Celphos (aluminum phosphide) poisoning is the most common cause of poisoning in India. The mechanism of action, acute and chronic effect on human body, its symptoms and signs, and the line of treatment are well documented and research is still going on to find a suitable antidote. "Spontaneous ignition" is a rare but interesting finding in case of aluminum phosphide poisoning. We present the autopsy findings in this case report along with the probable factors that led to occurrence of such finding.

Cutaneous electrocution marks are the key indicator that aid forensic pathologists in establishing electrocution as the cause of death, especially when crime scene and internal autopsy findings do not provide significant information. The gross findings of electrocution mark are often confused with impact abrasion and the burns produced by high voltage flash are often indistinguishable with flame burns. The present study aims to identify cutaneous light microscopic histological indicators, which are peculiar to electrocution marks, burns and impact abrasions. Cutaneous tissue samples from injury sites and healthy areas were collected from 45 autopsy cases and examined under light microscope. The histological changes observed were intra-epidermal separation of cells, sub-epidermal separation, coagulative necrosis in the epidermis and dermis, epidermal and dermal cell nuclear elongation and streaming, pyknotic tightly packed epidermal nuclei, dark staining of epidermal nuclei, homogenization of dermal collagen, and vascular dilatation, congestion, hemorrhage and thrombosis. The study revealed that certain histological changes are helpful in differentiating electrocution mark from other types of injuries, which present themselves in various types morphologically and thus facilitate correct diagnosis during autopsy. Pyknotic and tightly packed epidermal nuclei was found characteristic of electrocution mark produced by high voltage current.

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Background and objective Ever since its emergence in December 2019, coronavirus disease 2019 (COVID-19) has affected more than 220 million people worldwide, resulting in more than 45 million deaths. The present autopsy-based study was undertaken to understand the pathophysiology of the disease and correlate the histopathological and virological findings with the antemortem clinical and biochemical determinants. Methods In this prospective observational study, autopsies were carried out on 21 reverse transcription-polymerase chain reaction (RT-PCR)-proven COVID-19 patients who had died of the disease. The histopathological findings of tissue samples from lungs, liver, and kidneys collected during the autopsy were graded based on their presence or absence; if present, they were graded as either focal or diffuse. The findings were correlated with antemortem clinical and biochemical findings. Postmortem tissue RT-PCR analysis was conducted, and findings were compared with postmortem histopathological findings. Results There was multisystem involvement with the COVID-19 cases. The involvement of lungs was observed in most of the cases (90.4%). The presence of viral RNA was observed in all the organs including the liver (57.1%) and kidney (66.6%). An association was observed between antemortem biochemical parameters [aspartate aminotransferase (AST), alanine aminotransferase (ALT)] and the histopathological features in the liver. No correlation between the Sequential Organ Failure Assessment (SOFA) score recorded clinically and lung histopathology was observed; nor was there any correlation between blood urea-creatinine levels and kidney histopathology. Conclusions Our study shows that COVID-19 is a multisystemic disease and the mortality associated with it is likely to be multifactorial. Despite the presence of amplifiable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various organs, no association could be established between the clinical and histopathology findings. Neither the duration of hospitalization nor the duration of mechanical ventilation showed any correlation with the severity of histopathological findings in the lungs at autopsy.

Precise reasons for severe manifestation of SARS-CoV-2 remain unanswered, and efforts have been focused on respiratory system management. Demonstration of unequivocal presence of SARS-CoV-2 in vital body organs by cadaver autopsy was the only way to prove multi-organ involvement. Hence, the primary objective of the study was to determine presence of the SARS-CoV-2 in various organs of patients succumbing to SARS-CoV-2 infection. A total of 246 samples from different organs of 21 patients who died due to severe COVID-19 illness were investigated by qRT-PCR, and SARS-CoV-2 was detected in 181 (73.57%) samples and highest positivity of SARS-CoV-2 being (expectedly) found in nasopharynx (90.4%) followed by bilateral lungs (87.30%), peritoneal fluid (80%), pancreas (72.72%), bilateral kidneys (68.42%), liver (65%) and even in brain (47.2%). The deceased patients were categorized to three subgroups based upon the extent of organs in which SARS-CoV-2 was detected by qRT-PCR (high intensity ≥80%, intermediate intensity = 65–80% and low intensity ≤65% organs involvement). It was conclusively established that SARS-CoV-2 has the property of invasion beyond lungs and even crosses the blood–brain barrier, resulting in multi-system disease; this is probably the reason behind cytokine storm, though it is not clear whether organ damage is due to direct injury caused by the virus or result of inflammatory assault. Significant inverse correlation was found between the Ct value of lung samples and number of organs involved, implying that higher viral load in lungs is directly proportionate to involvement of extrapulmonary organs and patients with higher viral load in respiratory secretions should be monitored more closely for any warning signs and the treatment strategies should also address involvement of other organs for better outcome, because lungs, though the primary site of infection, are not the only organ system responsible for pathogenesis of systemic illness.

Impalement injuries result when a hard elongated object penetrates the body cavity or any body part and remains in place. A rare and unusual case of impalement by a bamboo stick in the thoracic cavity through the oropharynx is described. Injury resulted when a man tried to pole-vault with a bamboo stick, which slipped and entered his mouth. Impalement injury through the natural orifice of the oropharynx is discussed, along with the mechanism of the trauma and subsequent death.