Indian Journal of Forensic and Community Medicine

75-78

Authors: Kajal Srivastava, Sumit Jethani, Bhavika Kalthe, Parul Sharma Khilnani, J.S. Bhawalkar, Shili Vyas

Background: Worldwide, one of the leading causes of mortality and morbidity in females is invasive cancer of the breast. Despite the advent of modern screening methods, more than 90% of cases of cancers of the breast are detected by women themselves, stressing the importance of breast self – examination. Nurses (para-medical staff) being a very important component of Health Staff who come in contact with patients and local population more frequently. Therefore teaching them Breast Self-Examination (BSE) would be a fast media to further educate the general population about the risk factors of breast cancer and five easy steps of Breast Self-Examination. The purpose of this study was to investigate attitude and practice of breast self-examination and to determine knowledge of risk factors for breast cancer among nurses in tertiary care hospital. Objectives: To study the knowledge of breast cancer and attitude and practice of Breast self-examination among nurses. Methods: A descriptive and cross-sectional study was performed. It was conducted in OPD and wards of Dr. D.Y. Patil Medical College, Pimpri Pune. The study sample included 200 staff nurses working in hospital. A simple questionnaire consisting of 20 questions on knowledge of risk factors of breast cancer, attitude for breast self-examination and practice for the same was administered through face to face interview. Results: regarding the risk factors of disease, majority subjects (61.5%) mentioned aging, nulliparity (54%), oral pills (59%), radiation at young age(85%) increases the risk of getting breast cancer. Regarding attitude for breast self-examination 82.5% mentioned that it causes embarrassment, 33.5% said it was troublesome and 54.3% time consuming. Regarding practice only 15.6% were performing BSE every month. Conclusion: The findings of this study may provide a basic ground for ideas for future nursing research and projects for nurses in India. This is an important initial step toward increasing awareness about breast cancer and it encourages early adoption of breast screening initiative.

83-86

Authors: Sarthak Juglan, Sandeep Singh, Rajiv Kumar Benzal, Jayanthi Yadav

Introduction: Decomposition Changes in the corpse is the final stage of degradation of the body. These changes sets in after disappearance of rigor mortis where by complex organic structures are broken down into simpler variants by the action of anaerobic bacterial flora and autolytic digestive action of enzymes outpoured during cellular death. Concealment of crime by hiding the bodies is a common practice. Often these bodies are found in various stages of decomposition at the time of recovery. Injuries (including open wounds) over body surface attract insects and provide warm and suitable micro-environmental conditions for eggs laying, in addition to natural and cozy body orifices. Aim: The objective of the present study is to correlate the cause of death (including open wounds) with respect to decomposition of human bodies, to study the distribution pattern of injuries over body and to find effect of clothing status on the overall decomposition process. Material and Methods: The present study was carried out during 2009-2012 and involved 100 human corpses in various stages of decomposition. All necessary and vital information was assembled from police papers regarding location of body, crime scene, last seen alive etc. History narrated by relatives was correlated with the condition of the body and police history. Cases were classified according to their status of decomposition, clothing status of the corpse was identified as partial, complete and naked. Injuries present were recorded according to their size and location. Observations and Results: Out of the total 100 cases studied, 6 cases were in stage 1, 31 in stage 2, 34 in stage 3, 25 in stage 4 and 4 cases were in stage 5. 55 cases were fully clothed, 28 cases partially clothed while 17 cases were naked. In 25% cases injuries were case of death. In 10% cases pathology and infection was cause of death. In 44% cases head (including face) & neck was the commonest site of injury. 60% cases of injuries were recorded in month of April to September. 82% of bodies found naked were recovered in advanced stages of decay. Conclusion: The present study highlights that while injuries are a definitive additive parameter to the process of decomposition, other cause of death also influence rate of decomposition of human corpses. Injuries, particularly in combination with other suited conditions over various body parts ideally allow for the growth of various predators and work cumulatively in ultimate demolition of the body. Exposed corpses were found especially susceptible to alterations in any given conditions.

