Indian Journal of Forensic and Community Medicine

Page No. 230-233

Authors: Kedar G. Mehta, Rinal Parikh

“Lifestyle”, a simple, yet not so simple 9 letter word introduced way back in the 1950s to denote roughly the way of life of a person, has undoubtedly undergone terrific changes over the decades. Sociology defines lifestyle as “the interests, opinions, behaviors and behavioral orientations of an individual, group, or culture.” Looking into the medical aspects of lifestyle, it essentially means all the activities or tasks the person indulges himself into, which somehow directly or indirectly, influence his body functions. India is a country of traditions and culture, a nation where, lifestyles vary from state to state as per the variations in terrains or occupation. Going back to the pre-gadget era, where man was not so dependent on the inventions of technology as he is today, their lifestyle was way different and in many ways, better than today. Strenuous physical work daily, walking for long distances easily, eating healthy home cooked meals everyday, engaging in lively sports and other recreational habits daily- all these habits of the past have been taken over by the modern world. No doubt technology is a boon to mankind, but it has also brought various drawbacks.

Page No. 240-244

Authors: Ramesh C. Patil, Ashfakhussain Magi, Anand Mugadlimath, Rekha Hiremath

Introduction: Radiographic survey for appearance and fusion of ossification centers of various bones is undoubtedly one of the best methods for age estimation especially in children and adolescents till ossification is complete. The appearance of ossification centers for carpal bones especially for pisiform bone is one of the vital evidence for estimating age in young children between 9 and 13 years. Material & Methods: The present study to estimate the age of children based on radiographic evaluation of the appearance of ossification center of pisiform bone was undertaken in the department of Forensic Medicine and Toxicology, Al-Ameen medical college Vijayapur. Duration of study period is from July 2014 to August 2016 (two year) and it is a cross sectional study. Results: The mean age at which males show appearance of pisiform is 9.5+1.71 years and in case of females it is 9.5+1.7 years. The p value is <0.05 indicating that there is significant age difference in males and females with reference to appearance of ossification center of pisiform bone. Conclusions: The accurate or precise age of the individual cannot be stated by radiological examination, but a reasonable range of age can be arrived by considering the timing of appearance of ossification centers. Hence application of radiological procedures for assessment of age in living individuals is a reliable method.

Page No. 251-253

Authors: PJ Manvar, DK Vadgama, HM Mangal, PR Varu, RD Vaghela

Background: In cases of sudden death, cardiovascular disease (45 to 50%) was the most important cause of the sudden natural death. Keeping in view of the foresaid facts, it was considered worthwhile to study the coronary artery atherosclerosis in Rajkot region. Material and Method: Present study was conducted from January 2014 to December 2014 at department of Forensic Medicine, P.D.U. Govt. Medical College, Rajkot. A detailed history was taken as to the circumstances of death with special reference to any signs and symptoms suggestive of myocardial ischemia. The routine autopsy technique (Virchow’s1) was used for post mortem examination. Results: Incidence of coronary artery disease is more in males as compared to females. Most common risk factor observed in death due to coronary artery disease was Hypertension (20.09%), followed by smoking (14.95%) and followed by diabetes mellitus (12.62%). Narrowing of lumen was maximally observed in left anterior descending coronary artery.

Page No. 257-262

Authors: Fremingston Marak, Mima Maychet B. Sangma, Ganesh Kumar, Priyadharshini M

Background: In India, for individuals older than 4-years of age, more life years are lost due to traffic accidents than cardiovascular diseases. In India over 80,000 persons die in the traffic crashes annually, over 1.2 million injured seriously and about 3,000,000 disabled permanently. Objectives: To assess the pattern of injuries leading to deaths from road traffic accidents in a tertiary care hospital in Puducherry. Method: It is a retrospective study of all medicolegal autopsies of road traffic accidents conducted between January 2015 to December 2015 at the Mortuary of Forensic Medicine Department, IGMC&RI, Puducherry, India. Results: RTA accounted for 10.52% of the total cases. The highest number of victims of accidents were in the age group of 51-60 years with 32 cases (22.9%), followed by age group of 31-40 years. Male preponderance was seen in present study (85.7%) with a male female ratio of 6:1. Highest number of accidents is seen among the Hindus (94.3%) during evening hours (42.86%) maximum number occurring in the month of October (13.57%) and on weekends (40.71%). Motorcycles were the commonest vehicle involved (46.43%) and Pedestrians comprises highest number of casualties (46.43%). Abrasion (44.28%), Laceration (30.7%) and Contusions (20%) were the most common associated injuries. Most of the victims died of craniocerebral injuries (46.43%) and intracranial haemorrhages (33.57%). Conclusion: Road Traffic accidents are one of the most common vehicular transport accidents involving the motorcycle where pedestrians are the casualties in most of the cases.

