Estimation of stature from index and ring finger length in Davangere district.

Estimation of stature plays a special role in the field of forensic medicine and forensic anthropology. Present study was designed to investigate the ability of estimating stature from right index and ring finger length. Methods: The study was carried out by taking the measurement of index and ring finger length of right hand and individual’s actual height of 250 medical students (125 males and 125 females) of 18 to 25 years of age. The study was carried out in department of forensic medicine and toxicology at SSIMS & RC Davangere, Karnataka state, India. Obtained data was analysed statistically to establish the relationship between a person’s index and ring finger length of right hand and stature. Results: Regression equation and ‘P’ values were obtained. A moderate correlation was observed between index and ring finger length of right hand and calculated height of an individual which is statistically highly significant. Conclusion: The present study would be useful for anthropologists, Investigating Officer (IO) and forensic experts.

Estimation of stature from shoe print length while walking in females.

In Forensic Anthropology, estimation of stature from feet dimensions plays an important role in establishing individual’s identity. The foot length reflects a biological correlation with height suggesting that height may be estimated from shoe print length also. Various anthropometric studies have been conducted on foot in relation to growth and development, ergonomics, evaluation, orthopedics and other medical sciences. However, there is only little investigation, which focused on forensic importance of shoe print. Analysis of shoe prints can reveal very important clues, which can be used as forensic evidence in crime scene investigation. To study the relationship between Stature and Shoe Print length while walking, total 500 females from Karnataka in the age group of 18 to 21 years were examined. The stature estimation was done with linear and multiple regression equations. Recorded shoe print length was measured along parallel axis. The multiplication factors were also computed. The regression formula was checked for their accuracy and reliability. Highly significant and positive correlation was observed between stature and Shoe Print length while walking.

Forensic view on aluminium phosphide poisoning.

In India, acute aluminium phosphide poisoning (AAlPP) is a serious health care problem. This study aimed to determine the characteristics of AAlPP and the predictors of mortality at the time of patients' admission. We studied consecutive admissions of patients with AAlPP admitted to the intensive care unit (ICU). We noted 38 parameters at admission to the hospital and the ICU and compared survivor and non-survivor groups. A total of 54 patients were enrolled comprising 10 females and 44 males and the mean ingested dose of poison was 0.75 ± 0.745 grams. The mortality from AAlPP was 59.3%. We found the following factors to be associated with an increased risk of mortality: a serum creatinine concentration of more than 1.0 mg % (P = 0.01), pH value less than 7.2 (P = 0.014), serum bicarbonate value less than 15 mmol/L (P = 0.048), need for mechanical ventilation (P = 0.045), need for vasoactive drugs like dobutamine (P = 0.027) and nor adrenaline (P = 0.048) AAlPP causes high mortality primarily due to early haemodynamic failure and multi-organ dysfunction.

Suicidal acid injury: A case report.

Deaths from exposure to caustic substances are infrequently reported in the Forensic Medicine literature. A case of death due to Sulphuric acid ingestion in a patient of Major Depressive Disorder is being reported. This patient was planned for Electro-convulsive therapy, prior to the procedure he had been to bathroom. And when planned to prepare for the procedure on the ECT table, his mouth has smell of pungent odour. This made the psychiatrist to withhold the procedure and subjected him for observation. Later he complained of severe chest pain and restlessness, for which he has been shifted to emergency ward with possible precautions taken before shifting. He was provisionally diagnosed of acid ingestion but there was no history either from patient or from his relatives, as patient has consumed in the bathroom just before the Electro convulsive therapy. Diagnosis was confirmed only after autopsy report. The legal issues concerning suicide in mentally ill patient, autopsy findings, forensic issues and Patho-physiology concerning death by acid ingestion have been discussed.

High dose chemotherapy followed by autologous haemopoietic stem cell transplant in multiple myeloma.

BACKGROUND: High dose chemotherapy followed by autologous stem cell transplant is currently used for the treatment of patients with advanced multiple myeloma. However, there are no reports of the results of this treatment modality in Indian patients. METHODS: Fifty patients with advanced multiple myeloma underwent treatment with high dose melphalan followed by autologous stem cell transplant (bone marrow: 7; peripheral blood stem cells: 43). The patients' ages ranged from 26 to 65 years (median: 52 years) and 35 were men. All patients had received chemotherapy initially with a mean of 9.4 cycles (range: 1-36). Thirty patients had evidence of chemosensitive disease at the time of transplant. The mean interval from diagnosis to transplant was 17.5 months (range: 3-129 months) and the median number of mononuclear cells infused was 4.86 x 10(8) per kg (range: 2-10.48). RESULTS: Post-transplant, 43 of 50 patients engrafted. The median number of days to engraftment (absolute neutrophil count > 500/cmm) was 12 (range: 9-24) and to achieve platelet transfusion independence (> 20,000/cmm) was 13 (range: 8-36). Seven patients died prior to engraftment. Grade III-IV oral mucositis was the major non-haematological toxicity. Excluding the 4 patients who had complete response prior to the transplant and continued in the same status post-transplant, 31/46 patients (67%) responded; complete response was achieved in 25 (54%) and partial response in 6 (13%). Patients with chemosensitive disease had higher rates of complete response; 20 of 26 patients with partial response at transplant achieved complete response compared to 5 of 20 patients with persistent/refractory disease (p < 0.01). Currently, 34 of 50 (68%) patients are alive, 17 (34%) disease-free, 6 with disease are on salvage therapy, 11 (22%) with positive monoclonal protein but asymptomatic are under observation. Nine (18%) patients have died; 8 due to progressive disease and 1 of an unrelated cause. The median follow up for the entire group is 26 months (range: 1-144 months). The Kaplan-Meier probability of overall and progression-free survival for the whole group at 30 months is 62% +/- 8.11% (SE) and 42% +/- 9.54% (SE), respectively. A haemoglobin level < or = 10 g/dl (p < 0.003) affected the survival adversely. Chemosensitive disease (p < 0.008) at transplant and complete response post-transplant (p < 0.0001) were associated with significantly longer survival. CONCLUSION: High dose melphalan followed by autologous stem cell transplantation is an effective treatment for patients with advanced multiple myeloma and achievement of complete response is associated with improved survival.

