy requirement to scrupulously avoid direct and indirect conflicts of interest. Therefore I/we hereby agree to promptly inform the editor-in-chief of any business, commercial or other proprietary support, relationships, grants or research support or any other interests that I/we may have which relate directly or indirectly to the subject of the work. 6. I/we also agree to the authorship of the paper in the following sequence: Authors' Names in sequence Signatures of authors 1. 2. 3. 4. 7. Detailed contribution statements (i.e., if a manuscript has more than one author: who contributed what part?) - If the manuscript has more than one author, please be kind enough to specify here the specific part played by each author towards the preparation of the final paper. 8. I/we understand that my/our paper may be published in a future issue as “publication ahead of print” or “epubahead.” [As mentioned in the guidelines page, the paper will be available online and citable by other workers, right from the day/year of publication as “epubahead”]. 9. I/we transfer the copyright of the paper/all associated photographs, line diagrams and other associated material to "Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology." Signed (First/Main author) Current Position with complete mailing address Telephone number Email Submission letters through Email Submission letters can be submitted via Email, as a scanned copy. They must (1) Clearly show signatures of authors (2) Must be on institution or personal letterhead (3) Should have contact details of all authors [emails, phones etc]. In addition, authors must keep in mind the following rules. (A) All documents related to the paper must be submitted in one lot and not in parts. (B) Only one paper [plus all related documents] can be submitted per email. More papers may be submitted, but each paper [plus all related documents] must be sent in a separate email. Some sample letters are given below. Please click to enlarge. S ubmission letters can be on multiple pages as below. 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Note - This journal DOES NOT ACCEPT PAPERS THROUGH ANY OTHER WEBSITE / LINKS, than the one mentioned here. Why should you publish with us? Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology is indexed with most leading indexing databases, thus ensuring maximum visibility among your peers. The content of the journal being freely accessible to all is another factor of great advantage. This greatly increases the chances of your paper getting cited in other journals /books of repute. For some examples, please click links below: National Library of Medicine, Bethesda, USA Please see visit this journal at National Library of Medicine, USA. References in Journals Aggression and Violent Behavior. 2003 Sep;10(3):153-7. [Please see reference on page 145, highlighted in yellow]. International Orthopaedics (SICOT) (2004) 28: 187–190 [Please see reference 7, highlighted in yellow]. Journal of Clinical and Forensic Medicine. 2003 Sep;10(3):153-7. [Please see reference 15, highlighted in yellow]. Journal of Trauma. 2004;57:125–129. [Please see reference 18, highlighted in yellow]. J Forensic Sci, Jan. 2005, Vol. 50, No. 1. [This is a book review. Please see mention of the journal highlighted in yellow]. Pediatr Nephrol (2005) 20:1610–1614. [Please see reference 20, highlighted in yellow]. Journal of Clinical and Forensic Medicine. 2005 Jun;12(3):149-52. [Please see reference 14, highlighted in yellow]. The American Journal of Forensic Medicine and Pathology : March 2006 - Volume 27 - Issue 1 - pp 75-78 [Please see reference 12, highlighted in yellow]. Traffic Injury Prevention, Volume 7, Issue 1 March 2006 , pages 70 - 75 [Please see reference to this journal highlighted in yellow]. The American Journal of Forensic Medicine and Pathology : March 2007 - Volume 28 - Issue 1 - pp 86-90 [Please see reference 28, highlighted in yellow]. The Spine Journal 8 (2008) 703–704 [Please see reference 4, highlighted in yellow]. Leg Med (Tokyo). 2009 May;11(3):107-10. [Please see reference 4, highlighted in yellow]. References in Books / Book chapters Essential Forensic Biology , by Alan Gunn, 2nd ed ( Wiley , 2009) [Please see the reference on page 397, highlighted in yellow]. Forensic Entomology - An Introduction , by Dorothy E. Gennard, 1st ed ( Wiley , 2007) [Please see the reference on page 17, highlighted in yellow]. Forensic Evidence Science And The Criminal Law , by Terrence F. Kiely, 2nd ed ( CRC Press , 2006) [Please see the 11th reference on page 328, highlighted in yellow]. Manejo de la evidencia física de posible fuente biológica [Spanish], by Mercedes Salcedo Cifuentes ( Universidad del Valle , 2007) [Please see reference 29 on page 52, circled in yellow]. You can also visit this book on google books by clicking here . Please go to page 52. Other Papers of Interest Growing Visibility of Indian Biomedicine and Life Sciences Journals in Global Alerting Services , by N.C. Jain. 30 May 2008. Sawant, S. The current scenario of open access journal initiatives in India. Collection Building . 