Displaying publications 1 - 20 of 35 in total

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  1. A study of sudden natural deaths in medico legal autopsies in University Malaya Medical Centre (UMMC), Kuala Lumpur
    Kumar V, San KP, Idwan A, Shah N, Hajar S, Norkahfi M
    J Forensic Leg Med, 2007 Apr;14(3):151-4.
    PMID: 16914354
    The main aim of this study is to determine the causes and the epidemiological aspects of sudden natural deaths. Data were collected from 545 sudden natural autopsies in UMMC, Kuala Lumpur over a five-year period, from 1st January 2000 to 31st December 2004. There were 475 males and 70 females. The largest number of sudden natural deaths was in the age group of 41-50 years. 35.8%, 30.5% and 11.7% of the patients were Chinese, Indian and Malay, respectively. A majority of the patients were married (59.8%) and came from the semiskilled-unskilled group (30.6%). The monthly distribution was almost constant. Cardiovascular diseases were the most important cause contributing 64.9% in sudden natural deaths.
  2. Accuracy and reliability of virtual femur measurement from CT scan
    Ismail NA, Abdullah N, Mohamad Noor MH, Lai PS, Shafie MS, Nor FM
    J Forensic Leg Med, 2019 Apr;63:11-17.
    PMID: 30825771 DOI: 10.1016/j.jflm.2019.02.010
    BACKGROUND: In the application of scientific human skeletal variation in medico-legal matters, virtual anthropology is the current technique performed to examine skeleton and its body parts. Hence, this study was conducted to assess the accuracy and reliability of virtual femur measurement through intra and inter-observer error analysis, and comparison was made between the virtual and conventional methods.

    METHODS: A total of 15 femora were examined with four parameters i.e. maximum length of femur (FeMl), diameter of femoral head (FeHd), transverse diameter of midshaft (FeMd) and condylar breadth (FeCb). Osteometric board and vernier calipers were employed for the conventional method, while CT reconstructed images and Osirix MD software was utilised for the virtual method.

    RESULTS: Results exhibited that there were no significant differences in the measurements by conventional and virtual methods. There were also no significant differences in the measurements by the intra or inter-observer error analyses. The intraclass correlation coefficients (ICC) were more than 0.95 by both intra and inter-observer error analyses. Technical error of measurement had displayed values within the acceptable ranges (rTEM <0.08 for intra-observer, <2.25 for inter-observer), and coefficient of reliability (R) indicated small measurement errors (R > 0.95 for intra-observer, R > 0.92 for inter-observer). By parameters, FeMl showed the highest R value (0.99) with the least error in different methods and observers (rTEM = 0.02-0.41%). Bland and Altman plots revealed points scattered close to zero indicating perfect agreement by both virtual and conventional methods. The mean differences for FeMl, FeHd, FeMd and FeCb measurements were 0.01 cm, -0.01 cm, 0.02 cm and 0.01 cm, respectively.

    CONCLUSION: This brought to suggest that bone measurement by virtual method was highly accurate and reliable as in the conventional method. It is recommended for implementation in the future anthropological studies especially in countries with limited skeletal collection.

