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Pathologic Changes: Increased loss of water without an increased loss of solute will create a low specific gravity. This situation can be caused by intravenous fluid therapy, hyperthyroidism, liver disease, pituitary neoplasia, progesterone or glucocorticoid therapy. A reduced ability to concentrate or dilute the glomerular filtrate will lead to an increased specific gravity and severe renal pathology. Normal: the specific gravity varies with the state of Specific Evaluation Substances filtered by the normal kidney generally have a molecular weight of less than 68,000 (eg, water, uric acid, urea, glucose, electrolytes). Two substances that are on the border of this molecular weight cutoff are hemoglobin and albumin. Most substances that are filtered by the kidneys are critical to normal bodily functions and are completely reabsorbed (eg, amino acids, glucose, vitamins). It should be noted that the sensitivity of these tests has been adjusted to detect what would be regarded as abnormal levels of certain substances in human urine. These sensitivities are not necessarily applicable to birds and the fact that a "higher" reading is obtained on an area of the test strip does not necessarily imply an abnormality. The color of the urine sample may also affect the results of some test parameters. Birds fed large amounts of protein (carnivores) have an acidic urine, while grain-eating birds have more alkaline urine. Companion birds with papillomatosis and other disorders that typically cause tenesmus may have acidic urine. In diabetes mellitus, birds may have blood glucose concentrations above 800 mg/dl. Any significant shift in energy production from carbohydrates to fats results in the increased oxidation of fatty acids and the production of intermediate metabolites that accumulate faster than they can be oxidized by the tissues. Catabolic processes such as severe hepatitis in combination with low blood glucose concentrations and diabetes mellitus can cause ketonuria. Biliverdin is the major bile pigment, but will not react with the bilirubin portion of a mammalian urine dip stick. Pathologic changes would be expected in cases of intravascular hemolysis and severe liver disease, but are seldom reported. Falsely high levels of urobilinogen in urine can be due to drugs which appear red in acid urine (eg, Vitamin B12) or if sulphonamides are present. With hematuria, individual erythrocytes lyse on the test area, giving individual spots of color. Blood in the urine may originate from the cloaca or from the urinary, reproductive or gastrointestinal tracts. Urinary Nitrite this test is included on many commercial test strips and is used to screen for bacteriuria. Urinary Sediment Examination of the urinary sediment is a valuable part of urinalysis but one that is often omitted. With time, Urinary Protein Normal: Trace amounts of protein can be detected in the urine of 90% of birds tested. Non-renal sources of proteinuria include hematuria, hemoglobinuria and hyperproteinemia, which are usually caused by an increase in the production of immunoglobulins. Inaccurate protein levels will be detected if the urine is alkaline or if the strip is soaked in urine (instead of briefly dipped), which leaches out the citrate buffer. Usually centrifugation is used to concentrate the sediment to approximately ten percent of its original urinary volume. All cells noted within the urine sediment may have origins within the cloaca or the urinary, reproductive or gastrointestinal tracts. The presence of any epithelial cells (eg, renal tubular cells) should be considered abnormal. Bacteria In mammals, it is believed that bacteria in excess of 3 x 104/ml of urine must be present before they are detectable in urinary sediment. Pathologic Changes: Reports of bacteria that are "too numerous to count" or numerous cocci and rods in reasonably clean urine samples should be viewed with suspicion. Bacteria may multiply en route to the laboratory, which will lead to high counts in the sample. Bogin E, Israeli B: Enzyme profile of heart and skeletal muscle, liver and lung of roosters and goose. Gerlach C: Differentialblutbild und Plasmaenzymuntersuch ungen bei Greifvogeln im Verlauf eines Jahres (Differential blood count and plasma enzymes in birds of prey during one year: May 1977-May 1978).