Page No. 267-271

Authors: Kartik Sudhakar Patil, Meenal V. Kulkarni

Background: ICDS is the largest government run health program for children with its foot spread across complete Indian Territory. Objective: Study was aimed to obtain information about the knowledge, level of awareness and utilization of the services provided under ICDS among women living in the urban slum. Methods: Study was a community based cross-sectional study, conducted through a preformed questionnaire and house interview of women of 151 households in a slum. Results: The awareness level about Anganwadi and various services provided by ICDS through Anganwadi among women was 91.39%. Immunization, Supplementary Nutrition(SN) and Health checkup were the known services in contrast to Referral services, Nutrition and Health Education (NHE), and Preschool Non-formal Education(PNFE) which were lesser known. Utilization of these services was 77.48%. In our study 37.5%, 31.25% and 18.75% pregnant women respectively utilized facility of Take Home Rations THR), health checkup and immunization & 38.46%, 30.77% nursing mothers respectively took regular THR, regular checkup. Among children beneficiaries, the group of 6-36 month consisted of 80 children among whom 41.25% took irregular SN, 70% were completely immunized, 60% had regular health checkups. In the group of 3-6 years out of 67 children, only 22.39% took regular SN, 71.64% were completely immunized, 62.69 had regular health checkups and meager 9% attended PNFE. Conclusion: Level of awareness was found to be good. Utilization was found to be better among children as compared to women.

Page No. 276-279

Authors: S. Shavukath Ali, B. Karunakar, M. Narayana Reddy

An Analytical study conducted on cases of organophosphorus poisoning, of which all are Positive cases declared in Forensic Science Laboratory, Hyderabad. Pesticide poisoning is a significant problem in India. Organophosphorus compounds cause most self poisoning deaths in southern and central India. Among cases preponderance of male sex over female sex. It shows that maximum incidence of deaths from Organophosphorus poisoning are seen in 3rd decade of life followed by 4th and 5th decade for the both the sexes follow the common trend of overall suicidal deaths. Deaths from Organosphosphorus poisoning are 3 times more in married group compared to unmarried group in both sexes and shows that the commonest motive for suicide from Organophosphorus poisoning is health related problems in both the sexes compared to other problems. Chronic poisoning due to environmental pollution affecting the food chain and the community at large can be diagnosed and proper preventive and rehabilitative measure can be undertaken. All the records of the poisoning fatalities were studied in detail and statement prepared to show the frequency of individual poisons, age and sex distribution.

Page No. 284-287

Authors: Vijaykumar Mane, Jyoti Markam, Roseline F. William, Vidya DC, Trupti B. Naik

Introduction: Recently organ transplantation has become a safe and viable procedure for prolonging the lives of people suffering from organ failures, and as a result the need for organs has increased. Health care professionals are the most critical link in the organ procurement process and therefore, their knowledge, attitudes and behaviors are essential factors in the creation and promotion of an environment that has a positive influence on organ donation rates. Objective: To assess the knowledge, attitude and practices towards organ donation among third year medical students in the study setting. Materials and Methods: A cross sectional study was conducted among third year medical students at a Private tertiary care hospital in the rural area of Maduranthakam Taluk, Kanchipuram district, Tamil Nadu. Data was collected anonymously in a pretested and semi structured questionnaire after taking an informed consent and those who were absent on the day of data collection were excluded from the study. Data thus obtained was entered and analyzed using WHO Epiinfo software version 3.5.4. Results: The present study demonstrated favorable attitude and adequate practices among medical students towards Organ donation despite their limitations/gaps in knowledge about the same. The study identifies several areas where educational interventions are necessary. Recommendations: Need to introduce topic on Organ donation and transplantation in the undergraduate medical curriculum in order to improve knowledge of medical students. Further, appropriate use of mass media like television and newspapers will go a long way in creating awareness among them.

156-162

Authors: Aarati Pokale, Mandar D Karmarkar

Context: Medical certificate of cause of death (MCCD) is a vital document issued by a doctor for which World Health Organization has prescribed a standard format. There are many rules and regulations about filling and issuing this certificate. Accuracy in certifying the cause of death is desirable at many levels as it affects international health statistics. Aims: 1) To compare knowledge and awareness about rules, regulations, and format of medical certificate of cause of death amongst doctors. 2) To audit medical certificates of cause of death issued. Settings and Design: Cross sectional study hospital based carried out between September to December 2014. Methods and Material: Faculty members, residents, and interns attending the MCCD training session filled a pre structured, semi open ended, self- administered questionnaire. An audit of medical certificates of cause of death issued between September to December 2014 was done. Statistical analysis used: Data entered in Microsoft excel. SPSS 19.0 statistical software was used for analysis Results: Of 91 participants, 22% were from paediatric department, 35% had between 1-5 years of work experience. Statistically significant association was seen between department and knowledge of full form of MCCD, immediate & contributory cause of death, Form IV & IV A, & separate stillbirth form (p<0.05). Statistically significant association was found between work experience, uses of MCCD, immediate and antecedent cause and use of form IV and IVA (p<0.05). Of the 98 certificates reviewed 92% did not mention time interval. Only 7% certificates were free of error. Conclusions: There is a need to adopt multi faceted approach to increase knowledge and awareness about rules, regulations of MCCD in doctors to improve accuracy and reliability of data.

168-171

Authors: Mukesh Shukla, Monika Agarwal, JV Singh, AK Srivastava, Devesh Singh

Background: HIV/AIDS has adverse impact not only on physical but also mental, social, and financial aspects of the infected individual. Quality of life (QOL) among these individuals is therefore becoming crucial for measuring commonly used endpoints. Objective: To study the quality of life (QOL) of HIV-positive people on antiretroviral therapy. Material and Methods: A hospital-based cross-sectional study was conducted among 100 adult HIV-positive patients at two tertiary care hospitals of Lucknow. Systematic random sampling was used to recruit patients. Quality of Life was assessed using WHOQOL-BREF scale. Results: Mean age of the PLHAs was 39.08±9.72 and majority (73.0%) of the study participants were male. QOL score were highest for physical health domain (10.45±1.35) followed by psychological domain (9.38±1.33), environmental domain (8.73±1.11) and social relationship domain (8.05±1.90) respectively. A significant difference (p<0.05) was observed in mean score for social relationship domain with subjects counselled within the last three months and those who were adherent to the treatment had a higher mean score of QOL mean score. Conclusions: The present study revealed intermediate level scores for quality of life for PLHAs. Therefore for improving each and every facet of quality of life all the psychological, emotional and medical needs should be properly addressed through combined efforts by health care providers as well as the community.

