Indian Journal of Forensic and Community Medicine

193-197

Authors: Santhosh Chandrappa Siddappa, Anupam Datta

Background: With a sudden rise in population throughout the globe there is a surge in the medico-legal cases as well. These medico-legal cases differ among regions based on socio-economic status, cultural diversities, capability of law enforcing agencies and the prevailing standards of health care services available in the community. Aims and Objectives: To know the pattern and profile of medico-legal cases in a tertiary care hospital. Materials and Methods: This is a prospective study in which 4066 medico-legal cases were studied. This cases attended in Casualty department, J.J.M. Medical College and Bapuji Hospital from 1st October 2014 to 30th September 2015 and the information was collected with respect to their demographic profile, age and sex wise distribution, time period between injury and reporting to casualty, time of occurrence, type of injury, manner of injury, prognosis and the mortality profile. Results: Out of 4066 cases studied, 2918 (71.76%) were males and 1148 (28.23%) were females. Majority of the victims belonged to an age group ranging 21 – 30 years of age (37.67%). The urban victims constituted 2134 (52.48%) compared to the rural counterparts, 1932 (47.51%). Road traffic accidents constituted a majority of cases (47.73%), poisoning and fall constituted 16.84% each followed by assault in 6.19% of cases. Majority of the victims (51.94%) reported to the casualty within 1 hour of incident. 78.99% of the victims were discharged from the hospital after treatment. The peak time of attending to the casualty was during 12 pm to 6 pm and the manner of injuries were accidental in nature in majority of the cases (69.03%). Conclusion: This study shows the frequency of medico-legal workload in a tertiary care hospital, public attention and awareness towards medico-legal emergencies, urges round the clock availability of medico-legal experts to deal effectively with the legal responsibilities, sensitize the doctors to handle those cases including proper documentation and certification of medico-legal cases and also provides a valuable information for government, health care policy makers, law enforcing agencies to take effective measures.

203-213

Authors: Ambika Prasad Patra, Kusa Kumar Shaha, Anand P Rayamane, Sachidananda Mohanty

Aim of study: The demographics and characteristics of sexual assaultare changing. Hence, the aim of the study is to: a. To describe victim, assault characteristics for women alleging rapeaccording to the type of penal sections egistered by the police. b. To record the time between the last sexual assault and the examination, and to find out the reasons of delayed reporting of rape cases. c. To provide descriptive data on the medico-legal findings. d. And, to do a comparative review of the existing literatures. Material and method: This study is based on 244 numbers of examined rape victims reported to the Department of Forensic Medicine& Toxicology during the period from January 2010 up to December 2013. Victims were referred from investigating police authorities for evidentiary examination. Study included all cases registered under Section 376 Indian penal code (punishment for rape) by the police, with or without sections of other offences e.g. gang rape, rape followed by murder, abduction and rape, sexual intercourse made deceivingly or by an impostor; and rest all types of medico-legal cases were excluded. The prospective data regarding victim’s socio-demographic variables, detailed history of the alleged act, her relationship with the alleged accused person, date, time, place of occurrence of the crime,frequency of occurrence, reasons for delayed reporting, information regarding bathing, changing of clothing after the act, and use of any barrier methods by assailantswere collected fromthe rape victims, accompying family attendents, from the police, physical examination findings, laboratory investigation findings, and from any other available documents. Results: Most commonly alleged charge was ‘abduction and rape’ (46%), and least reported ones were gang rape, rape and murder (1%), and only ‘rape’ alleged in 8% cases. About 89% of the alleging women were 11-30 years old, with a median of 23.7 years, and mean 25 years; 57% were unmarried, 40% were educated up to the junior college level, and 55% were above the poverty line. A majority of cases (75%) were from rural and semi-urban areas. In 97% cases, the alleging woman knew the alleged accused person. Most commonly, boyfriends, friends, or the acquaintances were the culprits (70%). The fatal forms of sexual assault like gang rape, rape and murder usually done by the unknown assailants. The crime in 82% cases had occurred in Indoors. Out of which 60% cases had allegedly occurred at either victim’s home, or the alleged accused person’s home or office. Majority (47%) of cases reported during winter season, and the least (16%) in rainy season. A majority (60%) of the cases reported after 7 days of the alleged incident. The latency of reporting of cases varied from 24 hours to 2.5 months with a median of 27 days. Physical force for sexual intercourse was used in 46% of cases, but physical injuries found in 2-3% of cases only (extra-genital injuries in 2% and genital injuries in 3% of cases). The risk factor for the detection of genital injury is the presence of extra-genital injury [Odds Ratio (OR) 1.2, 95% Confidence Interval (CI)]; and, the risk factors for the presence of genital injuries in the absence of extra-genital injuries are, age below 12 years (OR 3.3, 95% CI) and beyond 38 years (OR 1.2, 95% CI). In 2%, cases seminal stain and foreign pubic hairs retrieved from the body of the victim. The victim women had witnessed use of condom by the alleged offender in 18% of cases. Conclusion: Though all age groups are prone for rape, unmarried women in their first three decades are more vulnerable. A known victim-offender relationship usually associated with the less physical or genital injuries, and less fatality. While evaluating rape cases possibility of false allegations of rape should not be ignored. Presence of physical or genital injuries is neither predictive nor essential for conviction. Medical examiners need to be circumspect while recording non-medical variables for a successful prosecution.