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Other prominent organs include the lung (lu), heart (h), liver (li) and proventriculus (p). Dotted lines mark the caudal edge of the eighth rib (r), the flexor cruris medialis muscle (m) and the pubic bone (p). The entrance site is at the junction of the eighth rib and the flexor cruris medialis muscle. The medial wall of the caudal thoracic air sac (a) becomes contiguous with the lateral wall of the abdominal air sac. In this view, a clear, unobstructed view of the ostium (o) of the caudal thoracic air sac indicates that the tip of the endoscope is within this air space. Also visible are the dorsal edge of the left liver (li), lung (lu), proventriculus (p) and the confluent wall of cranial thoracic and caudal thoracic air sac (open arrow). Ostium (o), lung (lu), proventriculus (p), liver (li), confluent wall of cranial and caudal thoracic air sacs (open arrow) and confluent wall of caudal thoracic and abdominal air sacs (arrow). Also visible are the left adrenal gland (a), ilium (i), cranial pole of the left kidney (k), left common iliac vein (arrow) and aorta (open arrow). Also visible are the left adrenal gland (a), right and left common iliac veins (arrows) and the caudal vena cava (open arrow). Vessels are seen through the abdominal air sac in the peritoneal membrane overlying the gonads (arrows). Also noted are the lung (lu), cranial pole of the left kidney (k), epididymis (e), right testicle (rt), caudal vena cava (arrow) and right kidney (rk). Also visible are the left adrenal gland (a), cranial pole of the left kidney (k), lung (lu), dorsal ligament of the oviduct (arrow) and common iliac vein (open arrow). The vessels coursing across the oviduct, kidney and ovary are present in the abdominal air sac. The nondescript, fatty-appearing ovary (o) is difficult to identify, but the dorsal ligament of the oviduct (arrow) coursing across the kidney (k) confirms that this is a female. The vessels coursing across the kidney and ovary are in the peritoneal membrane and are seen through the abdominal air sac. The cranial pole of the left kidney (k), lung (lu), left common iliac vein (open arrow) and aorta (a) are also visible. Note the developing follicles (f) and the characteristic yellowish ("cooked egg") appearance of the involuted ovary, indicating previous ovulation sites (open arrow). The cranial pole of the left kidney (k) and dorsal mesentery (dm) overlying the right kidney are also noted. The vessels seen crossing the ovary are those that are present in the peritoneal membrane and are visible through the abdominal air sac. Also visible are the kidney (k), caudal pole of the testicle (t) and a loop of intestines (i). Also visible are the ureter (u), kidney (k), renal portal vein (arrow), synsacrum (s), ischium (i), aorta (a) and a loop of intestines (in). The ureter (u), kidney (k), and vessels in the abdominal air sac are also visible. Also visible are the cranial pole of the right kidney (k), the right adrenal gland (a), the caudal vena cava (arrow), the cranial mesenteric artery (open arrow) and the dorsal mesentery (dm). This endoscope is excellent for patients weighing less than 100 grams or in small anatomic sites (eg, sinus, trachea, oviduct). The major disadvantages of these very small endoscopes are their fragility, relatively small field of view and transmission of less light, which limit usefulness in larger body cavities. The advantages of the larger optics are greater light transmission and a bigger image circle. For these reasons endoscopes with a 30° offset are recommended for general diagnostic purposes. Specialized telescopes (eg, 70°, 90°, 130° angles) are not useful for general avian applications. Minimum Diagnostic Working Set for Examination and Biopsy Elements listed in "A" as well as: Diagnostic sheath for 2.

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Permeability may also play a crucial role since the virtual intracellular concentration of vesicles, in the case of tumor cells, could be higher than in normal ones (See also the following section for a detailed discussion of the possible role of the plasma membrane fluidity) [24]. Finally, at low concentration tumor cells do not respond significantly to the treatment thus suggesting that this population is not homogeneous but includes an intrinsically more resistant sub-population. Murine fibroblasts 3T6 were grown in the presence of vesicles at the indicated concentration and time. After this treatment the cytotoxic effect of vesicles is minimal (see results of the previous figure). A second good candidate to ascertain the mode of cell death is represented by measuring the level of membrane lipoperoxidation which is a good diagnostic of the response to an oxidative stress damage at membrane level. The role of the plasma membrane as a target for cat-anionic vesicles emerges from studies on the biochemical alterations of the lipid bi-layer as discussed in following section. This molecule reacts with the free aminogroups of proteins, of phospholipids and/or with nucleic acids forming stable covalent bonds that eventually determine a loss of membrane fluidity, which is the basis of its functional deficit [82, 83]. A good tool to evaluate the role of this damage in the activation of the cell death process is provided by the assessment of three main phenomena: i. Non-treated cells were the negative control while H2O treated cells represented the positive control. The comparison between the effect of H2O2 and vesicles is purely qualitative and no quantitative information can be inferred. In contrast, in vesicle-treated cells the immuno-reaction evidences two different bands (with molecular weight of 116 and 85 kDa, respectively), and the amount of the cleaved fragment increases with concentration of vesicles. Mitochondrial release of cytochrome c Western blot pattern (Panel C) and quantitative analysis of cytochrome c (Panel D). Nanobiotechnology 169 the release of cytochrome c from mitochondria signals unleashes apoptotic progression. In particular the expression of Bcl-2 gene is drastically reduced in cells exposed to cat-anionic vesicles. This gene codes for a protein located at the membrane level where it prevents the cytoplasmic release of death factors. Cat-anionic vesicles do show cytotoxic action at relatively high concentrations and interestingly, they are more toxic towards human tumor cells than normal stabilized murine fibroblasts. This effect, as mentioned above, may be explained by an