176-179

Authors: Sunil Kumar DR, Kotresh, Prabhudeva, Narayanaswamy, Bharatesh Shetty, Reynold Washington

Background: Syphilis is a common but curable STI especially among high-risk populations in India and FSW are at higher risk of acquiring STIs including syphilis. Limited access to medical care can reduce individual treatment thereby indirectly facilitating transmission within the population. There is increased risk of HIV acquisition and transmission of HIV because of ulcerative syphilis. Objectives  To know the sociodemographic characteristics, prevalence and treatment rate of syphilis among female sex workers attending KHPT clinics in Karnataka. Method: The study data was collected from female sex workers attending 168 KHPT programme associated clinics and laboratories in Karnataka12. Out of 24,678 female sex workers, 3715 were selected for study and screened for syphilis. The female sex workers were screened for syphilis collecting blood samples by using Rapid Plasma Reagin (RPR) test. The sociodemographic characteristics were obtained using a predesigned questionnaire. Results: Among FSWs 75.61% (2809) were illiterates and 19.36%(720) were literates. 1314(35.37%) were married, 289(7.77%) were Unmarried, 226(6.08%) were divorced and 598(16.09%) were widows. Majority of FSW 2563(68.99%) were soliciting in street/public place, 704(18.95%) were home based and small proportion (6.23%) belong to brothel and Lodge based. Overall, 3715 FSWs were tested for syphilis. Among them 393 (11.89%) were reactive for syphilis. Among the reactive 319(81.17%) were treated for syphilis. The prevalence of syphilis was 11.89% and treatment rate was 81.17% among female sex workers in Karnataka. Conclusion: The prevalence of syphilis was high among female sex workers attending KHPT clinics in Karnataka and majority of them were treated for syphilis. Even though prevalence of syphilis is more, the treatment coverage was high in female sex workers. Achieving good treatment coverage therefore will help not only to reduce syphilis incidence but also HIV disease burden in the high risk population and general population since the relationship between syphilis and HIV is well established. This study has shown syphilis continues to be highly prevalent among female sex workers and targeted intervention programmes need to focus on curable STI like syphilis.

183-186

Authors: SM Mathur, Brajesh Kumar, Sumit Ahluwalia, Rekha Mathur

Background and Introduction: Among the various health problems like Population explosion, Infections, Malnutrition, Environmental sanitation, LBW, etc. Population explosion is one of the most serious problems encountered by a developing country like India. About three fourths of the world’s population lives in the developing countries. Although, in terms of population USA ranks third in the world after India, there is yawning gap of 978 million between the populations of these two countries. The United Nations has estimated that world’s population grew at an annual rate of 1.23 percent during 2000-2010. China registered a much lower annual growth rate of population (0.6 percent) during 2002-2012, as compared to India (1.4 percent). Three countries of SEAR, i.e., India (17.5 percent), Indonesia (3.49 percent) and Bangladesh (2.19 percent) are among the most populous ten countries of the world. At present India’s population is second to that of China. According to UN projections India’s population will reach 1.53 billion by the year 2050, and will be the highest population in the world. Aims and Objectives: To study the socio-economic profile of acceptors of Laparoscopic sterilization in rural area. Method and Material: Present study is retrospective cross - sectional study. It was conducted on health record of 283 Laparoscopic sterilized women, operated from 1st April 2015 to 31st March 2016, in PHC Achrol, District Jaipur, Rajasthan. Results: In the present study most of the females who undergone laparoscopic sterilization were from 24-30 years(90.10%) of age group. 93.63% females belonged to Hindu religion and only 5.65% to Muslim community, and only 0.70% were from Sikhs. In the present study 43.47% belonged to Gen and OBC, 28.97% belonged to SC and remaining 27.56% were from ST caste. 80.91% got themselves operated when the youngest child was less than 3 yrs of age. Ladies from socio-economic class I represented 3.89%, II represented 6.71%, III represented 14.49%, IV represented 32.15% and V represented 42.76%. Only 15.19% Husbands of laparoscopic acceptors were uneducated and among the acceptor ladies 17.66% were uneducated. With one male child survived 49.11%, two male child survived 40.28% and with three male child survived 10.60%, got themselves operated. Conclusion: Three major deterrents to development are illiteracy, poverty and social inequality and injustice. Out of these, illiteracy is probably most important from the point of view of family planning. Two major strategies to contain population growth are family planning and education. About one- third of Indian women use female sterilization as a method for regulating fertility, analysis reveals that people from different socio-economic, religious and demographic strata do not generally opt for sterilization in equal proportion. In this respect existing agencies like VHGs, SHGs groups, AWWs, Sahali, and other paid grass root level workers, requires more motivation and dedication to work, which is normally not seen. Some NGOs can also make a change in situation if they are properly guided and monitored.