220-224

Authors: Vijay Kautilya D, Sathish K V, Shruti Prabhat Hegde Vijay Kautilya D, Sathish K V, Shruti Prabhat He

Background: Abuse of psycho active substances has been a problem in the society since ages. And the patterns of substances abused keep changing in every society. Street children are a marginalized group of our society who harbour a variety of social and cultural problems. There is an urgent need to understand their problems better so as to be able to cater to their needs. Method: This is a cross sectional descriptive study where 30 street children were interviewed regarding their personal and work problems. Patterns of abuse of substances by these children was studied based on their interview. Results: Most of the children have ended up on the street to escape from exploitation at home. Due to pressure and influence from friends they take to substance abuse. They start with tobacco; proceed to solvent abuse (80%), alcohol (80%), and cannabis (63.3%). Use of tobacco and solvents starts early at an average age of 8 years. Cannabis is taken by older children. Conclusion: These children face a variety of problems at home and also at work. They are highly exploited by the community. Most children take to high risk behaviour to overcome these hardships. Better understanding of this socially out cast community is the need of the hour in order to curb this evil of substance abuse.

229-233

Authors: V. J. Aghera, K. N. Pipaliya, D. M. Dabhi, H. M. Mangal, P. R. Varu, P. J. Manvar

Background & Objectives: Poisoning is most commonly encountered cause of death in medico legal autopsies. Diagnosis of poisoning is based on post-mortem examination and chemical analysis of viscera. Chemical analysis of viscera by FSL is time consuming process and sometimes it cannot detect poison. Present study can be helpful there to make diagnosis of poison from gross mucosal findings in stomach. Methods: Present study was conducted on randomly selected 150 cases of poisoning from total autopsies performed in year 2012 at department of forensic medicine, PDU govt. medical college, Rajkot. To study gross mucosal findings of stomach, it was divided into three parts namely cardiac end, body-fundus and pylorus. Gross mucosal findings like pale, congestion, haemorrhage, erosion, flatten rugae, edema, colour changes were noted. Results: Haemorrhage and congestion of mucosa were found most commonly, irrespective of type of poison and site of stomach affected. Pylorus and body fundus of stomach were more affected in all cases of poison except ALP poison where cardiac end was more affected. Interpretation & Conclusions: On the basis of the gross findings of stomach mucosa, combining with other data (history, clinical findings) diagnosis of poisoning can be made but to confirm the nature of poison chemical analysis is must.

242-246

Authors: U B Ghaffar, Ahmed SM

Road traffic accidents (RTA) are continuing to be an occurrence of epidemic proportions both in the developed and developing world statistically becoming one of the leading causes of mortality and morbidity. In Saudi Arabia, road traffic injuries are increasing exponentially year by year in spite of advances in safety technology. This review is based on the analysis of all published articles on road traffic accident in KSA published during the last 10 years. Critical analysis revealed that most of these unfortunate events can be attributed to vehicles travelling at excess speed and or drivers disobeying traffic signals which are absolutely preventable in nature. RTA accounted for most of the trauma admissions to hospital with young adults, especially males, who are the at risk population. The most frequently injured body regions as reported in the studies were head and neck, followed by upper and lower extremities. Latest statistics of Saudi Arabia indicates that approximately 19 deaths and 4 injuries occur daily due to road traffic accidents. Hence, there arises an urgent need to compile a comprehensive demographic baseline statistics and pattern of injuries that will provide scientific evidence based information to effectively educate the public regarding road safety. It will also help to plan appropriate interventions that was previously overlooked to prevent such loss of life and lifelong disability.