intrinsic different membrane permeability of tumor cells with respect to normal ones as also discussed in the "classical" works by Van Blitterswijk and Shinitzki [89 - 91]. The possibility of using supra-molecular aggregates in nano-biotechnology for the delivery of molecules as diverse as nuclear acids, proteins and small molecules of pharmaceutical interest remains. Therefore a significant increase of the transfecting performance of the vesicles is monitored (Figure 7. The last set of experiments discussed the role the storage temperature from previous evidence from our laboratory [68, 72, 73] implicates that vesicles are quite stable in a temperature range of 15-25 °C. Actually freezing damages the molecular integrity of the vesicles, thus abolishing their transfection efficiency. Therefore, it is reasonable assuming that the freezing process disrupts the supra-molecular organization of the vesicles. Consequently their role as potential molecular bio-machines for the delivery of bioactive polymers is abrogated [91]. Conclusions Data presented in this contribution clearly indicate the strict relations between the structural organization of surfactants to form vesicular carriers and the related biological performances. From a functional point of view, the efficiency in biopolymer binding is directly related to the nature of the reported vesicles, that is their size and surface charge density. The major contribution to the binding efficiency is due to electrostatic effects, which ensures good stability to the resulting lipo-plexes and substantial possibility to their release from vesicles, when the latter are internalized into cells. Toxicity can be modulated by changing the surfactants or lipids to be used in the preparation of effectively biocompatible formulations. The possibility of using supra-molecular aggregates in nano-biotechnology for the delivery of diverse molecules, remains still open. Finally, one interesting aspect, yet to be investigated in detail, is the mode of cell death. Previous evidence from our laboratory indicates that administration of vesicles to cultured causes apoptosis. Therefore, the elucidation of the key step(s) in the process of cell death may help the investigators engaged in this field, to set up the best experimental conditions in which, to minimal cell mortality, corresponds an optimal delivery of the cargo molecule of biotechnological interest. The participation of a number of master and PhD students who actively participate to the experimental parts of this work should also be acknowledged.

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Physical Appearance Pure carbon monoxide is an odourless, colourless, non-irritating gas, which is lighter than air. A carbon monoxide concentration of 5000 ppm in air is lethal to humans after five minutes of exposure. Mode of Action Carbon monoxide has an affinity for haemoglobin which is 230 to 270 times greater than that of oxygen. The net result of all this is the decreased ability of oxygen to be carried by the blood and released to tissues. In the brain this can cause further mitochondrial dysfunction, capillary leakage, leukocyte sequestration and apoptosis. This change primarily occurs during the recovery phase when lipid peroxidation occurs, which produces an overall reversible demyelination in the brain. In a study on rats, the delayed effects of neuropathology following carbon monoxide poisoning were studied. The authors suggested that these findings may have clinical application in the treatment of delayed neurotoxicity with anti-inflammatory agents. The earliest manifestations are often non-specific and may be confused with other conditions. The venous changes that develop include engorgement and tortuosity, while oedema of the optic disc may be observed. Paracentral scotomata, homonymous hemianopia, tunnel vision, temporary blindness, and permanent blindness are known sequelae. Haematuria, albuminuria, renal failure, myoglobinuria, and acute tubular necrosis have developed with severe poisoning. Bullous lesions associated with carbon monoxide poisoning generally appear within 24 hours of exposure and are usually located on the palms and soles. Demyelination in the central nervous system and other effects may occur 48 to 72 hours after exposure. The most commonly involved regions of the brain include the globus pallidus and the deep white matter. Effects include headache, anorexia, nausea, apathy, lethargy, forgetfulness, subtle personality changes and memory problems, irritability and dizziness. These patients generally do not have gross abnormalities on physical or neurologic exam. Recovery from the acute episode may be followed by permanent neurological sequelae such as dementia, amnesia, psychosis, Parkinsonism, paralysis, chorea, blindness, apraxia, agnosia, amnestic/confabulatory state, depression, peripheral neuropathy, urinary/faecal incontinence, vegetative state, and akinetic mutism. Personality changes may also occur, with increased irritability, verbal aggression, violence, impulsivity and moodiness. Chronic Exposure: the following features are seen in chronically poisoned patients- a. Visual disturbances: homonymous hemianopia, papilloedema, scotomata, retinal haemorrhages. Permanent neurological sequelae are common and include amnesia, agnosia, apraxia, rigidity, personality changes, psychosis, blindness, and hearing impairment. Exposure to the foetus can result in permanent brain damage, including mental retardation, limb malformation, hypotonia, areflexia, basal ganglia damage, neuronal loss in the cerebral cortex, microcephalus, low infant birth weight, telencephalic dysgenesis, seizures, and stillbirth. Pulse oximetry: It is a non-invasive method of measuring oxygen saturation and is relatively easy to perform, painless, rapid, and accurate. The sensor consists of a light-emitting diode that projects two discrete wavelengths of light corresponding to saturated and unsaturated haemoglobin (660 and 940 nm) together with a photodetector. Similarly the oximeter overestimates oxygen saturation with increasing methaemoglobinaemia. A disparity between the oxygen saturation calculated from PaO2 values and pulse oximetry readings in fact should alert the physician to the presence of methaemoglobinaemia. Chest X-ray: this may reveal ground-glass appearance, perihilar haze, peribronchial cuffing and intra-alveolar oedema. Lucencies of the basal ganglia, particularly the globus pallidus is characteristic of severe carbon monoxide poisoning.