2009; 28(4) :159–163 Vancouver Style All manuscripts should conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Ann Intern Med 1997;126:36-47). References must be in accordance with Vancouver style. Please visit the following sites for guidance on Vancouver style. AMA Style Guide Bibliographic Services Division of the United States National Library of Medicine, National Institutes of Health BMA - Reference styles Citing your sources - Vancouver style Download reference styles Sample PubMed Central Citations Vancouver Style Vancouver Style Quick guide - How to use it The Columbia Guide to Online Style , second edition by Janice R. Walker and Todd Taylor We can provide help and support if needed: Guideline Support It is important that authors double-check the grammar and style used in the paper. 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This URL will be used by us to give a link to medIND medIND URL: http://medind.nic.in/iaj/t03/i2/iajt03i2p85o.pdf The complete citation in your paper should be as follows: Jha N, Srinivasa DK, Roy G, Jagdish S. Injury pattern among road traffic accident cases: A study from South India. Indian Journal of Community Medicine 2003; 28(2):85-90.medIND URL: http://medind.nic.in/iaj/t03/i2/iajt03i2p85o.pdf Please note that as with pubmed links, the medIND URL provided by you will not appear as such in the published paper. This URL will ONLY be used to provide medIND links to your citations. For one example of how medIND links will be provided to your citations, please click the following link: https://anil.aggrawal.org/ij/vol_006_no_002/papers/paper006.html Electronic journals For electronic papers, please provide citations like below: Friedlander, ER. Cryptogenic Organizing Pneumonia Masquerading as Coal-Worker's Pneumoconiosis. Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology [serial online] , 2007; Vol. 8, No. 2 (July - December 2007): [about 8 p]. Available from : https://anil.aggrawal.org/ij/vol_008_no_002/papers/paper002.html Published : July 1, 2007, (Accessed: June 23, 2025) What's new in your paper All papers must be accompanied by a separate sheet detailing these four columns: 1. What is already known on this topic? 2. What question did this study address? 3. What does this study add to our knowledge? 4. Suggestions for further development These columns will make it clear in the mind of readers, what exactly is the new message given in your paper. Furthermore, it would give them new ideas for further research in the area, which should be the aim of all good academic journals. For further guidance on the above matter, you may want to visit the paper by Edward R. 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< Back To Main Page. LinkedIn WhatsApp X (Twitter) Facebook Copy link Anil Aggrawal's Book Review Journal Volume-15 Number-1 (July -December) Book Review (Technical Section) Basic Sciences as applied to Forensic Medicine and Toxicology by Anil Aggrawal Publisher: Arya Publishing Company, India (1st edtion) Pages: XVIII + 301 Publication Date: 2025 ISBN: 9789360590864 Language: English Read >

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE APRIL 1999 ISSUE THE POISON SLEUTHS DEATH BY ARSINE GAS -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a middle aged man today. What has happened to him? Please tell me." "Good morning Tarun. The name of this middle aged man is Radhey. He used to work in a factory, where they used to make soldering flux. He was working in his factory five days ago, when at about 2 pm, suddenly he started having nausea, headache, vomiting and diarrhea. He had taken lunch only a few minutes before so naturally everybody started thinking that he had had food poisoning. His illness soon became worse. He started complaining of intense headache and pain in the loins. He passed urine after sometime, and everybody was alarmed to see that it was very dark. He was taken to the hospital, where the doctors were unable to diagnose his illness. However the history of having taken his meals only a few minutes before, and the non-specific symptoms prompted some doctor to write "undiagnosed poisoning" on the hospital case sheet." "So it was a case of poisoning? Was somebody else was poisoned too?" "No, nobody else was poisoned - of course presuming that Radhey died of poisoning. Only Radhey showed these