194-197

Authors: Sandesh H Chaudhari, Naresh Kumar, Gourav Thakre, Harshal Kawanpure, Bhupendra Gathe

Sternal foramen is a congenital round bony defect present in the body of sternum which results from incomplete union of the sternal ossification centres. Usually the defect is asymptomatic and only be detected by CT scan. But at times, it may be misinterpreted as gun shot or stab wound. In clinical practice, sudden unexpected death may take place during sternal puncture and biopsy as a result of cardiac puncture and tamponade. The present study was carried out by choosing 96 dry sternal bones which were used as a teaching material in the Department of Forensic medicine and Anatomy, CCM Medical College, Durg, Chhattisgarh and MIMER Medical College, Talegaon, Pune, Maharashtra. These sternal bones were examined for the presence of sternal foramen and it was found in 4.1% of cases. It is important for medical practitioners, radiologists and acupunturists to have a concrete knowledge of sternal anomalies before doing any procedures to avoid complications.

201-208

Authors: Ndubuka GIN, Ekezie J, Ngwogu KO, Nkuma-Udah KI, Okafor W

Sudden death of infant (SDI) is among the clinical conditions called sudden infant death syndrome (SIDS) referred to as death situation in which all clinical causative factors play apparent and hideous roles within an hour of unexpected death of infant within one year of age. To ascertain SDI at Abia State University Teaching Hospital (ABSUTH), a 6 year study of all infants’ death cases in record books were searched and two types of questionnaires added. Medical officers and hospital staff involved in infant healthcare were 343, and 1400 mothers contacted were of age ranges 18-40 years. Causes of SDI were respiratory failure 107, RTA 4, circulatory failure 25, alimentary distress 103, trauma and domestic accident 10, and cardiac failure 70 cases. Highest Frequency of occurrence in the years was observed in 1999 and gave 104. Commonest clinical characters were anemic heart failure, child neglect and abuse, drug toxicity, heamorrhage, and vagal inhibition. The rapidity at which SDI occurred in 25% of 107 respiratory failures was within 10 seconds to 5 minutes, and to 232 cases was within 24 minutes of hospitalization. Common clinical symptoms were mild to high fever, intermittent coughing and vomiting, malnourished body, respiratory distress, and apnea while 77% full term birth cases had body weight of 2100 to 2500g. Child neglect and abandonment were evident in 49% mothers of lean economies. SDI peak was from 5th to 8th months, at which periods 112 female and 168 male infants were wean to death by 280 mothers. Yearly highest incidence of SDI is 1999.

214-219

Authors: Zopate Pravin R, Waghmare CM, Tirpude Bipin H

Background: Burn is the most devasting of all the injuries and a major global public health crisis. Only limited studies have evaluated the epidemiological trends of burn injury. Aim: To evaluate prospectively epidemiological aspects of burn injury in the hospital situated in the central part of India. Study design: The consecutive 360 cases of burns admitted in our hospital were analyzed prospectively to review the scenario of burn over a period of 3 years. Results: The study revealed female (68.81%) predominance with female to male ratio of 2.2:1. Most of the victims of burn were between the ages of 21 to 30 years. Married (69%) outnumbered unmarried. Out of total female victims’ majority were Hindus, illiterate and housewives. The domestic burn was common with Kerosene stove with kerosene being the main accelerant. Shock was the commonest cause of deaths occurring within 48 hours of burn injury while it was septicemia in cases of deaths occurring after three days. Conclusion: Young married females were the commonest victims of burn injury. Considering the morbidity and mortality owing to burns, government and other social organizations need to put special efforts for the prevention and education programs against burn injuries

225-229

Authors: Praveen Athani, Vijayanath V, Vijaya NM, Anjanamma TC

Introduction: Estimation of stature from bone has anthropological and forensic importance. The bones of lower limbs particularly femur has yielded good results. It is well known fact that the intact femur has the highest correlation with stature & and it is widely used in the derivation of regression equations for the stature estimation. An intact femur is not always present for analysis in forensic cases, so it is necessary to derive regression equation for the estimation of stature from fragments of the bone. Aims and Objectives: The present study is aimed at estimating the length of the femur from femur bone fragments i.e. intertrochanteric crest length, transverse diameter of head & bicondylar width and subsequent estimation of stature from length of femur. Materials Methods: Samples of 100 femora were taken from the department of Forensic Medicine & Anatomy. Results: Intertrochanteric crest length, transverse diameter of head & bicondylar width were measured and regression equations were derived. The mean value of femur length is 43.05cms, the mean value of Intertrochanteric crest length is 65.85cms, the mean value of transverse diameter of head of femur is 41.12cms and the mean value of condylar width is 72.53cms.The Pearson’s correlation coefficient for Intertrochanteric crest is 0.645, transverse diameter of head is 0.764 and for condylar width is 0.728. Discussion: one study done by Sandeep Singh shows the comparison result with our study wirth mean value of 43.26cms. In study by Chandran have shown positive correlation for intertrochanteric length which is similar to our study. Bidmos have published regression equation with respect to transverse diameter of head is comparable with our study, majority of the work available in the literature by different workers has a positive correlation with our study. Conclusion: Among the above the transverse diameter of the head shows more statistically significant value compared to the others. Hence in the present study we can estimate the femoral length from femoral fragments by regression equation, then we can subsequently calculate the stature from the length of femur.