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Additional challenges should be added from time to time to keep the bird interested and the bird/trainer relationship strong. If it is biting because it is "spoiled" or needs to show dominance, it must first be trained to respect the client. Screaming Screaming is a serious behavioral problem, especially in cockatoos and macaws. The time of day and circumstances associated with screaming should be charted for several weeks in order to arrange training or play sessions for the time just before the screaming behavior usually begins. If that is impossible, the bird may be hooded or taken to a dark time-out location prior to screaming periods. The remainder of the training is routine, with special emphasis placed on the trainer leaving the room for increasing periods of time during the stay command. If the bird screams during training, the trainer should leave the room, and if it continues, the bird should be hooded or placed in a time-out location until it stops. Yelling back at a bird is never useful, as it will quickly learn that screaming is a good way to get attention. Once medical causes of feather picking have been ruled-out, psychologic causes should be explored. Sexual frustration is common in birds, especially in cockatoos and many domestically bred birds. Programmed in the wild to be constantly with a mate, a bird becomes distraught when its "person mate" is gone much of the day. It may also become jealous of other family members or maladjusted following a change in environment (eg, change of enclosure location, a new dog or child). Training is the first step in solving psychological feather picking, with correction of any dietary deficiencies being a critical part of the therapy. Birds that feather pick often consume pin feathers as if they are attracted to the taste of blood. A craving for the minerals, protein and fat of mature feathers may even be the cause for this pica. Birds given a balanced diet tend to feather pick less and spend less time chewing plants and perches. Many birds pick when first left alone, so early training in anticipation of the problem may be an effective preventive. Once feather picking is established, training may decrease the severity of the feather picking but will rarely stop the habit (see Chapter 24). Favoring One Person A bird that fiercely favors one person should be given the basic training, and when the training is finished, several other people should become involved in giving the commands and continuing the training interactions. Sexual stimulation such as stroking, playing with favorite toys and hiding in dark places should be avoided (Figure 4. When other people are present, the bird should be kept away from areas it wants to defend, such as shoulders and its enclosure. Sexually induced regurgitation, masturbatory behavior and pulling ears and jewelry can be corrected using preventive measures, basic training and finally, negative reinforcement. Going In and Out of Enclosure A bird that refuses to leave its enclosure should be fed just outside the enclosure door. With a perch stand placed near the enclosure door, the bird should be taught the "come" command while the trainer holds the food for several minutes. If this is repeated several times a day, the bird will gradually learn to perch outside the enclosure and can then be moved to other eating areas away from the enclosure. A bird that refuses to go back into its enclosure may be trained in the same manner by placing food in the enclosure for 15 minutes. If the bird enters within that time period, it is allowed to eat for a few minutes before the food is removed and the door is closed. A bird that has psychogenic polydipsia may respond to a similar behavioral modification program. Support Groups Veterinarians, bird trainers, behaviorists and bird clubs have begun to offer group support for prevention and correction of bird behavior problems.

