Original research paper epidemiological profile of suicide by hanging in southern parts of Kerala: An autopsy based study.

Suicide rate is increasing all over the world; but the rate is disproportionately higher in Kerala. One hundred and eighty one cases of known dead bodies of both genders brought for medico-legal autopsy with history of suicide by hanging, were studied at the Department of Forensic Medicine, State Medico Legal Institute, Government Medical College, Thruvananthapuram, Kerala, India. There was a male preponderance in the study group (71.3%) and majority of males were young or middle aged (82.1%) whereas females were adolescents or young adults (73.1%). Among the males, only 2.3% were farmers. Alcoholism was noted in 75.2% of males. Immediate psychological problems were the reason for suicide in 33.7% of cases, majority of them being married (55.8%). Soft materials, that were easily available, were used as ligatures (48.6%) which were tightened around neck by slip knots (58%) on the sides of neck (53%).

Snake envenomation: a hospital-based survey from Thiruvananthapuram, Kerala.

Objective: Analysis of the frequency of occurrence of different symptoms and complications in snakebite cases from a part of Kerala (Thiruvananthapuram), and to understand the demographic pattern of those cases. Method: Retrospective analysis of all venomous snakebite cases (108 cases) admitted in Government Medical College, Thiruvananthapuram, during the year 2004, by scrutiny of hospital case sheets. Results: Maximum number of paediatric cases were from the age group 7–9 years (52%). In adults, the most affected age group was 35–44 years (26%). Slight male preponderance was seen (59.3%). The time of bite was usually between 1700 hrs and 2000 hrs (49.1% cases). Time delay in seeking treatment was only up to 2 hours in 59.2% cases. The duration of stay in hospital was 1–4 days in 53.7% cases. The species of the snake could not be identified in 54.6%, identified as viper in 35.2%, as cobra in 6.5%, and as krait in 3.7% cases. Bite mark could be located in 67.6% of victims. Severe form of local reaction with blistering and ulceration were seen in 13.9% and lymph node enlargement in 8.3% cases. Haematological symptoms were evident in 54.6%, nervous system involvement in 6.5% and both together in 9.3% cases. Cardiovascular system complications (toxic myocarditis, ventricular ectopics and neurogenic hypertension) were observed in 1 case, hypotension in 15%, and bradycardia in 1.8% cases. Death occurred in 4.9% of older age group, and 11.1% in paediatric group, together constituting a frequency of 6.5%.

A comparative study of clinical and autopsy findings (clinical audit) in 100 cases died of trauma.

Clinical audit is the systematic analysis of quality of any aspect of patient care with the aim of identifying possible improvements. In the present study one aspect of clinical audit - a comparison of clinical findings and autopsy findings was done in 100 cases died of trauma and brought for autopsy to Medical College, Trivandrum. This Study was conducted to find out the frequency of discrepancy and the type of co-existing injuries along with the missed injury. The discrepancies were classified according to the classification by Battle et al and Andersen et al. No discrepancy was observed in 62%, class I discrepancy (Major) in 25%, class II (Major) in 3%, and class III & IV (Minor) in 5% each. The injuries very rarely over looked were head injuries (11.4%) and spinal injuries (16.7%). The most frequent missed ones were abdominal injuries (64.3%) and chest injuries (63.9%). In majority of missed injuries head injury was a common occurrence i.e. 88.8% of missed abdominal injury, 78.1% of missed chest injuries, and all cases of missed spinal injuries.