  3. Age estimation from structural changes of teeth and buccal alveolar bone level
    Koh KK, Tan JS, Nambiar P, Ibrahim N, Mutalik S, Khan Asif M
    J Forensic Leg Med, 2017 May;48:15-21.
    PMID: 28407514 DOI: 10.1016/j.jflm.2017.03.004
    Forensic odontology plays a vital role in the identification and age estimation of unknown deceased individuals. The purpose of this study is to estimate the chronological age from Cone-Beam Computed Tomography (CBCT) images by measuring the buccal alveolar bone level (ABL) to the cemento-enamel junction and to investigate the possibility of employing the age-related structural changes of teeth as studied by Gustafson. In addition, this study will determine the forensic reliability of employing CBCT images as a technique for dental age estimation. A total of 284 CBCT images of Malays and Chinese patients (150 females and 134 males), aged from 20 years and above were selected, measured and stages of age-related changes were recorded using the i-CAT Vision software. Lower first premolars of both left and right side of the jaw were chosen and the characteristics described by Gustafson, namely attrition, secondary dentine formation and periodontal recession were evaluated. Linear regression analysis was performed for the buccal bone level and the R values obtained were 0.85 and 0.82 for left and right side respectively. Gustafson's characteristics were analysed using multiple regression analysis with chronological age as the dependent variable. The results of the analysis showed R values ranged from 0.44 to 0.62. Therefore it can be safely concluded that the buccal bone level highly correlated with the chronological age and is consequently the most suitable age-related characteristic for forensic age estimation.
  4. Application of the Kvaal method for adult dental age estimation using Cone Beam Computed Tomography (CBCT)
    Marroquin Penaloza TY, Karkhanis S, Kvaal SI, Nurul F, Kanagasingam S, Franklin D, et al.
    J Forensic Leg Med, 2016 Nov;44:178-182.
    PMID: 27821308 DOI: 10.1016/j.jflm.2016.10.013
    Different non-invasive methods have been proposed for dental age estimation in adults, with the Kvaal et al. method as one of the more frequently tested in different populations. The purpose of this study was to apply the Kvaal et al. method for dental age estimation on modern volumetric data from 3D digital systems. To this end, 101 CBCT images from a Malaysian population were used. Fifty-five per cent were female (n = 55), and forty-five percent were male (n = 46), with a median age of 31 years for both sexes. As tomographs allow the observer to obtain a sagittal and coronal view of the teeth, the Kvaal pulp/root width measurements and ratios were calculated in the bucco-lingual and mesio-distal aspects of the tooth. From these data different linear regression models and formulae were built. The most accurate models for estimating age were obtained from a diverse combination of measurements (SEE ±10.58 years), and for the mesio-distal measurements of the central incisor at level A (SEE ±12.84 years). This accuracy, however is outside an acceptable range in for forensic application (SEE ±10.00 years), and is also more time consuming than the original approach based on dental radiographs.
  5. Application of third molar development and eruption models in estimating dental age in Malay sub-adults
    Mohd Yusof MY, Cauwels R, Deschepper E, Martens L
    J Forensic Leg Med, 2015 Aug;34:40-4.
    PMID: 26165657 DOI: 10.1016/j.jflm.2015.05.004
    The third molar development (TMD) has been widely utilized as one of the radiographic method for dental age estimation. By using the same radiograph of the same individual, third molar eruption (TME) information can be incorporated to the TMD regression model. This study aims to evaluate the performance of dental age estimation in individual method models and the combined model (TMD and TME) based on the classic regressions of multiple linear and principal component analysis. A sample of 705 digital panoramic radiographs of Malay sub-adults aged between 14.1 and 23.8 years was collected. The techniques described by Gleiser and Hunt (modified by Kohler) and Olze were employed to stage the TMD and TME, respectively. The data was divided to develop three respective models based on the two regressions of multiple linear and principal component analysis. The trained models were then validated on the test sample and the accuracy of age prediction was compared between each model. The coefficient of determination (R²) and root mean square error (RMSE) were calculated. In both genders, adjusted R² yielded an increment in the linear regressions of combined model as compared to the individual models. The overall decrease in RMSE was detected in combined model as compared to TMD (0.03-0.06) and TME (0.2-0.8). In principal component regression, low value of adjusted R(2) and high RMSE except in male were exhibited in combined model. Dental age estimation is better predicted using combined model in multiple linear regression models.
  6. Bandaged penis
    Murty OP, Mahinda HA
    J Forensic Leg Med, 2007 Jul;14(5):301-3.
    PMID: 16962816
    This is a case of a male in his late 30s who died due to acute myocardial ischemia. His penis was bandaged. The penis was inflamed and had infected abrasions. The possible relevances of such an incidental finding and its contribution to sudden death is explored. The case report shows photographs of the bandage in situ and its components, inflammation of frenulum, injury to the shaft, and the generalized inflamed and mildly swollen penis. These changes were considered to be caused by bites. The micro-photographic findings in the case were of acute myocardial ischemia, pulmonary oedema, and fatty liver.
  7. Comparative fly species composition on indoor and outdoor forensic cases in Malaysia
    Syamsa RA, Omar B, Ahmad FM, Hidayatulfathi O, Shahrom AW
    J Forensic Leg Med, 2017 Jan;45:41-46.
    PMID: 27997861 DOI: 10.1016/j.jflm.2016.12.002