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Examine syrinx also, some times aspergillus lesions are present only in the syrinx. With heavy scissors, remove the upper beak by a transverse cut as near the eyes as possible. This will allow inspection of the nasal cavity and will expose the open anterior end of the infraorbital sinuses. Make a longitudinal lateral incision through the wall of each sinus and examined them. If you suspect aortic rupture in turkeys (blood in the abdominal cavity), dissect the aorta starting at the origin near the heart and continuing distally till you can find the rupture. Examine the lungs by reflecting them medially from their attachment to the rib cage. For histopathology collect lungs at the entrance of the primary bronchus for best results. With knife or scissors make a longitudinal incision through the proventriculus, ventriculus, small intestine, ceca, colon, and cloaca. Examine brachial plexuses, sciatic nerves and vagus for any enlargements or loss of cross striation. The sciatic nerves are exposed by careful separation of the adductor and semimembranous and semitendinoses muscles. The intrapelvic portion of the sciatic nerves can be exposed by removal of the overlying portion of the kidneys by blunt dissection. Vagus can be examined on the lateral sides of the neck (it is easier to examine the left vagus) Using a sharp knife open each tibiotarsal joint (coxofemoral joint, stifle and foot pad if necessary) and examine the joint fluid for signs of exudate. Remove the calvarium with strong scissors cutting the skull starting at the atlantooccipital joint and continuing on and around till the cut is complete at the opposite side of the atlantooccipital joint. Other organs such as thyroids (at the thoracic inlet), parathyroids, adrenals, eyes, gland of Harder, ears, spinal cord with vertebrae intact should be collected for histopathology depending on the clinical signs and pathology. Therefore, consider obtaining blood samples for serology, culturing organs for bacteria and collect tissues for histopathology any organ that has lesion/s and save tissues for further tests. Bacteriology: Aerobic, anaerobic, campylobacter, mycology, coliforms, botulism toxin, etc. Toxicology: Heavy metals, selenium, vitamins (A and E), ionophore screen, mycotoxins, salt screen, trace element screen, anticoagulant screen, herbicide screen, cholinesterase, insecticides/pesticides, domoic acid, metaldehyde, avitrol, plant identification, zinc/aluminum phosphide, etc. Intestine: make smears on glass slides for coccidia and other parasites Transmission electron microscopy (negative stain): pool of small intestine (and ceca) in viral transport media. Liver also for vitamins (A, E), selenium, insecticides/pesticides, rodenticides and certain aflatoxins. If the bird/s is live observe the bird/s for clinical signs such as respiratory, diarrhea, neurological, weakness, etc. If blood is available make a blood smear especially from pigeons, wild birds, etc. Observe the exterior: conjunctiva/eyes, feathers, skin, nostrils, vent, uropygial gland, toes, keel, etc. If information is not available, talk to the owner regarding the breed and age (age is difficult to determine if wild caught). Record the nature and amount of contents if any in crop, proventriculus, gizzard, intestine. Record all lesions accurately, if necessary weigh organs like liver, heart, spleen, etc. Photograph the whole bird with accession # clearly visible if it is a legal or insurance case. Disposal of carcasses and remains: should be done according to the protocols; in a biohazard bag for autoclave or incineration especially psittacines. Save: i) Liver, spleen, kidney, lung, heart, brain, intestine in viral transport media for virology. Take the tissues for histopathology (see the list below) List of tissues to be collected for histopathology (Note: Take any tissue that looks abnormal/has a lesion. There are anatomical differences between various species (>22,000 subspecies) of birds and ages.

