Age Estimation in Indians Using Demirjian’s 8‐teeth Method

Abstract: Demirjian’s grading of tooth calcification is widely used to assess age of individuals with developing dentitions. However, its application on numerous populations has resulted in wide variations in age estimates and consequent suggestions for the method’s adaptation to the local sample. Conventionally, Demirjian’s method utilized seven mandibular teeth on the left side. A recent modification incorporated the third molar with a view to apply the method on a wider age‐group. Moreover, the revised method developed regression formulas for assessing age. This paper tested the 8‐teeth method using 547 Indians (348 females, 199 males) aged 7–25 years. Demirjian’s formulas resulted in inferior age prediction in Indians (9.2% misclassification at 99% confidence interval vs. 0% misclassification in the original study); therefore, India‐specific regression formulas were developed, which gave better age estimates (mean absolute error, MAE = 0.87 years) than the original formulas (MAE = 1.29 years). This suggests that Demirjian’s 8‐teeth method also needs adaptation prior to use in diverse populations.     

Accuracy of Identifying Juvenile/Adult Status from Third Molar Development using Prediction Probabilities Derived from Logistic Regression Analysis

The use of third molars in predicting juvenile/adult status (</≥ 18 years) has important legal ramifications. Third molar development was assessed using Köhler's grading on 268 orthopantomograms of Indian subjects. Logistic regression analysis was applied to determine allocation accuracy of juvenile/adult status and the level of probability that is “reliable” in predicting juvenile/adult status. Allocation accuracies ranged between 75.8% and 78.2% for the sexes combined, with minimal male‐female differences. Adults were categorized more accurately than juveniles, suggesting that Köhler's grading puts Indian juveniles at greater risk of unwarranted punishment. In both sexes, juvenile/adult status was “reliably” predicted when the probability was >80% using individual third molars (excepting the lower right third molar in males); combining upper and lower third molars on the left/right sides, “reliable” predictions were possible when the probability was >80% and >90% for females and males, respectively. Overall, “reliable” juvenile/adult status prediction was achieved in c. 36% of subjects.     

Post-traumatic left ventricular false aneurysm

Most false aneurysms of the heart represent contained ventricular free wall ruptures after myocardial infarction. Post-traumatic aneurysms also may follow penetrating or non-penetrating trauma to the chest. Regardless of the origin of the false aneurysm there is a propensity for aneurysm rupture. We report a patient who developed a false aneurysm of her left ventricle that developed post-motor vehicle accident. Her orthopedic problems were the clinical problems identified and after a hospital admission of 10 days she was discharged home. Four weeks later she died suddenly from anterior left ventricle false aneurysm rupture and tamponaide. Patients with significant chest wall trauma should be assessed for cardiac pathology prior to discharge. Presentation may be delayed and be overshadowed by more evident pathology. Trauma-related aneurysms may cause sudden death, and this may occur some later time after the trauma. Attributing the cause of death to the trauma, which may be remote, is important for the forensic investigator to remember.     

Fatal splenic arterial aneurysmal rupture associated with chronic pancreatitis

Splenic arterial aneurysms (SAA) are rare and are usually atherosclerotic and/or related to pregnancy. Because pregnancy is the most important predisposing factor, the strong predilection of SAA for women is not surprising. The authors report a case of SAA rupture in a man with chronic pancreatitis as the predisposing factor. A 56-year-old man with abdominal pain and hematemesis was resuscitated and underwent endoscopy, but he died 18 hours later of massive hematemesis before definitive surgery could be carried out. At autopsy, there was chronic pancreatitis with fibrous adhesions tethering the tail of the pancreas, spleen, and posterior wall of the stomach together. The SAA was indented into the posterior wall of the stomach, into which it had ruptured from without. He also had alcoholic cirrhosis but no esophageal varices or conventional gastric ulcers. Other important predisposing factors such as abdominal trauma, infective endocarditis, polyarteritis nodosa, and segmental medial arteriopathy were absent. Histologic examination confirmed the rupture of the SAA. The SAA had Monckeberg medial calcinosis but little evidence of atherosclerosis. The well-documented complications of acute and chronic pancreatitis include shock, abscess, pseudocyst formation, and duodenal obstruction. This report describes the rare complication of SAA rupture, which may be fatal.     

Univariate sex dimorphism in the Nepalese dentition and the use of discriminant functions in gender assessment

Sex dimorphism in the Nepalese dentition is described using univariate and discriminant analyses. Canines showed the greatest univariate sex dimorphism, followed by the buccolingual (BL) dimension of maxillary first and second molars. Overall, the maxillary teeth and BL dimensions showed greater univariate sex differences. However, less than half of the measured variables (46.4%) showed statistically significant differences between the sexes and the magnitude of sex dimorphism was reduced when compared to other populations. Moreover, reverse dimorphism--where females showed larger teeth than males--was observed in the mesiodistal dimension of mandibular second premolars. This reflects reduction in sexual dimorphism observed through human evolution and the consequent overlap of tooth dimensions in modern males and females. A specific purpose of the study was to develop discriminant functions to facilitate sex classification. A group of functions were developed considering the possibility of missing teeth and/or jaws in forensic scenarios. The functions permitted moderate to high classification accuracy in sexing (67.9% using maxillary posterior teeth; 92.5% using teeth from both jaws). The superior expression of sex dimorphism by means of discriminant functions is in contrast to the univariate results. This is due to discriminant analysis utilising the inter-relationship between all teeth within a dentition--these tooth correlations are not utilised in univariate analysis which results in a loss of information. It is inferred that large-scale statistically significant univariate differences are not a prerequisite for sex assessment.     

Searching for Kin Amidst Tragedy—Disaster Victim Identification Operations for US Bangla Flight 211

The nature of air disasters includes factors that exacerbate challenges in the identification process. Of the 49 deceased in the US Bangla air crash in Kathmandu, Nepal, four were intact, 11 presented with burn injuries, another 11 presented with partial charring, and 23 were completely charred. Personal belongings were useful in the identification phases for all types of victims. Fingerprints were obtainable and useful in intact victims and victims with less severe burn injuries; medical and surgical information was useful in bodies with burn injuries; finally, dental findings were useful in cases of extensive charring. Other useful methods in the process included marks of identification, physical features, and exclusion. In certain resource‐limited settings, especially in closed population disasters, where scientific identification (DNA, dental records, etc.) is not currently available, personal belongings, clothing, and physical findings analyzed by an identification team using a structured organization may be cautiously used as the primary means of identification.