    Forensic entomology refers to the science of collection and analysis of insect evidence in order to determine the minimum time period since death. This study aimed to investigate the occurrence of forensically important flies on 34 human remains referred to Universiti Kebangsaan Malaysia Medical Centre over a period of three years. Entomological specimens were collected at the death scenes and/or during autopsies. Live specimens were reared into adults while preserved specimens were processed for species identification. Five families, seven genera and nine species of flies were identified from human remains. The results of the study showed Chrysomya megacephala (Calliphoridae) maggots occurred on corpses with the highest frequency (70.6%), followed by Ch. rufifacies (Calliphoridae) (44.1%), sarcophagid fly (Sarcophagidae) (38.2%), Synthesiomya nudiseta (Muscidae) (20.6%), Megaselia scalaris (Phoridae) (14.7%), Lucilia cuprina (Calliphoridae) (5.9%), Ch. nigripes (Calliphoridae) (5.9%), Eristalis spp. (Syrphidae) (5.9%) and Hydrotaea spinigera (Muscidae) (2.9%). The greatest fly diversity occurred on remains recovered indoors (eight species) compared to outdoors (three species). Whilst, single and double infestations were common for both indoor and outdoor cases, multiple infestation of up to six species was observed in one of the indoor cases. Although large numbers of fly species were found on human remains, the predominant species were still those of Chrysomya, while S. nudiseta was found only on human remains recovered from indoors. The present study provides additional knowledge in the context of Malaysian forensic entomology and the distribution of forensically important flies which is of relevance to forensic science.
  8. Condom-murder
    Murty OP
    J Forensic Leg Med, 2009 Jan;16(1):35-9.
    PMID: 19061848 DOI: 10.1016/j.jflm.2008.05.017
    Condom-murder is term used to describe a homicide where a person has been killed due to his recreational sexual behaviour and the killing has strong links with the recovered condom/contraceptive material on the scene or was in personal possession of victim. It can provide immediate clue about perpetrator. We present six cases of a similar nature. Four males and two females had condoms in their vicinity at crime scene. All incidents occurred at different timings and different places but there was striking similarity in method of killing. In four cases hands were tied on the back in three cases; similarly legs were also tied in three cases. In three cases strong electric cords were used. The presence of condoms give clue for investigation, possibility of DNA identification, about type of sexual behaviour as recreational and commercial method in these cases.
  9. Dancing to death: A case of heat stroke
    Nadesan K, Kumari C, Afiq M
    J Forensic Leg Med, 2017 Aug;50:1-5.
    PMID: 28651196 DOI: 10.1016/j.jflm.2017.05.008
    Heat stroke is a medical emergency which may lead to mortality unless diagnosed early and treated effectively. Heat stroke may manifest rapidly, hence making it difficult to differentiate it from other clinical causes in a collapsed victim.(1) We are presenting a case report of twelve patients who were admitted to our emergency department from a music festival held on 13-15th of March 2014. They developed complications arising from a combination of severe adverse weather condition, prolonged outdoor physical exertion due to long hours of dancing and drug-use, resulting in heat stroke. Three of them died while the remaining patients survived. Their condition was initially misdiagnosed as a classical illicit drug overdose. This was based on the history of drug ingestion by some of the patients who attended the music festival on that day. The information in this case report aims, to create awareness amongst members of the medical team on duty in outdoor events, pre hospital responders and ED physicians when treating and managing similar cases in the future. In addition it is intended to warn the organizers of such events to take adequate precautions to avoid such tragedies in the future.
  10. Dental age estimation employing CBCT scans enhanced with Mimics software: Comparison of two different approaches using pulp/tooth volumetric analysis
    Asif MK, Nambiar P, Mani SA, Ibrahim NB, Khan IM, Sukumaran P
    J Forensic Leg Med, 2018 Feb;54:53-61.
    PMID: 29324319 DOI: 10.1016/j.jflm.2017.12.010
    The methods of dental age estimation and identification of unknown deceased individuals are evolving with the introduction of advanced innovative imaging technologies in forensic investigations. However, assessing small structures like root canal volumes can be challenging in spite of using highly advanced technology. The aim of the study was to investigate which amongst the two methods of volumetric analysis of maxillary central incisors displayed higher strength of correlation between chronological age and pulp/tooth volume ratio for Malaysian adults. Volumetric analysis of pulp cavity/tooth ratio was employed in Method 1 and pulp chamber/crown ratio (up to cemento-enamel junction) was analysed in Method 2. The images were acquired employing CBCT scans and enhanced by manipulating them with the Mimics software. These scans belonged to 56 males and 54 females and their ages ranged from 16 to 65 years. Pearson correlation and regression analysis indicated that both methods used for volumetric measurements had strong correlation between chronological age and pulp/tooth volume ratio. However, Method 2 gave higher coefficient of determination value (R2 = 0.78) when compared to Method 1 (R2 = 0.64). Moreover, manipulation in Method 2 was less time consuming and revealed higher inter-examiner reliability (0.982) as no manual intervention during 'multiple slice editing phase' of the software was required. In conclusion, this study showed that volumetric analysis of pulp cavity/tooth ratio is a valuable gender independent technique and the Method 2 regression equation should be recommended for dental age estimation.
  11. Development of a Reference Data Set (RDS) for dental age estimation (DAE) and testing of this with a separate Validation Set (VS) in a southern Chinese population
    Jayaraman J, Wong HM, King NM, Roberts GJ
    J Forensic Leg Med, 2016 Oct;43:26-33.
    PMID: 27441983 DOI: 10.1016/j.jflm.2016.07.007
    BACKGROUND: Many countries have recently experienced a rapid increase in the demand for forensic age estimates of unaccompanied minors. Hong Kong is a major tourist and business center where there has been an increase in the number of people intercepted with false travel documents. An accurate estimation of age is only possible when a dataset for age estimation that has been derived from the corresponding ethnic population. Thus, the aim of this study was to develop and validate a Reference Data Set (RDS) for dental age estimation for southern Chinese.