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Note that the bacterial population consists primarily of gram-positive rods and cocci; no gram-negative bacteria or yeast are present. Although the choanal slit is normally free of gram-negative bacteria, transitory gram-negative rods in the pharynx are common. To avoid the misinterpretation of an improperly stained sample, it is important to scan the entire slide and make certain that both gram-positive and gram-negative organisms can be identified. These nonpathogenic yeast are frequently passed in the feces and should not be misinterpreted as a fungal enteritis. Detecting an abnormally high number of yeast in the crop or feces is an indication that a bird is immunosuppressed. Finding gram-negative staining yeast is an indication that the staining process was improperly performed. Non-viable yeast that have been killed with antifungal therapy will appear as clear halos against the stained background. The techniques involved in the evaluation of the avian hemogram are easily performed by in-house veterinary laboratory personnel. Because avian blood does not store well (eg, during transport), hematologic results obtained soon after collection are preferred over those performed several hours later. In general, birds are better able to tolerate severe blood loss than mammals, which is due to their greater capacity for extravascular fluid mobilization. However, there is a marked variation among avian species in response to blood loss, which may be a reflection of differences in blood volume or extravascular fluid depots. In healthy Mallard Ducks and racing pigeons, a blood volume equivalent of up to three percent of the body weight can be collected. In Passeriformes, pheasants and Psittaciformes, up to one percent of the body weight can be collected with few ill effects (0. The choice of a blood collection site is influenced by the species of bird, preference of the collector, physical condition of the patient and volume of blood needed. Blood collected from capillaries (eg, blood from clipped nails) often results in abnormal cell distributions and contains cellular artifacts such as macrophages and material not normally found in peripheral blood (Figure 9. Other anticoagulants, such as heparin, interfere with cell staining and create excessive cell clumping, resulting in erroneous cell counts and evaluations (Color 9. The right jugular vein is usually chosen over the left for blood collection because in many birds it is the larger of the two. To collect blood from the jugular vein, the bird is properly restrained with the head and neck extended (Figure 9. Extending the neck encourages the highly movable jugular vein to fall into the jugular furrow. In many species, there is a featherless tract of skin (apterium) overlying the jugular vein; therefore, lightly wetting the feathers with alcohol in this area will aid in the visualization of the vein. Blood is collected into a syringe, and the size of needle is governed by the size of the vein. Complications of jugular venipuncture include difficulty in proper restraint of the bird or stabilization of the vein and hematoma formation. Improper attention to technique and hemostasis can cause a large hematoma to form during or following jugular venipuncture. However, jugular venipuncture becomes a skill perfected with practice, and complications are infrequent in skilled hands. Venipuncture of the ulnar or wing vein is a common method for obtaining blood from medium to large birds. A needle is inserted into the vein, which is found crossing the ventral surface of the humero-radioulnar joint (elbow) (Figure 9. Blood is either aspirated into a syringe or allowed to drip from the needle hub into a microcollection device. Collecting blood in this manner reduces but does not eliminate hematoma formation. Hematoma formation, which can be severe, is common when the ulnar vein is used for blood collection. A needle with an extension tube, such as a butterfly catheter,d aids in stabilization during sample collection to minimize tearing of the vein. Blood collected from a toenail clip may yield abnormal cell distributions and cellular artifacts.

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Artificial (Induced) Induced abortion may be: Justifiable abortion (therapeutic) Criminal abortion Natural abortion may be: Isolated abortion Recurrent abortion natural Abortion Spontaneous or natural abortion occurs usually in first or second trimester of pregnancy and the causes3 are as mentioned in Table 19. Inhersupport,shemayproduce falsethingssuchasmenstrualpadsorkilledanimalfetus pertaining that it is abortus material. Unmarried girls and widows may, at times, resort to criminal abortion when child is product of illicit sexual intercourse. Thisisdonetogetridofthedevelopinglife or in some cases to save the honor and pride of self or family. A poor family may procure criminal abortion to avoid theadditionofamembertofamily. Thesefamiliesseek the services of an unskilled person since he may take fewer fees in comparison with a qualified one. When female is pregnant, these people do sex determination test (at present unlawful act) and if the sex of baby is found to be female, they persuade the pregnant lady to abort the product of conception. Local abnormalities Retroverted uterus Fibromyoma Cervical incompetence A Section. Explanation:A woman, who causes herself to miscarry, is within the meaning of this section. Explanation: It is not essential to this offense that the offendershouldknowthattheactislikelytocausedeath. Examples are: ­ Ergot preparations ­ Synthetic estrogen ­ Pituitary extract ­ Quinine ­ Gossypium (cotton root bark) 2. Emmenagogues:Thesedrugspromoteuterinecongestion and induce bleeding thus expelling product of conception. Irritants: these are of following types ­ Genitourinary tract irritants ­ these agents produce inflammation of genitorurinary tract and reflexly irritate the uterus and induce uterine contraction ­ example Cantharides, turpentine oil. Abortifacient drugs Ecbolics Emmenogogues Irritant poisons Systemic poisons Abortion pills Abortion stick Section B. Local violence Forensic Medicine Methods used A 348 PrinciplesofForensicMedicineandToxicology ­ Application of abortion paste ­ Use of root of plant asAbortifacient agent ­ Syringing:eitherforaspirationoffluidorforced filling of uterine cavity with fluid and air. B) By skilled person ­ Low rupture of membrane ­ Vacuum aspiration ­ Dilatation and evacuation ­ Use of laminaria tent ­ Use of prostaglandins. Incomplete abortion pressureonabdomenbykneadingorfirmlymassaging the abdomen ­ Cupping:aflamelight(diya)isplacedonabdomen and a metal mug (lota) is placed over the flaming light (diya). Septicemia numberofabortionsbeingperformedeveryyearbyuntrained persons in totally unhygienic conditions. Breasts: Are heavy, enlarged, areola and nipples are pigmented, clostrum/milk may ooze on squeezing the breasts. Vagina: Tags of membrane, partial aborted material, blood, foreign body, abortion stick etc. Uterus: May be enlarged on bimanual examination or may be showing signs of involution. Swab from cervical canal will reveal chemical used for procuring abortion and can be used for bacteriological examination. Septicemia Tetanus Endometritis Renal failure Peritonitis Sterility Recurrent abortion Causes of Death in Criminal Abortion 1. Forensic Medicine A 350 PrinciplesofForensicMedicineandToxicology · Uterus:Enlarged,cavitymayshowpresenceofpartially separated product of conception, foreign body, blood clots, presence of any paste or chemical, evidence of injury or perforation etc. Examination of Aborted Material · Police may request medical examiner to examine a substance alleged to have been expelled from uterus as product of conception. If it happens to be product of conception, it may be suggestive of criminal abortion. Insuchcasespresenceof chorionic villi on microscopic examination will confirm that it is product of conception. If only placenta is sent for medical examination thenitshouldalsobeexaminedtoascertaininjuriesortears and any degenerative changes in its surface.