251-254

Authors: Nirmalya Kumar Sinha, Uday Basu RoyChowdhury, Dulal Chandra Das, Sumandev Chakraborty, Somnath Maity

Child sexual abuse is a common and a serious public health problem in every society. It not only leaves a permanent scar on the mind and the body of the victim, but also put her entire family into shame and humiliation. The majority of sexual assault cases is never reported to avoid social stigma and the number of reported sexual assault is the only tip of the iceberg. We present a case of a victim who died from smothering after sexual assault, sustained lacerated injury over the posterior wall of the vagina at its lower part including perineum, hymen and labia minora of both sides. There were multiple injuries all over the body. We attempt to highlight a case of rape murder complex, which is of rare occurrence in the semiurban regions of West Bengal, India.

125-129

Authors: S R Saritha, K. Sasikala

Back ground and objectives: Fall from height in to water with mention of injuries, were included in the international classification of diseases (ICD) as fall from height. Severity of the injuries depends on various biological and circumstantial factors. This study was taken up with the objective to describe the pattern of injuries and socio- demographic profile of victims of fall from height into water with mention of injuries. Method: Descriptive autopsy based study on 53 cases of fall from height into water with any mention of injuries conducted at State Medico legal Institute, Medical College, Thiruvananthapuram, Kerala during the period from May 2006 to April 2008. Results and interpretation: Majority of victims were males (69.8%). Age ranged from one year one month old female child to 90 years old elderly female. Incidence was maximum in lower and lower middle income group (88.7%). Place of incidence was home in 66% of cases. Accidental death constituted 50.9%. Majority died due to fall into well (88.7%). Significant number of victims fell down from a height range of 5 to 10 meters (39.6%). Drowning was the foremost cause of death irrespective of height of fall (58.5%). External injuries were invariably present in all cases and internal injuries in 41.5%. Most frequent region involved was head in 33.9% cases. Injury severity was not proportional to the height of fall. Conclusion: Falls are extremely common, the severity not necessarily being directly related to the distance that the person falls. Along with other factors, surface of impact also plays a major role in determining the severity of injuries in cases of fall from height.

135-140

Authors: B. L. Jat, S. R. Kochar, Rashmi Gupta, Deepali Pathak, Dharmesh K. Sharma, Kusum Gaur

Background: Majority of medico-legal cases brought to the forensic specialist for assessment of age for both the victims and accused. Among newer technologies used for that Computed tomography (C.T. Scan) technology has become increasingly more accurate and precise. Objectives: To find out ability of Computed tomography (C.T. Scan) for assessment of age in age group of 10-22 years Material and Method: This study was carried out on 64 healthy subjects Sphenoid sinus was analyzed in coronal and axial position followed by 3-dimensional reconstruction in CT scan. Volume of Sphenoid sinus was assessed and significance of difference of volume of Sphenoid sinus as per age, sex and diet was assessed with Analysis Of Variance (ANOVA) and Post-hoc tests. Result: Although age wise volumetric measurement of sphenoid sinus through CT scan was found significant in only some age groups when estimated at one year interval from 10-22 years but when estimated at interval of two years interval it was found significant for most of ages. Volumetric measurement of sphenoid sinus through CT scan at the interval of 4 years was found significant in every age group. Significance of difference in volumetric measurement of sphenoid sinus as per sex, residence was found significant along with age but as per type of diet it was not found significant when assessed by age interval of 2 years. Conclusions: Age wise volumetric measurement of sphenoid sinus through CT scan can be found correct for most of ages from 10-22 years at interval of 2 year of age. Age can be estimated 100% volumetric measurement of sphenoid sinus through CT scan at the interval of 4 years from 10-22 years.