69-74

Authors: Midha T, Rao YK, Kaur S, Martolia DS

The Indian Journal of Forensic and Community Medicine (IJFCM) provide a forum for the rapid publication of topical articles on medicine and all clinical aspects of forensic medicine, community medicine and related specialties. The Journal carries definitive reviews, original communications, hypotheses, learning points of important issues, offering critical analysis and scientific appraisal. Indian Journal of Forensic and Community Medicine (IJFCM) explore all aspects of modern day forensics, applying equally to children or adults, either living or the deceased. The range of topics covered includes forensic science, medicine, nursing, and pathology, as well as toxicology, human identification, mass disasters/mass war graves, profiling, imaging, policing, wound assessment, sexual assault, anthropology, archeology, forensic search, entomology, botany, biology, veterinary pathology, and DNA. The journal also seeks to publish quality research in the fields of Public Health, Community Medicine, Epidemiology, International Health, Reproductive and Child Health, Occupational Health, Communicable and Non-communicable Diseases, Family Health, Environment & Health as well as Demography. Forensic Science and Community Medicine presents a balance of forensic research/community based research and reviews from around the world to reflect modern advances through peer-reviewed papers, short communications, meeting proceedings and case reports. Aims & Scope: Indian Journal of Forensic and Community Medicine (IJFCM) is an open access medical journal which aims to publish peer reviewed research articles, case reports and short communications focused on current advancements in the field of forensic science and criminology. IJFCM is an important and reliable source of advanced information on developments in the f

79-82

Authors: Suraj Sirohi, Chakresh Jain, Aditya Khatri, Sanjay Dixit, Shailesh Rai

Background: Health insurance policies insure against several illnesses and guarantee a financial security if ever a treatment is required. Objectives: The main purpose of study was to find out awareness of health insurance among households in Indore. Secondly to assess the awareness of people regarding government sponsored health insurance schemes and in last to find out source of information regarding health insurance & the reason for not having health insurance. Focus was on the variables like the Education, Gender, Occupation, Income, type of the families etc. Material & Method: The study was conducted in Indore city and 200 subjects were selected from randomly selected general people. The collected data were analysed with the help of various tools and techniques to draw meaningful inferences and conclusion which were obtained using Excel and some using SPSS. Results: Result shows that 41% of the respondents heard the term health insurance. 66% were interested in having a health insurance and almost equal 63.4% were willing to spend less than Rs.1000 for health insurance. Conclusion: Many people aware but had incomplete information regarding various aspects of health insurance & its importance. Hence it is important to increase the awareness community on various aspects of health insurance in view to meet the ever rising medical expenses in view of unpredictable illness & injuries.

87-91

Authors: S. Balusubramanain, A. Gokulakrishnan

The present study was carried out between 2012 and 2015. A total of 5068 autopsies were conducted of which 15.7% (n – 764) cases were deaths due to hanging. The commonest ligature materials of choice were Sari. In 68% of the cases, hanging was complete. Females (n – 343) and males (n – 421) were equally affected. The major age group involved in both the sexes was of 31–40 years, contributing to 60.7% of the self-suspension. Majority of the ligatures had a fixed type of knot contributing to 97.73% (n – 658) of the suspensions and only 2.27% (n – 106) showed slip knot. Based on position of knot all cases were divided into four categories according to the position of the knot on the neck (I–IV) and further based on position of the body they are further classified into complete and partial hanging (A & B) Of the 764 cases of hanging, transverse laceration in the intimal layer was seen in 412 cases in which most of them were identified by histological examination rather than naked eye examination, Amongst complete hanging (IA, IIIA, IVA) shows more incidence of carotid tear than posterior partial hanging (II B).

96-100

Authors: Sudalaimuthu R, Manoharan C, Gururaj Biradar, Shankar M Bakkannavar, Edwin Joe A

Background and Objects: Estimation of time since death from rigor mortis in various parts of the body plays vital role in forensic investigations. The aim of the study was to find out the appearance of rigor mortis in pyloric sphincter and how far it influences in toxicological analysis. Methods: Study was done on 60 known corpses (34 males and 26 females) during and prior to the medico legal autopsy at Tirunelveli Medical College, Tamilnadu, India. The dye was introduced into the stomach through Ryle’s tube intubation and examined for presence of dye in the small intestine after various time intervals. Results: Among 60 cases, dye was not found in 26 cases when the time since death was less than 12hours. The dye was noted in small intestine in 34 cases where the time since death was after 12hours. Interpretation: This study clearly proves that rigor mortis of pyloric sphincter passes off by 12hours since death. When the time since death is concluded as more than 12hours, preservation of stomach and small intestine separately is of no value. Mere presence of poison in stomach and small intestine is not a confirmative evidence of ante mortem poisoning. Conclusion: This study proves that rigor mortis in pyloric sphincter shows major impact in determination of cause of death and in toxicological analysis.

108-109

Authors: Roshan Timmappa Mudaraddi, Jannatbi Ladsab Iti

Background: Road traffic accidents are increasing at an alarming rate throughout the world. Rapid growth of transportation system, industrialization, urbanization and increase in population is responsible for the ‘veritable epidemic’. Inadequate traffic planning and lack of traffic sense have worsened the situation particularly in the developing countries. Objectives: To study the co-variables among victims of road traffic accidents. Method: Information regarding Road Traffic Accident was taken from casualty register for the month of October and November. Results: 72% were males, vehicles involved in accident by two wheeler was 40% and 70% of the accidents occurred within city limits. Weekend accidents accounted for 37% and 42% of passengers were involved in accidents. 83% were conscious when brought to the hospital and 67% had simple injuries compared to 33% with grievous injuries. 12% were found to be under the effect of alcohol when brought to casualty. Conclusion: The number of accidents is significantly more during 10am to 2pm and 5pm to 8pm. The percentage of female drivers was significantly less than that of males. Weekend accidents were more compared to weekdays and 2/3rd of them had simple injuries. So there is a need for proper traffic planning and strict enforcement of traffic rules.