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Locally (on skin), benzene has a strong irritating effect, producing erythema, burning and, in more severe cases, oedema and blistering. Benzene has been classified as a human carcinogen by various international monitoring agencies. The causal relationship between chronic exposure and a variety of haematologic disorders has been known for the last 50 years or more. These include aplastic anaemia, acute myeloblastic leukaemia, haemolytic anaemia, and pancytopenia. Benzene exposure is associated with translocations between chromosomes 8 and 21, and hyperploidy of 8 and 21 in the circulating lymphocytes of workers exposed to benzene. Headache, dizziness, irritability, nervousness, fatigue, anorexia and epistaxis may also occur with chronic benzene poisoning. An epidemiological study of pregnant women in a large petrochemical industry showed a positive correlation between reduced birth weight and exposure to benzene and work stress. Hydrocarbons and Pesticides Section 8 Forensic Issues Most cases of poisoning result from accidental exposure. In India, accidental kerosene poisoning is quite common in the paediatric age group, since it is a popular household fuel and is often negligently left around in the kitchen in bottles or cans. Suicidal ingestion of hydrocarbon products is not uncommon because of easy availability of many of these agents. Experimental animal studies and some studies on cancer incidence and mortality in human occupational groups suggest that hydrocarbon exposure is associated with renal neoplasia. Physical Appearance Colourless, volatile, inflammable liquid, with a strong, pleasant odour. Benzene can be recovered from coal tar and produced from the hydrodemethylation of toluene under catalytic or thermal conditions. A chief source of benzene is catalytic reformat, wherein the naphthenes and paraffins contained in naphtha are converted to aromatic hydrocarbons. Most of the benzene produced is generally derived from the petrochemical and petroleum-refining industries. Benzene is metabolised extensively in the liver and excreted in the urine, with 51 to 87% excreted as phenol, 6% as catechol, and 2% as hydroquinone. Monitoring benzene in expired air and urine phenol levels may be useful for observing workers exposed to benzene. Analysis of urinary t, t-muconic acid appears to be a better indicator than phenol for assessment of exposure to low levels of benzene. Gas chromatography head-space analysis is the preferred method for determining benzene in blood or urine. Toluene and Xylene produce similar (though milder) manifestations on acute exposure and are managed by supportive measures, with the same precautions in decontamination as for other hydrocarbons. Sources Treatment Acute exposure is treated on the same lines as in the case of aliphatic hydrocarbons. Consider gastric lavage with a large-bore orogastric tube after a potentially life-threatening ingestion if it can be performed soon after ingestion (generally within 60 minutes). Naphthalene occurs naturally in the essential oils of the roots of Radix and Herba ononidis, and crude oil. Naphthalene can also be produced by boiling coal tar oils at temperatures between 200­2500 C, followed by crystallisation and distillation. It can also be derived from catalytic processing of petroleum, or isolated from cracked petroleum. Naphthalene is formed in cigarette smoke by pyrolysis, and is also a photodecomposition product of carbaryl, an agricultural pesticide. Forensic Issues Most cases of exposure (acute and chronic) are occupational in nature. Its metabolites alpha and beta naphthol as well as naphthoquinone are powerful haemolytic agents. Naphthalene is first metabolised by hepatic mixed function oxidases to the epoxide, naphthalene-1,2-oxide. The epoxide is enzymatically converted into the dihydrodiol, 1, 2-dihydroxy-1,2-dihydronaphthalene or conjugated with glutathione.