144-146

Authors: Vijaykumar P Mane, Trupti B Naik, Mallappa O, Omprakash Ambure

Introduction: Malnutrition is widely recognized as a major health problem in developing countries. For practical purposes, anthropometric measurements are the most useful tool for assessing the nutritional status of children. Mid upper arm circumference (MUAC) has been proposed as an alternative to weight-for-height (W/H) index as a measure of acute malnutrition because of its low cost and ease of performance, particularly for rapid field assessments of nutritional status in circumstances where resources and trained personnel are limited. Objectives: To estimate the validity of mid-upper-arm circumference (MUAC) measurement as a screening method in detection of wasting among preschool children Materials and methods: A community based cross sectional study was done for a duration of 3 months in Bhadravati taluk, Shivamogga district, Karnataka state. 210 preschool children of either sex in the age group of 1-3 years (12- 36 months) were included in the study by cluster sampling technique. Anthropometric measurements were recorded using standard techniques. Results: The prevalence of wasting and severe wasting was found to be in 21 (10%) and 2 (0.9%) of preschool children respectively using mid upper arm circumference against 28 (13.3%) and 6 (2.9%) respectively using Weight for Height index. The sensitivity of MUAC in detecting wasting was found to be around 35% in our study whereas the specificity was 95%. Conclusion: MUAC could identify very few children as undernourished against W/H index. Further studies are needed to test the findings of our study.

150-153

Authors: Manjunath S Kamble, Sangita C. Shelke, Bilkish Patavegar

Introduction: Immunization not only reduces morbidity and mortality from potentially infectious diseases, it also interrupts disease transmission in the community. In a developing country like India, children are not immunised at all or partially immunised and the usage of health services is also different for different segments of society. According to NFHS III data, only 44% of infants are completely immunized, which is much less than the desired goal of 85% .So, the study was undertaken to assess the immunisation status of children ( 3-6 years) coming to anganwadis under the urban field practice area of B.J.Medical College, Pune. Aim and Objective: To assess the immunization status of children (3-6 years) coming to Anganwadis. Methodology: A cross- sectional study was done among 3-6 years old children coming to anganwadis under urban field practice area of B.J.Govt.Medical College, Pune. The study was conducted between January 2013 to July-2014. All children who were enrolled in anganwadis and the parents/guardian of children who were willing to participate were included in study after taking written informed consent. Data was analysed using SPSS softwareVersion 17. Results and discussion: The number of children coming to anganwadis were more in the age group of 4-5 years (39.98%). There were more females as compared to males i.e. 41.18% & 36.44% respectively. The Immunization status was associated with various parameters but significant association was found with parameters like sex, socio-economic status, underweight and wasting (p<0.05). Most of the study results were similar to the findings of other studies conducted at different places and at different time intervals. There were few studies which showed contrast results to our study. Summary and conclusion: Majority of children were completely immunized. (85.43%). No association was found between different age groups and immunization status. (p=0.9058). It was also observed that more number of male children (21.19%) were partially immunized as compared to female children (8.82%). The number of children who were completely immunized were having lesser underweight and wasting as compared to partially immunized and unimmunized children. (p<0.05).The association was not statistically significant. (p>0.05) with respect to stunting. Recommendation: All efforts should be taken to immunize those children who were partially immunized or not immunized at all.

158-166

Authors: Anupam Datta, Santhosh Chandrappa Siddappa, Viswanathan Karibasappa Gowda, Siddesh Revapla Channabas

Introduction: Examination of bones is important for identification of deceased and determination of sex. The mandible is the largest and hardest facial bone, that commonly resist post mortem damage and forms an important source of information about sexual dimorphism. Aim: The purpose of the study is to analyze sexual dimorphism in the mandibles of South Indian population. Materials and Methods: A random collection of 50 adult, dry, complete, undamaged human mandibles of South Indian population were subjected to metrical parameters like Gonial angle, Bigonial width, Height of ramus, Bicondylar breadth, Mandibular length, Length of lower jaw, Mandibular index, Body thickness, Coronoid height, Bimental breadth, Symphyseal height and Body height using Mandibulometer and Digital Vernier caliper. Statistical Analysis used: The data’s were expressed as Mean ± SD and then analyzed by unpaired t-test by using IBM SPSS Statistics 21. Discriminating point and limiting points were also calculated. Results: After obtaining all the measurements, unpaired ‘t-test’ was performed. The Gonial angle, Bigonial width, Height of ramus, Bicondylar breadth, Mandibular length, Length of lower jaw, Body thickness, Coronoid height, Bimental breadth, Symphyseal height and Body height showed statistically significant gender difference. Conclusion: The present study highlighted that the gender of the mandible can be determined using different metrical parameters as an additional tool to establish the identity of a person.

