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.

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.

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.