121-123

Authors: V. Dekal, Shruthi P

Hanging, a form of deliberate self-harm accounts for a large proportion of autopsies which forensic experts come across in their clinical tenure at various hospitals in almost all parts of India. A retrospective study was conducted in the Department of Forensic Medicine and Toxicology, Kempegowda Institute of Medical Sciences, Bangalore from April 2004 to March 2006, with an objective to study the post mortem findings in autopsy cases of hanging. Out of 810 autopsies, 27.9% cases were that of hanging. Most cases were atypical (95.6%) and complete hanging (90.3%) with the ligature mark situated above the thyroid cartilage. 34.1% of cases had dried salivary stain at the angle of mouth and 1.3% cases showed involuntary discharge. The incidence of fracture of hyoid bone was 15.49% of cases. This study depicts the possible findings in a suspected case of hanging which ought to be anticipated to avoid any flawed opinion.

128-132

Authors: Manoharan C, Dhanalakshmi V, Thangam D, Edwin Joe A

Background & Objectives: Estimation of age in elderly person is often required in medico legal practice. Estimation of age in elderly person is comparatively more difficult than in young persons. The aim of the study was to determine the age of an individual from fusion of various parts of the sternum. Methods: Sterna were obtained from 53 males and 47 females aged between 14 years to 75 years from known corpses during medico-legal autopsies at Tirunelveli Medical College, Tamilnadu, India by dissection and maceration of soft tissues. Results: When the segments of the body of sternum are fused, the age of an individual should be above 21 years. If the manubrium and body of sternum is not fused, the age of the Individual is less than 35 years in males and less than 43 years in females. If the xiphoid process and body of sternum is fused, the age of the individual is more than 32 years in males and more than 40 years in females. Interpretation: Age estimation from union of manubrium and xiphoid with the body of the sternum seem to be reliable where the sex is already determined. Fusion of segments of body of sternum is a more reliable in estimation of age of an individual irrespective of the sex. Conclusions: This study proves that sternum is a reliable tool to estimate the age of a person.

138-141

Authors: Anjanamma TC, Vijaya NM, Vijayanath V, Praveen Athani

Unnatural deaths includes death caused due to criminal intent of a person behind or result of negligent act or planned omission of some person and also those where there is no illegal intent at all but death followed due to some accident or mishap. Unnatural deaths may imitate the law and order situation in a particular area of authority. This study is concerned with study pattern of unnatural deaths in MVJ medical college and research hospital for a period of two years. We found 236(87%) cases of unnatural deaths by analyzing 273 cases of deaths. Study revealed 99 cases of unnatural deaths in 2014 and 137 cases in 2015 with 14% increment. Deaths were more common in males 152 (64.4%) than in females 84 (35.6%). Majority of unnatural deaths occurred among the age group of 31-40 years. The frequency patterns of unnatural deaths are 67% RTAs, 7% homicide and 26% suicide. Poisoning is preferred method used to commit suicide with 36 (58%) out of 61 suicidal cases, followed by 14 (24%) of hanging, 5 (9%) of burns, 3 (5%) of drowning and 3 (4%) fall from height. Major cause of suicide was family problems 27 cases (44%), 15 (24%) were due to love affair. Female outnumbered male in committing suicide due to lack of support from family and society.

146-151

Authors: Sunil Kumar DR, Kotresh, Amruth, Prashanth, Neeta PN

Background: Delay in Tuberculosis diagnosis and treatment is associated with increased transmission, morbidity and mortality. Patient and provider factors are responsible for such delays. We conducted a study to estimate these delays and identify associated factors among new sputum positive (NSP) Tuberculosis patients in Tumkur district, Karnataka. Methods: We interviewed 234 NSP patients to collect information on their health seeking behavior. We conducted univariate and multivariate analysis to identify factors associated with longer delays. Results: Median patient, health system and total delay were 15, 13 and 36 days respectively. Significant factors associated with total delay included patients’ knowledge about Tuberculosis, seeking care from non-specialized individuals as the first action, consulting >2 health facilities before diagnosis and consulting private health facilities. Patients with low family income and those who had high expenditure on consultations before initial diagnosis were associated with patient and health system delay respectively. Conclusion: It is necessary to increase community awareness about Tuberculosis symptoms and availability of free treatment at public health facilities. Educating private physicians about the need for maintaining a high index of suspicion of tuberculosis and sensitizing drug-store owners to refer the chest symptomatic to government health facilities would also help in reducing these delays.