172-175

Authors: Sudhir, Chaitra M, Deepa K

Background and objective: Health is a fundamental human right in India and several other countries. The policy concern in developing countries such as India where 70% of the population lives in rural area is not only to reach the entire population with adequate healthcare services, but also to secure an acceptable level of health for all the people through the application of primary healthcare programs. Health insurance is one of the most important aspects of health care management system. This paper tries to identify the determinants of health insurance in rural India. Methods: A Cross sectional community based study was done with sample size of 290 households estimated by using 25% national coverage according to Public Health Foundation of India. The study was conducted between July 2014 to August 2014. 290 families were covered from two Primary Health Centres which come under field practice area of our medical college. A pretested semi structured questionnaire was used to collect data. Data was entered in excel sheet and analysed using SPSS version 17 software. Results and interpretation: In this study 72.5% of respondents were in age group 26-45yrs, 69.4% of respondents were female,82.1% were from below poverty line family,72.4% were from nuclear family, 81% of respondents were aware of health insurance but only 53.1% were actually insured and off the respondents who were not insured 40.9% were not aware of health insurance. The male gender, nuclear family, affordability to pay premium, higher educational status and awareness regarding health insurance was significantly associated with being insured. Conclusions: The main determinants of being insured were male gender, nuclear family, affordability to pay premium and higher education status. In order to bridge this gap in rural India of not being insured is to educate them in order to bring about behavior change among the respondents.

179-181

Authors: T.Vedanayagam, V. Sathyamurthy

The identification of sex from human remains is of fundamental importance in forensic medicine, especially in criminal investigations, in the identification of missing people and in anthropology for reconstructing the lives of ancient civilization. The technique of osteometry has been successfully used in the estimation of stature, age, sex and race in Forensic Medicine. The accuracy of determination of the sex from skeletal remains varies with the age of the subject, bones available, fragmentation and biological factors. The objective of this study is to measure the size of the foramen magnum and find out whether the sex of an individual can be made out from these measurements. The study sample consists of 420 human bodies which underwent autopsy, comprising of 260 male and 160 female bodies within the age group of 18-60 years. The age group of 18-60 years was selected because the sexual characteristics of the bone do not begin to manifest themselves until the stage of puberty is attained. Hence the lower limit of age was fixed as 18 years. Since all the sutures of the cranium get fused by the age of 60, the upper limit was fixed at 60years. Based on the transverse diameter of the Foramen magnum, the sex determination can be done with 99.9% confidence limit. There is no statistically significant difference in the sagittal diameter.

76-81

Authors: Balaji Arumugam, Iyappan. M, Hariharan. N, Reddy R G, Selvaraju K S, Franklin Roy. J

Background: Despite the increasing prevalence of chronic diseases and co-morbidities, the essential attributes of the patient and family approach of care, are still to be defined in terms of disease-specific approaches. Effective improvements in family-based approach will require alternative ways of thinking about chronic care design and practice. Objectives: The study was designed with the objectives of assessing the approach of the family members towards chronic disease persons in their family. Methodology: The study was conducted as a community based cross sectional study during November and December 2013, in a nearby village among the families affected from any of the chronic disease. The study participants were selected randomly from the community and they were interviewed using a preformed pretested questionnaire after getting the informed consent. The questionnaire includes general information about the family and the person affected from the chronic disease, money spent, duration of disease, approach of the family members towards the diseased person. The data were analyzed using EPI-INFO software version 3.5.1. Results: A total of 105 persons were interviewed, among whom 44 (41.9%) were suffered from Diabetes Mellitus, 14 (13.3%) were having Hypertension, tuberculosis 9 (8.6%), Osteoarthritis 8 (7.6%) and the remaining had co-morbid chronic diseases. Among the family members 82 (78.1%) had satisfactory attitude towards the diseased persons. Around 52 (49.5%) ignore the diseased persons for celebrations, 35 (33.3%) ignore them for decision making, 23 (21.9%) gave a separate room and 18 (17.1%) felt that treatment expenditure as waste of money. As far as the knowledge, attitude and practice were concerned, attitude and practice were associated (p < 0.05) with lesser age group and nuclear family using chi-square test. Conclusion: Our study had concluded that the overall approach and knowledge, attitude and practice of the family members towards the chronic illness patients in their family was not satisfactory.