    MATERIALS AND METHODS: A total of 2306 subjects were selected from the patient archives of a large dental hospital and the chronological age for each subject was recorded. This age was assigned to each specific stage of dental development for each tooth to create a RDS. To validate this RDS, a further 484 subjects were randomly chosen from the patient archives and their dental age was assessed based on the scores from the RDS. Dental age was estimated using meta-analysis command corresponding to random effects statistical model. Chronological age (CA) and Dental Age (DA) were compared using the paired t-test.

    RESULTS: The overall difference between the chronological and dental age (CA-DA) was 0.05 years (2.6 weeks) for males and 0.03 years (1.6 weeks) for females. The paired t-test indicated that there was no statistically significant difference between the chronological and dental age (p > 0.05).

    CONCLUSION: The validated southern Chinese reference dataset based on dental maturation accurately estimated the chronological age.

  12. Diabetic artefacts in forensic practice
    Murty OP
    J Forensic Leg Med, 2009 May;16(4):218-23.
    PMID: 19329080 DOI: 10.1016/j.jflm.2008.07.010
    A case is presented where confusion arose about skin lesions and whether they were diabetic or electrical in 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. also had fracture of skull and ischemic necrosis of right side of cerebrum; and contrecoup lesions. Findings are documented with photographs of the lesions. The article also depicts photographs of the scene where the victim had fallen and sustained skull fracture.
  13. Dramatic lightning injury with exit wound
    Murty OP
    J Forensic Leg Med, 2007 May;14(4):225-7.
    PMID: 16914357
    This is a case report of an environmental accident due to lightning where one school boy sustained current, blast, and flame effects of it. A bolt of lightning directly struck the pole of a football ground and the scatter struck the child. In addition to burn injuries, he showed an exit wound of lightning in left foot. The exit wound of lightning current is a very rare finding. The body of victim had flame and heat effect of atmospheric electricity on head and neck, face, and trunk. In this incidence of lightning other team mates of the victim were safe. The patient survived the attack.
  14. Emerging global trends and development in forensic toxicology: A review
    Shukla S, Khanna S, Gani Mir TU, Dalal J, Sankhyan D, Khanna K
    J Forensic Leg Med, 2024 Mar 19;103:102675.
    PMID: 38522117 DOI: 10.1016/j.jflm.2024.102675
    This study conducts a comprehensive analysis of forensic toxicology research trends, publication patterns, author's contributions, and collaboration. Utilizing the Scopus database, we scrutinized 3259 articles across 348 journals spanning from 1975 to 2023. Analysis employed diverse software tools such as VOSviewer, RStudio, MS Excel, and MS Access to dissect various publication aspects. We observed a notable surge in publications post-2007, indicating heightened research interest. Leading contributors included the United States, Germany, and Italy, with Logan B.K. emerging as the most prolific author. Forensic Science International stood out as the primary journal, publishing 888 articles and accruing significant citations. Keyword co-occurrences such as "forensic toxicology," "forensic science," and "toxicology" underscored core thematic areas in the field. Moreover, extensive research collaboration, especially among Western nations in Europe, was evident. This study underscores the imperative for enhanced collaboration between developing and developed nations to foster further advancements in forensic science. Strengthened partnerships can catalyze innovation, facilitate knowledge dissemination, and address emerging challenges, thereby propelling the field of forensic toxicology toward new frontiers of discovery and application.
  15. Estimation of stature by using lower limb dimensions in the Malaysian population
    Nor FM, Abdullah N, Mustapa AM, Qi Wen L, Faisal NA, Ahmad Nazari DA
    J Forensic Leg Med, 2013 Nov;20(8):947-52.
    PMID: 24237796 DOI: 10.1016/j.jflm.2013.09.006