1-4

Authors: Amol Hartalkar, Sheetal Hartalkar, Krithika Peshwe, Bhola Nath

Objective: To find the frequency of patients with diabetes, taking proper self-foot care according to standard international practice guidelines and its result on foot health. Methods: This cross sectional study was done in Department of Medicine at a rural teaching hospital included 100 patients with diabetes. Patients were probed for their foot care practices and those practicing more than 60% of American Diabetes Association (ADA) guidelines for foot care were labelled as practicing "Proper foot care". Foot examination was also performed and examination findings were compared with foot care practices. Results: The mean age of eligible patients was 51.5+10.7 years. Only six (6%) patients were found to be following recommended foot care practices. Statistically significant correlations found between fungal foot infections and foot drying practices, proper foot hygiene & frequent foot washing and, in growing toe nails and improper nail trimming. Use of inappropriate footwear was associated with corns, callosities and ingrowing toe nails. It also showed that good foot care practice was associated with foot care education. Conclusion: The study found that limited numbers of patients with diabetes were following appropriate foot care in accordance to the ADA Guidelines. High risk behaviours were usual which could cause serious, but preventable, foot complications.

10-12

Authors: Vaibhav, Brajesh K Chahar

Introduction: Type 2 diabetes mellitus is a chronic disorder that affects the Quality of Life (QoL) of patients. The objective of the present study is to assess the health related Quality of Life of patients with type 2 diabetes mellitus. Method: This was a cross-sectional study of 140 type 2 diabetes mellitus patients, attending the diabetic clinic of a Tertiary care centre in Rajasthan, North India. Patients with type 2 diabetes mellitus between the age group of 25-75 were included in the study and data was collected using pre-designed questionnaire. The Qol of patients were assessed using SF 36V2 questionnaire along with the socio-demographic profile. The data was analysed using appropriate descriptive and inferential statistics using SPSS. Result: The mean age of subjects was 56±11.6 years and the mean duration of diabetes mellitus was 10.9±8.3 years. 47.9% of patients were overweight and 20.7% were obese. The mean HbA1c (glycosylated haemoglobin) was 8.3±1.5%. The patients with type 2 diabetes had significantly lower scores in all domains of QoL. Males had higher QoL scores than females and the difference was found to be statistically significant (p<0.05). Conclusion: This study finding indicates that QoL of patients with type 2 diabetes mellitus is relatively poor. Diabetes mellitus significantly affects the QoL especially in females. Therefore much attention must be paid to identify and implement measures for achieving better management of diabetes mellitus and ultimately improving the QoL of patients with type 2 diabetes mellitus.

20-24

Authors: Anas Ahmad Khan, Atul Kumar Singh, S.B Gupta, J.P Singh, Huma Khan, Sonam Maheshwari

Background: The Integrated Child Development Services (ICDS) scheme was launched in 1975, to provide holistic development of children through a package of services aimed at reduction of child malnutrition, morbidity and mortality. Objectives: To find out available infrastructure at Anganwadi Centers. To study the utilization of supplementary nutrition service by beneficiaries at Anganwadi Centers. To find out the reasons given by beneficiaries for not utilizing supplementary nutrition service. Materials and method: A Cross sectional observational study conducted at Bareilly in 22 Anganwadi Centres selected by multi-stage sampling technique. Selected Anganwadi Centres were visited and selected Anganwadi workers and beneficiaries were interviewed. Observations: 85% of lactating mothers, 83.6% of pregnant women, 78.8% of adolescent girls, 61% of children in the age group >6 months upto 3 years and 50.6% of beneficiaries in the age group >3 years upto 6 years received supplementary nutrition. Conclusion: Utilization of supplementary services was found to be highest among lactating mothers followed by pregnant women and lowest among beneficiaries in the age group >3 years upto 6 years.

31-35

Authors: Syed Jawwad Ali Hashmi, Momin Kashif Mustafa, Jagannath V Dixit

Objective: 1) To study knowledge and awareness about risk factors and complications of hypertension among engineers. 2) To identify missing opportunities to diagnose hypertension. Methodology: A questionnaire based cross-sectional study was conducted during the month of July 2013 amongst 80 engineers undergoing training in WALMI (water and land management institute), Aurangabad. Results: The knowledge about complications associated with hypertension was considerably low. For instance, only 15.6% believed that hypertension can cause kidney failure while 40.6% of the respondents agreed very much that severe hypertension can lead to heart attack which could lead to the death of the affected person. Only 9.4% agreed that hypertension can result to retinal failure. Among 80 participants we found 22 persons having blood pressure above 140/90 mm hg on both readings of which only 10 were aware of their hypertension of which only 6 were taking medicines of which only 4 persons were taking regular medicine and follows all advice given by doctor about life style modification. Conclusion: In the main time, one of the cornerstones to achieving positive health behavior towards hypertension is through public education. This calls for compulsory on-job screening and educative programs in the form of seminars and conferences for all categories of staff.