peculiar symptoms. The tentative diagnosis of "undiagnosed poisoning" flared up everybody's tempers, especially those of Radhey's relatives. They thought that somebody had surreptitiously mixed poison in his food. And all suspicion fell on another man Suleiman." "Why on Suleiman doctor?" "Because and Radhey apparently did not have good relations. They did not even talk to each other. Nobody knows how their fight started, but it is for sure, that they were sworn enemies. After Radhey was taken to the hospital, the doctors tried their level best to save him, but they could not, and he died today morning after an illness of about four and half days. The doctors refused to give a death certificate, as they did not know the illness Radhey was suffering from. Meanwhile the relatives of Radhey actually lodged an FIR in the police station, in which they alleged that Suleiman had poisoned Radhey, and he should immediately be taken in custody. Apparently the relatives of Radhey had some political clout too, so the police had to act fast. Now they have sent this body to me. My job obviously is to find out how Radhey actually died." "Very interesting indeed. That explains the big mob outside your mortuary. When I came to meet you, I was surprised to see several people sorrounding this mortuary several of whom were toting cellulars." "Yeah, they are very influential people, and apparently they would leave the mortuary only after they have come to know of the cause of Radhey's death. The pressure on police was so much that they had to arrest Suleiman." "What does Suleiman say doctor?" "I have talked to Suleiman myself. The police has also talked to him. He says he has absolutley no hand in this killing. He has hired a lawyer for his defense and he is pressurizing the police by saying that they can not arrest his client without any solid evidence. So the police are finding themselves in a Catch-22 situation. As you can understand, I have been showered upon with a very heavy responsibility." "Yes indeed. I can understand that. Now where do you start from?" "Tarun, I have already started actually. Whenever a death occurs in a factory, I make it a point to visit the factory first and see what kind of activities were going there. I found that Radhey was involved in making soldering flux by putting zinc scrap in hydrochloric acid." "Please explain this to me in some great detail doctor." "Tarun, in several industries there is a "rough and ready" practice of producing zinc chloride to provide a soldering flux by putting zinc scrap in hydrochloric acid. This is actually not recommended as sometimes a very poisonous gas arsine may form in this process. The zinc scrap may contain arsenic as an impurity, and when arsenic acts with hydrochloric acid, it forms arsine (AsH3) a very dangerous gas." "So you think Radhey died of arsine gas?" "I can't say for sure at present, but after you know more about this interesting gas, you can make a guess yourself." "Looks like we are on the trail of yet another interesting poison. Doctor please tell me more about arsine gas." "Tarun, arsine is a very toxic gas, a molecule of which contains just four atoms - three of hydrogen and one of arsenic. It is a colorless inflammable gas. It is supposed to have an odour of garlic, but it is not always apparent, especially when a person is suffering from common cold. It is an unstable compound which when exposed to light or moisture, decomposes to deposit arsenic. It is heavier than air, its vapour density being 2.68 times that of air. You might be surprised to know that the German chemist Gehlen died of accidental arsine poisoning in 1815." "Oh, I didn't know that." "Tarun, arsine is one of the most poisonous gases known. It can kill outright. Even brief exposure to moderate concentrations can cause serious illness. I will give you some figures which will tell you something about the killing power of this gas. The four most poisonous gases are carbon monoxide, phosgene, chlorine and arsine. Inhalation of carbon monoxide in concentrations of 1000 parts per million (ppm) for a few minutes can cause death. The equivalent figures for Chlorine and Phosgene are 400 ppm and 50 ppm respectively, meaning thereby that they are more poisonous. Obviously the lesser concentration required for killing, more poisonous the gas. You would be surprised to know that in the case of arsine, only a concentration of 10 ppm inhaled for about half an hour could be dangerous. And at such low concentrations, the pecualiar garlic odor of the gas may not be apparent at all. The safe maximum concentration of carbon monoxide - generally considered by all to be very toxic - is 100 ppm, while that of arsine is just 0.05 ppm. This can give