    Estimation of stature is an important step in developing a biological profile for human identification. It may provide a valuable indicator for an unknown individual in a population. The aim of this study was to analyse the relationship between stature and lower limb dimensions in the Malaysian population. The sample comprised 100 corpses, which included 69 males and 31 females between the age range of 20-90 years old. The parameters measured were stature, thigh length, lower leg length, leg length, foot length, foot height and foot breadth. Results showed that the mean values in males were significantly higher than those in females (p 
  16. Estimation of stature from hand and handprint measurements in Iban population in Sarawak, Malaysia and its applications in forensic investigation
    Zulkifly NR, Wahab RA, Layang E, Ismail D, Desa WNSM, Hisham S, et al.
    J Forensic Leg Med, 2018 Jan;53:35-45.
    PMID: 29149652 DOI: 10.1016/j.jflm.2017.10.011
    Handprints and dismembered hands are commonly found during crime scene investigations and disaster victim identifications, respectively. It has been indicated that the accuracy of handprint and hand measurements for estimating stature maybe population specific. Since Iban is the largest ethnic population in Sarawak, Malaysia and because the application of anthropometry of hand and handprint within this population as well as other populations within the Southeast Asian countries remain unreported, this present study that investigated the reliability and accuracy of these two anthropometric aspects acquires forensic significance. Upon measuring the height, 21 measurements were recorded on each hand and the corresponding handprint of 50 male and 52 female consented adult Iban subjects. Using univariate statistics as well as simple and multiple regression analyses, interpretation of the measurements examined here was attempted. Results revealed that lengths of hand and handprint are the more reliable traits for estimating stature in both the male and female Iban subjects (p 
  17. Fatal burns in Manipal area: a 10 year study
    Kumar V, Mohanty MK, Kanth S
    J Forensic Leg Med, 2007 Jan;14(1):3-6.
    PMID: 17046310
    The purpose of this study was to record and evaluate the causes and the magnitude of the fatal burn injuries retrospectively. An analysis of autopsy records revealed 19.4% cases of burn injuries amongst the total autopsies done over 10years period (1993-2002) in the mortuary of the department of Forensic Medicine of Kasturba medical College, Manipal. The majority of deaths (78.5%) occurred between 11 and 40years of age group with preponderance of females (74.8%). The flame burns were seen in 94.1% of the victims followed by scalds and electrical burns in 2.8% and 2.5% cases, respectively. The majority of burn incidents were accidental (75.8%) in nature followed by suicidal (11.5%) and homicidal (3.1%) deaths. The percentage of burn (TBSA) over 40% were observed in most of the cases (92.5%). The majority of deaths occurred within a week (69.87%) and most the victims died because of septicemia (50.9%).
  18. Fatal injuries among motorcyclists in Klang Valley, Malaysia
    Ramli R, Oxley J, Noor FM, Abdullah NK, Mahmood MS, Tajuddin AK, et al.
    J Forensic Leg Med, 2014 Aug;26:39-45.
    PMID: 25066171 DOI: 10.1016/j.jflm.2014.06.007
    Motorcycle fatalities constitute the majority of road traffic deaths in Malaysia. The aims of this study were to describe the pattern of fatal injuries among Klang Valley fatal motorcyclists and to describe the factors associated with fatal (vs non-fatal) injuries.
  19. Gunshot wound in skeletonised human remains with partial adipocere formation
    Mohd Nor F, Das S
    J Forensic Leg Med, 2012 Jan;19(1):42-5.
    PMID: 22152448 DOI: 10.1016/j.jflm.2011.07.008
    We present a case of skeletonised human remains. In the present case report, a body was exhumed from the ground above a cemetery. On exhumation, the body was partially-skeletonised with adipocere formation on the upper part of the body. Autopsy of the body showed two bullets in the right thigh muscle and lumbar vertebrae between L4 and L5. Postmortem changes and destruction of soft tissue made it impossible to determine direction of fire through the body, even in a careful complete autopsy.
  20. Hanging without knot in the noose
    Kumar V
    J Forensic Leg Med, 2007 Jan;14(1):35-8.
    PMID: 16530454
    Death by hanging is believed to be a painless method of committing suicide. In most cases the noose has a knot and on this basis only it can be labeled as atypical or typical hanging. A 35 year Chinese man committed suicide by hanging with a ligature material made of electric wire where there was no knot present on the noose.
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