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Y the sympathomimetic effects of cocaine increase myocardial oxygen demand and the alpha-adrenergic mediated coronary vasoconstriction limits coronary artery blood flow. Y Cocaine inhibits endogenous fibrinolysis, increases thrombogenicity, and enhances platelet aggregation. Direct pyrogenic effect due to action on thermoregulatory centres in the hypothalamus. Body temperature often soars to 108 to 112°F, and does not respond to conventional antipyretics. Headache: Three patterns of cocaine-induced headaches have been identified ­ - Pattern 1-Develops within minutes, and lasts for 2 to 48 hours. The headache is usually occipital or bilateral, with associated throbbing, photophobia, nausea, and vomiting. It is mostly frontal, with associated throbbing, nausea, and sometimes diplopia and dizziness. It is also frontal, with associated throbbing, nausea, vomiting, photophobia, and occasionally neck stiffness. Convulsions: Generalised tonic-clonic, partial motor, and partial complex seizure have all been reported. Sometimes there is lethargy and decreased level of consciousness which can persist up to 24 hours ("cocaine washed out syndrome"). Cerebrovascular accidents are not uncommon, and include subarachnoid haemorrhage, intracerebral haemorrhage, cerebral infarction, transient ischaemic attacks, migraine-type headache syndrome, cerebral vasculitis, and anterior spinal artery syndrome. Chapter 16 Stimulants Toxicokinetics Absorption- Y Ingestionandinsufflation: Cocaine is well-absorbed from oral, nasal, and pulmonary routes. Y Intravenous injection: Onset of action is within seconds, and peak action occurs in 3 to 5 minutes. Minor metabolites include norcocaine ecgonine, ecgonidine, norecgonidine methyl ester, norecgonine methyl ester, and m-hydroxybenzoylecgonine. Y Patients with lower plasma cholinesterase levels may be predisposed to more severe cocaine toxicity. Since children have lower plasma cholinesterase levels, they may be affected by smaller amounts of cocaine. In addition, the metabolic half-life of cocaine may be increased by lower plasma cholinesterase concentrations. Mydriasis and/or loss of eyebrow and eyelash hair from smoking crack cocaine may occur. Central retinal artery occlusion and bilateral blindness due to diffuse vasospasm. Tachyarrhythmias of all types can occur, including sinus tachycardia, atrial fibrillation or flutter, other supraventricular tachycardias, ventricular premature contractions, ventricular tachycardia, torsades de pointes, and ventricular fibrillation. Thermal injuries to the upper airway leading to epiglottitis, laryngeal injury, and mucosal necrosis have been reported after smoking "crack" or free base cocaine. Rhabdomyolysis with hyperthermia, massive elevation of creatine phosphokinase, and acute renal failure: Although the mechanism of cocaineassociated rhabdomyolysis is unclear, it is postulated that it may result from ischaemia due to vasoconstriction, direct toxicity, hyperpyrexia, and increased muscle activity from agitation or seizure activity. Intestinal perforation: It is postulated that cocaine blocks the reuptake of noradrenaline leading to mesenteric vasoconstriction and focal tissue ischaemia and perforation. Hepatic necrosis (centrilobular, midzonal, and panlobar) has been reported in overdose. Renal failure, usually secondary to myoglobinuria and rhabdomyolysis, has been reported after intravenous or intranasal cocaine use. Increased incidence of spontaneous abortion, low birthweight, and abruptio placentae. Infants exposed to cocaine in utero may display tremulousness, impaired orientation, increased startle response, irritability, muscular rigidity, arousal deficits, impaired motor ability, and lower scores on the Brazelton Neonatal Behavioral Assessment Scale (measuring interactive behaviour and response to environmental stimuli). Priapism has been observed after topical application of cocaine to the glans penis. Severe metabolic acidosis has been reported due to seizures, agitation, and hypotension.

References:

  • http://ldh.la.gov/assets/docs/BayouHealth/Informational_Bulletins/IB12-29.pdf
  • https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0514_coveragepositioncriteria_genetic_testing_repro_carrier_prenatal.pdf
  • https://pediatrics.aappublications.org/content/pediatrics/early/2017/10/26/peds.2017-2695.full.pdf
  • http://online.crohnscolitisfoundation.org/site/DocServer/Specific_Carbohydrate_diet.pdf?docID=34292
  • https://www.rch.org.au/uploadedFiles/Main/Content/kidsinfo/english-asthma.pdf
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