Autologous bone marrow/stem cell transplantation: initial experience at a north Indian referral centre.

BACKGROUND: High-dose chemotherapy and/or radiation therapy rescued by autologous bone marrow or peripheral blood stem cells is being increasingly used for the treatment of haematological and solid malignancies. While few centres in India use this modality of therapy, the worldwide experience is encouraging. We, therefore, analysed the results of our initial experience with this therapeutic modality. METHODS: Forty-two patients [multiple myeloma (17), Hodgkin's disease (4), non-Hodgkin's lymphoma (3), chronic myeloid leukaemia (2), acute myeloid leukaemia (2), acute lymphoblastic leukaemia (2), epithelial ovarian cancer (6), breast cancer (4), primitive neuroectodermal tumour and testicular germ cell tumour (1 each)] underwent high-dose chemotherapy followed by either autologous bone marrow transplant (n = 9), peripheral blood stem cell transplant (n = 30) or both (n = 3). The indications for transplant included either advanced stage at diagnosis, other adverse prognostic indicators during the course of their disease, or relapse. The data were analysed retrospectively in December 1998 using hospital records. Follow up data of all the patients were available. RESULTS: Thirty-four of the 42 patients (81%) showed stable engraftment. Eight patients (19%) died in the early post-transplant period (day 5 to day 52 post-transplant). Seven patients died due to neutropenic infections and one due to acute renal failure. Of the 34 surviving patients, 20 were alive at the time of analysis and 14 had died. All but one death in this group were due to progressive primary malignancy. The median overall survival for all patients was 17 months and for the 34 engrafted patients it was 27 months. An analysis of factors affecting survival revealed that patients with chemosensitive disease had a longer overall survival (20.9 v. 6.1 months, p = 0.04) compared to those with chemoresistant disease. CONCLUSION: Autologous bone marrow or peripheral stem cell transplantation is a feasible procedure in India with an acceptable morbidity and mortality. It should be offered more frequently to properly selected patients.

Blood stem cell transplantation: current concepts.

Mobilized peripheral blood haematopoietic progenitor cells are increasingly being used as against bone marrow (BM) transplants, following high dose chemotherapy and/or radiotherapy for the management of chemosensitive malignancies. Rapid haematopoietic reconstitution as evidenced by reduced duration of neutropaenia, fewer donor platelet infusions, shorter hospital stay and reduced cost of treatment are the advantages of this procedure. Reduced tumour cell contamination of mobilized blood compared to bone marrow however, has not been substantiated. Mobilization of lymphokine activated killer cells (LAK), use of blood stem cells (BSC) for allogeneic transplants and ex vivo expansion of the mobilized cells are emerging as the future areas for research. Addition of interleukin-3 (IL-3), stem cell factor (c-kit ligand) and PIXY-321 appear to open-up new vistas by enforcing trilineage and multilineage haematopoietic reconstitution.

Storage of haemopoietic stem cells for autologous bone marrow transplantation.

For reinfusing autologous bone marrow cells after high-dose chemotherapy and/or radiotherapy it is necessary that an effective technique for their storage is available. The traditional method uses 10% dimethyl sulphoxide as cryoprotectant, a rate-controlled computerized freezer programmed to cool the cells at a constant rate of 1 degrees C per minute and liquid nitrogen as the storage system. The method is time-consuming, expensive and requires technical expertise. Moreover, it is often associated with varying levels of clinical toxicity following infusion of the preserved cells. Processing the harvest to reduce the initial volume and the mature cells has been shown to be beneficial in reducing the volume of the cryoprotectant and the incidence of toxicity. An alternative, cost-effective method using a cryoprotectant mixture of 5% dimethyl sulphoxide, 6% hydroxyethyl starch and 4% albumin has been found to be effective even when the cells are stored at -80 degrees C without rate-controlled freezing. However, its efficacy needs to be evaluated for extended periods. The current use of purging and cell sorting methods seems to be promising.