40-42

Authors: Samdarshi N, Kumar Brajesh, Singh S, Hossain S, Saxena R

Background & Objectives: As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. WHO recommends early initiation of breastfeeding (i.e. within one hour of giving birth). Early breastfeeding within 1 hour and exclusive breastfeeding for first 6 months are the key interventions to achieve reduction in child malnutrition and mortality. The present study was hence conducted to study the prevalence of Breastfeeding practices including time of initiation, giving colostrums, pre lacteal feeds and Exclusive Breastfeeding (EBF) among infants (up to 6 months of age) in rural population. Methodology: A community based cross-sectional study was conducted in rural areas of Achrol village, Jaipur during June 2014 to October 2014. 340 infants were selected for interview but mothers of only 246 infants gave the consent. The study was carried out from door-to-door basis, using semi structured, pre-defined and pre tested questionnaire after taking informed consent. Results: 246 infants upto 6 months were included in this study, among them early initiation of breast feeding (i.e. within 1 hour of birth) was seen in 32(13.0%) of infants. Pre lacteal feed was given in 92.7% of infants, who had received some kind of pre-lacteal feed other than colostrums against the concept of exclusive breast feeding and surprisingly Tea was the commonest (47.81%) followed by honey (26.32%). Colostrums was given in only 83(33.7%) infants. Defying the concept of EBF, majority of the infants i.e.222 (90.2%) were given some kind of top feed even during the first 6 months. Only 24(9.8%) were exclusively breast fed. Conclusion: Early initiation and exclusive breast feeding, giving colostrums and avoiding pre lacteal feeds is not practiced at a desired level; which we would like to promote through the institutions conducting deliveries, by proper counselling of mother during antenatal visits and by educating the health care providers and community.

47-50

Authors: Jyoti Landge, Armaity Dehmubed, Swati Ghonge

Introduction: Maharashtra might claim to be among the most progressive states in the country, but the girl child continues to remain under threat. Present study was conducted to asses awareness and perception about female foeticide among secondary school children. Objectives: To assess the awareness and perceptions of school children regarding female feticide. Materials and Methods: Study Design: A Cross- sectional study. A total of 300 students who were in 8th to 10th class, English medium were enrolled for study. The information was collected by administering a pretested semi structured questionnaire to the students that had both multiple choice and open ended questions. After taking the consent of the head teacher (principal) of school, the purpose of the study was explained to the students. The students were asked to fill the questionnaire in the presence of investigators and class teacher. Data was entered and analysed by means of simple comparisons and proportions using SPSS16. Results: Out of total 300 students, 285(95%) were heard about female feticide. Main source of information was TV among 174(58%), followed by newspaper 77(25.66%), 227(75.66%) felt that female feticide is harmful for society and 210 (70%) felt that it is a crime. Answer to female feticide should be stopped? Revealed that punishment 85(28.33%) and equal status to girls 88(29.33%) will help to solve this problem. Conclusions: Students were aware about this social evil. They felt that this social crime will be harmful for society and it should be stopped.

56-59

Authors: Yadukul.S, Ashwin Kamal, Shivakumar BC, Udaya Shankar

Background: Hanging (self-suspension) is that form of asphyxia which is caused by suspension of the body by a ligature which encircles the neck, the constricting force being the weight of the body. The person will use any article readily available for this purpose, like a rope, metallic chains and wires, leather strap, belt, bed sheet, scarf, dhothi, saree, turban, sacred thread, etc. The Doctor who performs the autopsy should note whether the mark on the neck corresponds with the material alleged to have been used in hanging, and if it is strong enough to bear the weight and the jerk of the body. Methods: The present prospective study is done in the Department of Forensic Medicine & Toxicology, Sapthagiri Institute of Medical Sciences & Research Institute, Bengaluru for a period of 6 months considering the inclusion and exclusion criteria. Results: During our study period, a total of 102 Autopsies were conducted in the Department of Forensic Medicine and Toxicology, Sapthagiri Institute of Medical Sciences, Bengaluru. In this study, the incidence of Hanging is 33.33% (34 out of 102). Males outnumbered the female with a male: female ratio of 10:3 with highest incidence of hanging being noticed in the age group of 16-30 years (62%). Soft material (77%) was the most commonly used ligature material than the hard one. Conclusion: To conclude, this study will educate and provide awful information for the Investigating Officer (Police and Magistrate) in investigating cases of Hanging.

64-68

Authors: Juglan Sarthak, Chaturvedi Kumar Rajesh, Kulshrestha Pankaj, Soni J.N

Introduction: In recent decades the use of entomology as a strong tool on human corpses can help in estimation of time of death or post mortem interval in addition to others parameters related with postmortem interval. Forensic entomology is the name given to any aspect of the study of insects and their arthropod counterparts that interacts with legal matters. Since many insects are associated with the human body after death, they are always a potential source of evidence in case of murders or suspicious deaths. Aim: The objective of this study involves the evaluation of postmortem interval from entomological evidences, to study the effect of temperature and humidity on the determination of postmortem interval by using entomological techniques and correlating it with autopsy derived postmortem interval. Material and methods: The present study was conducted on 100 corpses with the guidance of expert Entomologist at the Mortuary of Gandhi Medical College, Bhopal and all necessary information regarding the scene of crime, methodological data collection, meticulous collection of specimens and routine post mortem examination of corpses were done, to find out the mode and manner of death. Decomposed corpses were categorized in five stages: Stages I Fresh, Stage II - Bloated, Stage III Acute decay stage-IV post decay and stage V – Dry or skeletonized. Observation and Result: The statistical data collected from this study showed that out of 100 cases 54 cases were of known individual, where 46 cases were of unknown identity of these 82 cases were male and 18 cases were female. Commonest species of insects found on dead bodies were Calliphorids in 78.2% cases followed by Sarcophagids in 12.6% cases, Face (including orbit, nose and ear) was the common site where entomological evidence was found (39 cases) followed by neck. The postmortem interval determined from entomological evidences was correlated with the interval as determined from routine autopsy examination and in 66% cases the two intervals were found to be in the same range. Conclusion: The present study clearly highlights the importance of forensic entomology in estimating precise postmortem interval which can be used as alternative tool in cases of decomposed bodies with entomological evidences.