92-95

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

Background: It is well known that Medical education is highly challenging and mind exhausting field which affect the mental health of Medical students. Stress is an external constraint which upsets an individual both mentally and physically and Medical education is perceived as stressful. The postgraduate students of Medical field suffer from higher stress that definitely affects the mental wellbeing of these students. Methods: This cross-sectional study was conducted in January 2014 on 300 Medical students to assess the level of stress, anxiety and depression in Postgraduate Medical aspirants, belonging to different Medical Colleges of Indore with the help of Pre-designed semi-structured questionnaire schedule. Graded using Mental Health Inventory Scale. Results: It was found in present study that out of randomly selected 300 students, 24% students had depression, 42% had anxiety, 27% experienced change in behaviour, only 35% had general positive effect & life satisfaction and 49% had emotional ties. Conclusion: The present study concluded that depression, stress and anxiety are the major growing mental problems among the medical post graduate aspirants students. Student counselling services need to be made available and accessible to come out from this morbidity.

101-107

Authors: Bharatesh Devendra Basti, Girish B

Background: ART treatment has resulted in a marked decrease in the mortality and morbidity associated with HIV infection. Follow-up and monitoring is essential in patients initiated on ART to track clinical progress and monitor wellbeing. Objectives: 1. To determine the effect of Anti-retroviral Therapy (ART) on CD4 Count in treatment-naïve HIV/AIDS patients. 2. To determine the effect of ART on Weight gain and haemoglobin percentage in treatment-naïve HIV/AIDS patients. Materials & Methods: Longitudinal study was conducted at the ART centre, North Karnataka for a period of 1 year among 242 HIV infected patients. CD4 count, haemoglobin, weight, etc were measured at the time of initiation of ART and at the end of 6 months of ART. Statistical analysis: Data analysed using Epi-Info 6 software. Tests used were mean, proportions, Chi square test and Paired T test. Results: 54(22.3%) were in the age group of 25-29 years, 133(55%) were females and 109(45%) were males. Male to female ratio is 1:1.2. CD4 counts >200 cells/mm3 at the initiation of ART were in 82 (33.9%) patients and at the end of 6 months were in 187 (85%) of patients. Increase in the CD4 counts was noticed in 206 (95.8%) patients after 6 months of ART. Significant increase in the mean CD4 count by 165.7182 cells/mm3, mean CD4 percentage by 7.3591% & weight by 2.4727 kg were noted. Conclusions & Recommendations: CD4 counts and CD4 percentage in HIV patients increase substantially with proper ART. Initiation of ART at an earlier stage has significant better results than wait for the counts to lower.

110-120

Authors: Suruchi Pandey, Brig. Rajiv Divekar, Shiva Gupta

The present paper is a review of practices adopted by hospitals in Pune with respect to the bio-medical waste management norms. The study was undertaken to check whether the bio-medical waste management rules are being followed or not in hospitals, Clinics and diagnostic centers in Pune. This paper is an interesting insight on the awareness level of health organizations about waste management rules. Pune municipality has been strictly following provisions of bio-medical waste management. The research done for this paper clearly reveals that there is a lot of ignorance by hospitals, clinics with regards to waste management and the other important issue is that there is a lot of a cost involved in treating the waste. The data has been collected from 10 health institutions like big hospitals, small hospitals, clinics etc.regarding their habits of treating the waste. And the results reveal that there is an urgent requirement of training for the staff of the hospitals as 50% (Primary sources) of staff is not clear about the standard waste management practices. Therefore, PMC should consider this issue and make sure that standard bio-medical waste management practices are being followed in all the hospitals/clinics of Pune. The present paper also attempts to provide a solution followed by recommendations based on its observation. It demonstrates some good practices adopted by some of the hospitals under the study. The main purpose of this paper is to spread awareness about the rules (colour coding, handling of waste etc.) of handling of biomedical waste in hospitals which can be followed if a little care is taken by each hospital staff in separating the waste at starting level itself. Mainly highlighting the harmful effects of biomedical waste to the environment if not disposed of properly. This paper also highlights the health hazards to the people handling this waste in the like laundry workers, nurses, medical personnel and other employees of the hospitals.