you some idea of the lethality of this gas" "Oh, sure. From the figures it appears to be about 2000 times more poisonous, which is remarkable. Especially considering the fact that everybody considers carbon monoxide to be a very deadly gas." "Exactly. Like carbon monoxide, arsine is a cumulative poison too. This means that it is excreted much more slowly from the body than it is absorbed. This results in gradual accumulation of the poison in the body which can be very dangerous. A good simily is of a tank, in which poisonous water is entering much faster than it is being let out. This would ultimately result in overloading of the tank with the poisonous water." "Yes, I understand. But what is the significance of a cumulative poison doctor?" "Tarun, it means that repeated or prolonged exposure to even a very low concentration can be dangerous. Thus a cumulative poison - that whose excretion rate is slower than that of its absorption- is a much more dangerous poison, than a non-cumulative poison. The hazard of arsine gas exists in a number of industries including the refining of metal, the manufacture of corrosive acids, galvanizing and electroplating. It is also a risk in laboratories. There was a time when the use of wall papers colored with pigment which contained Scheele's Green, yielded arsine in the home, when acted upon by a mould. This could create severe poisoning in the inmates, especially considering that arsine is a cumulative poison." "Just a minute doctor. What is Scheele's Green?" "Tarun, Scheele's Green is a popular name for cupric arsenite. Its formula is Cu3(AsO3)2.2H2O. It is named thus in the memory of the famous Swedish Chemist Kark Wilhelm Scheele (1742-1786). It is a brilliant green pigment which was once used for paints, but since it is a potentially poisonous compound, it is no more used now. When mould acts on this compound, arsenic may get combined with hydrogen molecules and may form arsine, which may be very poisonous. Arsine may be produced in quite a few other remarkable ways." "What are those doctor? Please tell me." "Tarun, I know of a unique case of industrial poisoning by arsine in which three men were poisoned - one of them fatally. They were engaged in unloading fish scrap from the hold of a wooden schooner. The close, warm atmosphere promoted bacterial activity and, in turn, the production of arsine." "Oh that is indeed quite unusual." "Yes. Another likely source of arsine is the interior of tanks used in the preparation of sulphuric acid from iron pyrites (sulphide). Some of the deposits in these tanks was hard and had to be scraped from the walls. It contained upto 45% of arsenious oxide. The production of arsine from this material was unsuspected for quite some time. In yet another case, a person had cleaned a water jacket by pouring freshly diluted hydrochloric acid into its pipes. Fumes were liberated and he was in close contact with them in an unventilated room for about half an hour. The acid contained an "inhibitor", which proved to be a mixture of sodium arsenate and aniline hydrochloride. Arsine was produced from the inhibitor n the presence of nascent hydrogen and the man was severely poisoned." "Oh, I see. Arsine can be produced in most unusual circumstances. It does appear to me that Radhey too got involved in arsine poisoing." "Yes, it became apparent to me, when I came to know that he was involved in making the soldering flux by that precarious method, which I have described you just now. My suspicion was confirmed to a great extent when I heard that he had passed dark urine. This was because of the presence of hemoglobin in the urine." "Why should hemoglobin appear in the urine in a case of arsine poisoning?" "Arsine is a deadly poison tarun. It hemolyses (breaks) all the Red Blood Cells of the body. This liberates hemoglobin which ultimately finds its way in the urine which become dark. I have made some slides of the blood of this patient, and you can see under the microscope that all the R.B.C.s are broken. This is a very strong indication that he had died of arsine poisoning. Moreover his kidney tubules are blocked by these broken R.B.C.s which is another finding in favour of arsine poisoing. Coupled with his peculiar history, I am sure Radhey died of arsine poisoning, which is an accidental poisoning. Suleiman had nothing to do with it. Come, let us tell the police about it." "Very clever indeed. This was a most interesting discussion doctor. Without your masterly deduction, police could have unnecessarily went on harassing Suleiman. Radhey's relatives and other people might have thought, it was a case of killing by Suleiman. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about death by aflatoxins. "