87-90

Authors: Balaji Digamber Almale, Seema S Bansode-Gokhe, Sudam Rambhau Suryawanshi, Ashok Jaykumar Vankudre,

Introduction: The police as one of the visible important component governance and control have always been under intense scrutiny and hence vulnerable to wide spread criticism. Growing unemployment, increasing violence and rising expectations of the people have caused serious challenges before police. They work routinely for 12 hours or more often goes a couple of days nonstop at police station with a catnap in between. The truth is that many policemen live lives of fatigue and despair so the objective of present study was to find health status of Mumbai police. Aim and Objective: To study health profile of Mumbai Police Material Methods: The present study was conducted in Mumbai district selected police stations. A multistage and systematic random sampling technique was used to represent a total of 276 policemen out of 40,000 police population. Results: We found 40-50 age groups predominant among policemen. Maximum policemen were married (91%). Educational qualification in policemen were secondary (36.2%), higher secondary (48.6%), graduation and above (15.2%). In our study 55% were addicted to nicotine alcohol abuse in 26% policemen. Most of the policemen were complaining of musculoskeletal problems (62.7%), gastrointestinal problem (51.8%), and dental problems (41%). Prevalence of hypertension was 42.4%. Forty eight percentage policemen were pre obese while 20% obese in this study. Conclusion: policemen require periodic medical examination to remain healthy. Government machinery require to look into the health problems of Mumbai policemen to form a comphrsnvice health insurance policy. Periodic counselling is required on health issue as well as job stressor from team consisting of specialist in medicine, psycharity, dieticians and psychologist.

95-99

Authors: Kamlesh Jain, Bala DV, Kartik Trivedi, Haresh Chandwani

Background: Medical Certification Cause of Death (MCCD) Scheme is an important tool to obtain reliable and scientific information in terms of causes of mortality. In India still MCCD are registered only in 14% case of all death. The present study was conducted to assess the accuracy and completeness of the Medical Certificate of Cause of Death (MCCD) forms, study the leading causes of death derived from the MCCD forms and to find out the life expectancy at birth in male and female. Methodology: A total of 7392 MCCD forms were available during one year from the Ahmedabad Municipal Corporation’s Registrar Birth and death office and all of them were scrutinized for the completeness of the certificate and tried to find out the cause of death in which underlying cause of death was written. Data collected was analyzed using Epi-Info software (version 6.04d). Appropriate statistical tests were applied. Results: Out of total 7392 MCCD forms, 7336 (99.2%) mentioned age and 7299 (98.7) mentioned sex of the deceased person. Only 151(2.04%) forms were completely filled. The completeness for immediate cause, antecedent cause, and underlying cause was 95.56%, 66.67% and 40% respectively. Main leading cause of death in the present study was disease of circulatory system 868(29.35%), followed by Neoplasm (16.54%) and Certain infectious and parasitic disease (16.44%). Conclusion: The present study showed incompletely and inaccurately filled MCCD forms. Therefore adequate training and proper sensitization of the private and government doctors regarding the usefulness of MCCD data is required.

106-109

Authors: Suresha, Manjunatha S N

Background: Biomedical waste management is an important area in hospital safety and sanitation. Despite the presence of legislation there are many concerns and deficiencies in the optimum practice of the guidelines prescribed. Hospital waste produced is hazardous and carries variety of health risks, if not handled and disposed properly. The target group affected is vast, starting from doctors, patients, general public and waste handers. Teaching hospitals should act as leaders in following the right practices and should also involve themselves in training other health professionals in the appropriate hospital waste management. So it becomes imperative for the teaching hospitals to adopt the best practices in this area. Method: The study was undertaken to study the current practices of hospital waste management at K.R. Hospital & Cheluvamba Hospital, attached to Mysore Medical College, Mysore. It was a cross sectional study done using a checklist. Thirteen major departments in the two hospitals were selected for the study. The questionnaire was administered to the staff nurses in these locations to know their knowledge and attitude regarding safe hospital waste management. Results: 48.7% of Staff nurses were trained but showing poor level of knowledge regarding color coding used for different categories and their method of disposal. Majority were not using protective devices provided to them showing lack of attitude. From the observation made we could see that basic facilities like colour buckets, bags, needle burners were missing in many locations and in most of the locations waste produced was not being properly processed in the next stage, showing that none of them could ensure for safe waste management without break in the series. Conclusions: Periodic training, supervision and monitoring by staff and strengthening of the infrastructure are required.

118-121

Authors: Makandar U.K, Abdul Ravoof, Rajendra R., Patil B.G.