124-127

Authors: T. Selvaraj, T. Sudharson

Introduction: Poisoning is a global issue occurring all over the world involving people of all ages and gender, from all ethnic and economic groups. It is estimated that there are over 3 million cases of organophosphorus poisoning per year worldwide with approximately 300,000 deaths. Recent data from National crime bureau of India shows suicide by consumption of pesticides account for 14.7%, 14.4% and 10.9% of all cases of suicidal poisoning in the year 2012, 2013 and 2014 respectively. Aims of the study: To assess the demographic patterns of OP poisoning with respect to age, sex, occupation, education, socioeconomic status. Materials and Methods: A retrospective study was conducted in a tertiary care teaching hospital in Madurai, Tamil Nadu. Hospital records of patients with history and clinical features of OP poisoning in the year 2014 were reviewed. Results and discussion: 67% of poisoning cases were in the age group 21-40 years. The incidence was higher in males than in females. More than 50% of the victims in our study were illiterates. 78% cases were from rural area. 85% cases belong to lower and middle class. Farmers (40%) were the major victims. Suicide was the most common manner of poisoning. Methyl parathion was the most common poison consumed (26.5%). Nausea and vomiting (88%) were the most common clinical features. Atropine psychosis (29%) was the most common complication. Mortality rate was 12%. Conclusion: Illiteracy, poverty, cheap and easy availability of the OP compounds, lack of employment and stressful life-style were the common reasons behind suicidal poisoning. Health education of farmers, other agricultural labourers and young people about the toxic and detrimental effects of OP compounds will help in preventing suicidal and accidental poisoning to some extent.

133-137

Authors: Kedar Mehta, Hemali Patel

Introduction: Oral health and diseases receive little concern in India though their consequences affect the body as a whole. A prerequisite of progress towards optimal oral health is to understand where we stand today. So present study was carried out to evaluate oral hygiene awareness and associate barriers to avail oral health curative services among cross section of patients attending our centre. Materials and Methods: 276 subjects who gave informed consent were included out of 300 in this cross sectional study conducted at dental trust hospital, in Bhavnagar, Gujarat. A pretested, semi structured, self-administered questionnaire was given to each of the participant. Data so collected was calculated in terms of percentages and proportions. Results: 261 (94.5%) subjects were of the view that oral hygiene is mandatory for overall health of the body, whereas hundred ninety-five (70.7%) of the subjects visited a dentist only for symptomatic reasons. 216 (78.3%) of the subjects cleaned their teeth only once in a day and reasons for not brushing teeth twice were being lazy, tired and forgetfulness as mentioned by them. Having no serious dental problem and expensive dental treatment were marked as the major barriers in receiving oral health care services and regular visit to dentist. Conclusion: This study illustrates the peoples’ neglective attitude towards their own oral health. Although majority of the respondents were aware about the necessity to maintain oral hygiene, very few of them translated it into practice. People need to be motivated for positive oral health care seeking behaviour through various campaigns and educational interventions.

142-145

Authors: Pradip Kumar Thakuria, Aditya Madhab Baruah

Coronary artery stenosis and the resultant cardiac ischemia is a leading cause of deaths worldwide. With studies all over the world in the topic, a study for the same in the geographical area of Kamrup, Assam is attempted. Males are most commonly involved. Increased incidence is found in the later decades of life. However the younger age group is also involved in a few cases. With greater education and urban residency cases are also seen on the higher side. Smoking and alcohol are the major risk factors. Businessmen and service holders are commonly affected. There is need of life style change in general public as well as cardiologists and treating physicians to think of early treatment, to avoid untoward complications.

152-155

Authors: Suraj Sundaragiri, Vijayadurga Koppada

Terson’s syndrome is vitreous hemorrhage occurring consequent to subarachnoid hemorrhage. We present here the case of 60 years old male person who met with road traffic accident. He was transported to a hospital where diffuse subarachnoid hemorrhage was diagnosed radiologically. But before further studies could be Pursued, and surgical intervention started, his condition deteriorated and he died. The autopsy demonstrated diffuse subarachnoid hemorrhage of the brain with bilateral vitreous hemorrhage. Terson’s syndrome is certainly an indicator of increased risk of mortality without early surgical attention. This paper reports here radiological and autopsy findings of such case and recommends further studies to estimate of the frequency of vitreous hemorrhage in patients with subarachnoid hemorrhage, and to compare its mortality in patients with and without vitreous hemorrhage. It also recommends the forensic pathologists to assess the vitreous hemorrhage in all cases of subarachnoid hemorrhage with aneurysmal or traumatic brain injury.