Indian Journal of Forensic and Community Medicine

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.