1189. Non-Pathological adult crania are studied, out of them 510 Male crania and 251 Female crania are from North India while 285 Male and 143 Female crania are from South India. Prevalence of Metopism in the North Indian Male crania is 12 crania (2.35%) and female crania is 5 Crania (1.99%) while. In South Indian Crania the prevalence of Metopism was in Male 11 Crania (3.85%) in female it was 5 Crania (3.49%). It is observed that, Prevalence was more in South Indian Crania of both sexes as compared to North India. It is also observed that, Prevalence of Metopism is more in Male Crania of North India & South Indian Crania compared to female crania of both North and South India. Previous workers have studied only regional or racial skull but the sexual dimorphism and regional comparison this study appears to be new method. Study is important for anthropologist, anatomist and medico-legal expert above all to radiologist & Neurosurgeon who confuse in the fracture of crania1.

1-6

Authors: Geetu Singh, Bhakt Prakash Mathur, Shobha Chaturvedi, Preeti Rai, Disha Agarwal

Introduction: As Sub-centres are the first contact point with the community, the success of any nationwide programme would depend largely on the well-functioning Sub-centres providing services of acceptable standard to the people. Objective: Literature reviewed shows few studies on monitoring and supervision aspect of subcentres reflecting need to further assess this domain. In the above context, this study was carried out to highlight the monitoring, supervision and quality control at subcentres in district Jhansi. Material and Methods: This was a crosssectional study in district Jhansi from 2012-2013.20 subcentres were selected and ANMs from selected centres were interviewd. Results:All ANMs prepared the Sub- Centre plan for the year, they had due list of beneficiaries for all villages under subcentres. Supervision and record checking at periodic intervals by the male and female health supervisors from PHC (at least once a week) and by MO (at least once in a month) was done only at 50 -60% of subcentres. Citizen's charter in local language was displayed at none of subcentres. Availability of various guidelines issued by GOI or State Govt was absent in all subcentres. Conclusion:The study concludes that monitoring of subcentres need to be strengthen to ensure efficient working of human resources and appropriate utilization of various services by community.

13-22

Authors: Suchitra Lisam

Background: The introduction of a three years Diploma in Medicine and Rural Health Care (DMRHC) course in 2005 under the purview of Assam Public Health Act has lead to augmentation of human resources through deployment of Rural Health Practitioners (RHPs) in Assam, India. Objectives: The study aimed to understand the performance of Sub-Centers (SCs) in terms of ranges, uptake and quality of primary health care services in SCs with and without RHPs over consecutive three years since deployment of RHPs at Health Sub-Centers (HSCs) in April, 2008. Methods: We used mixed research method i.e. qualitative technique complemented by quantitative analysis of data. Purposive sampling method was adopted for selection of HSCs in High Focus Districts (HFDs) where RHPs were deployed. Key Informant (KI) interviews were conducted comprising of RHPs, Auxiliary Nurse Midwives (ANMs), beneficiaries and government officials to gain perspectives about RHP model, service delivery and challenges etc. Semi structured, open-ended questionnaires were used for KI interviews and checklists for community group discussions. Results: Performance of HSCs with RHPs has improved substantially in terms of management of Out Patient Department (OPD) cases and institutional deliveries as compared to HSC without RHPs over the years from 2010-11, 2011-12 and 2012-13. RHPs cited DMRHC was apt for serving the rural population. Key challenges include lack of referral transport, housing and promotion avenues. ANMs, beneficiaries and community perceptions of RHPs are positive in terms of managing increased number and types of common ailments, drugs availability, improved care, proper referral and initiation of institutional deliveries. RHPs had gained community‘s confidence in service delivery at HSC. Conclusions: Replication of RHP model is critical for improved rural health care systems, provided supervisory and support mechanisms are streamlined. Recognition of DMRHC, upgrade to a Bachelor’s degree course and creation of regular cadre is necessary for sustainability of rural health systems.

29-34

Authors: Shankar M Bakkannavar, Pradeep Kumar G, Vinod C Nayak, Ganesh Rajendiran, Swati Chhikara,

The violent deaths are increasing day by day in the developing world. Deaths due to asphyxia are one of the most important causes in the violent deaths. One hundred and thirty five asphyxial deaths were studied by the authors and described various epidemiological and demographical parameters of these deaths in the present study. The changing demographics and the increased incidence and variations observed are described here. Males outnumbered females in asphyxial deaths. Most common age group involved was 21 – 30 years. Hanging was the most common method of death constituting 56.3% of cases. Majority of the hanging cases took place in homes with suicide being the preferred manner. The victims drowned in river in most number of cases followed by well. The strangulation deaths constituted for 8.8% of total asphyxial fatalities. But not a single case of suffocation was reported.

43-49

Authors: Neeta PN, Prashanth N, Shivaswamy MS, Shilpa K, Mallapur MD

Background: Risks of milk-borne zoonoses posed by the informal market are amplified by poor handling procedures in the market, the lack of quality standards and the fact that most consumers prefer raw milk over pasteurized milk. Objective: To evaluate microbial quality and health risks associated with consumption of raw milk. Methods: A community based cross sectional study was done among 250 households to assess knowledge regarding health risks associated with consumption of raw milk. Microbial quality assessment was undertaken by evaluating 10% of households (25) by collecting 50mL of raw milk, in rural area of Karnataka. Milk quality was assessed using a combination of tests in order to quantify the occurrence of Brucellosis (milk ring test, BMRT), Coliform bacteria (coliform test, CT). Methylene blue reduction test (MBRT) and Specific gravity was used as an indicator of adulteration. Results: None of the participants had knowledge that milk can transmit the diseases. But one third of them could name some reasons for milk contamination as addition of water, unclean handling, utensil or animals. Among randomly selected 25 samples, 13 milk samples were from own house animals and 12 were from vendors. Mean specific gravity was 1.0250 ± 0.007. Nine samples (36%) showed positive results for CT and MBRT; whereas 2 samples (8%) were positive for BMRT. Conclusion: It can be concluded that raw market milk in the study area is of poor bacteriological quality and hazardous for human consumption. This highlights the need to implement good hygiene practices and effective monitoring from production through the delivery chain to the consumer. Further studies are needed for detection of standard plate count for E.coli, toxins that are produced by E. coli, other pathogenic spore forming bacteria (Bacillus spp& Clostridium spp) and other harmful microorganisms.

56-63

Authors: Gourikumari Padhy, Rabi Narayan Padhy, Sangeeta Das, Abhisek Mishra

On the evening of October 12, 2013 a very severe tropical cyclone, Phailin, brought damaging winds of more than 220 kilometres per hour (km/h), storm surges of up to 3.5 metres and torrential downpours to the eastern Indian states of Odisha. The impacts of Phailin and ensuing floods affected more than 13.2 million people, and caused enormous damage .The estimated total damage to houses, crops and public properties was 14373.47 crore. There was massive destruction of power supply system, communication and transportation system. However, early warning alerts, disseminated four days before landfall of Phailin, allowed for the evacuation and relocation of approximately 1.2 million people, resulting in the largest evacuation operation in India in 23 years. A total of 21 lives were lost as a result of the cyclone and an additional 23 lives due to severe flash flooding in the aftermath of the cyclone. A comparable cyclone, Cyclone 05B, hit Odisha in 1999 with winds of up to 260 km/h, but had a much more than 10,000 lives were lost. Early warning using multiple channels of communication and timely action saved lives during Phailin. Government cooperation, preparedness at the community level, and lessons learned from Cyclone 05B contributed to the successful evacuation operation, effective preparation activities and impact mitigation. This event exhibits the importance, benefits and effectiveness of the use of early warning for a massive disaster. The lesson learnt from this event can act as a guide for development of plan for management of other similar disasters in future.

67-70

Authors: Vinod C Nayak, Shankar M Bakkannavar, Somshekhar Sharma, Manu Sharma, Ranjit Immanuel James, Baishwa

Paraquat is one of the most dangerous poisons in the medical field as Ingestion of small quantities (>10mL) may damage lung irreversibly and also lead to renal failure causing to death. The paraquat is sold in more than 130 countries around the world to be used in small as well as large farms. The easy availability of this poison makes it a commonly employed agent for suicide. More than 93% of deaths due to paraquat poisoning are suicidal in nature and most of them are occurring in developing countries. The clinical features vary from case to case based on the amount and type of compound consumed. As it is a fatal condition, early diagnosis and proper management is warranted which can reduce the morbidity and mortalities. But sometimes early diagnosis may not save the victim as in our case. We present a case wherein the victim succumbed to acute respiratory distress following consumption of paraquat.