Sex determination from hand dimensions for forensic identification.

Background: Sex determination is an important and foremost criteria in establishing the identity of an individual. The issue of Sex discrimination can be very complicated in cases of intersex, bodies in advanced state of putrefaction, mutilated & fragmentary remains in which it is common to recover dismembered & peripheral parts of the body. It was realized that anthropometric measurements of the hand has been very useful tool in sexual identification. Objectives: This paper attempts to discriminate between male and female on the basis of hand dimensions, to investigate among the variables which can better predict sex, to derive sectioning point for discriminating sex and to reflect frequent hand index category among the sexes. Methods: The research study was based on 182 subjects (91 males & 91 females) within age 18-60 years, devoid of any deformity, fracture or surgical proceedings of either hand were randomly selected from Udaipur district of Rajasthan. Hand Length and Hand Breadth was obtained from each subject and results were analyzed using IBM SPSS computer software. Results: Hand length and hand breadth show statistically significant male – female differences at p<0.001. Hand Breadth was found as best predictor of sex in comparison with hand length. Frequency of hand index categories reveals that females have highest dolichocheir morphology of hand. Sectioning point analysis confirms that cut-off point of 43 and below is suggestive of male hand whereas above 43 were considered as female hand. Conclusions: This study has implications in mass disasters and in criminal cases where an isolated hand is recovered and needs forensic identification.

A Comparative Evaluation of Losartan/ Hydrochlorothiazide (Fixed Combination) versus Amlodipine Monotherapy on Left Ventricular Hypertrophy, Biochemical Parameters and Adverse Effects in Patients of Hypertension.

Background: Long-term administration of antihypertensives require better efficacy and tolerability. Moreover, the agent should regress left ventricular hypertrophy (LVH), which is an important predictor of cardiovascular events. Aims: To comparatively evaluate the effects of losartan/hydrochlorothiazide (LST/HCTZ) and amlodipine (AMLO) on LVH, biochemical parameters and adverse effects in hypertension. Material and methods: Two hundred fifty newly diagnosed hypertensive patients were randomly divided into two groups. LST 50 mg/HCTZ 12.5 mg and AMLO 5 mg once-daily, were administered. Biochemical parameters, adverse effects and ECG were recorded initially and after 6 months of therapy. Statistical analysis was done. Results: Both regimens significantly reduced mean SBP and DBP in each of the six follow ups (p < 0.001). LST/HCTZ caused regression of LVH in greater number of cases (26) than AMLO (20) and also showed a significant increase in mean values of serum creatinine, serum uric acid and high-density lipoprotein (HDL) levels and a significant decrease in Serum cholesterol. In AMLO group only serum creatinine was raised. The most common adverse effects in LST/HCTZ was dizziness (4.5%) and in AMLO group pedal edema (22%). Conclusion: Comparatively LST/HCTZ therapy causes regression of LVH in larger number of cases, increases HDL and is better tolerated.

Predictors of Hypertension among Adult Tribal Males of India.

Background: Cardiovascular diseases (CVD) have increased worldwide equally burdening people from different ethnic and socio-economic groups. Hypertension is an eminent modifiable risk factor for CVD and relates to body adiposity, which can be evaluated by various anthropometric measurements. Objective: The present study reports prevalence of under nutrition and hypertension, potential predictors of hypertension and new cutoff values for various disease associated adiposity markers in six tribal populations inhabiting different states in India. Methods: Cross sectional sample of 910 adult males aged 46.98 ±17.17 years was studied. Anthropometric measurement (height, body weight, body circumferences, skinfold thicknesses), blood pressure and socio-demographic characteristics were ascertained. General and regional adiposity indices, muscle diameter and fat % were derived. Descriptive, multivariate regression analyses were performed. Receiver operating characteristics (ROC) was used to determine optimal cutoffs values. Results: Underweight (45.3%) and hypertension [Systolic blood pressure (SBP) - 15.2%, Diastolic blood pressure (DBP)-25.5%] co-exist increasing the morbidity in the tribal population under study. General adiposity measures were better predictors of hypertension. Body mass index (BMI), fat% (negatively associated), age and mid upper arm circumference (positively associated) were independent risk factor for hypertension. Out of all reported cut offs, the new BMI cutoff values (20.12 kg/m2 and 18.98 kg/m2) and for mid upper arm circumference (MUAC) (21.44cm and 21.95cm) for predicting SBP and DBP respectively corresponding nearly to earlier reported standards by World health Organization (WHO). Conclusion: The inverse association of general adiposity markers with blood pressure among the present subjects indicates that CVD is not only prevalent among the affluents but is also affecting the socio-economically and nutritionally deprived groups. Population specific cutoffs for the anthropometric markers are needed to identify individuals with different body compositions at risk. Long term treatment expenses and health burden further depletes the limited economic resources of these vulnerable groups creating a vicious cycle of CVD and under nutrition.

An analysis of prescription patterns in cases of uncomplicated hypertension in a tertiary care hospital.

Background & objectives- Prescribing pattern in hypertension patients were found to be different from the recommended guidelines in the past. The objectives of the present study were to analyze prescribing trends in uncomplicated hypertension and to compare with those of current international guidelines with the objective to note any deviation. Methods- A prescription based analysis in 1400 hundred uncomplicated hypertensives in the age group 30 to 60 years was carried out. Results- Monotherapy was prescribed to 893 cases (M 407; F 486) and combination therapy to 507 cases (M 342; F 165). Overall, Calcium Channel Blockers (CCBs) were the most common agents used 787 (56.21%) cases, 350 monotherapy and 437 as combination therapy. Angiotensin Converting Enzyme Inhibitors (ACE I) 452 (32.28%) and Angiotensin II Receptor Blockers (ARBs) 231 (16.5%) cases were the next preferred groups. In double drug combination CCB+ Beta Blockers (BB) and for triple drug combination CCB+ARB+ Diuretics (D) were more preferred. A significant effect of age (p<0.01) on prescription of CCBs was noted. Prescription of ARBs and D were significantly (p<0.05 and <0.01 respectively) influenced by gender. Gender had no significant effect on the prescribing trend of antihypertensive agents in combination therapy, while a significant effect (p<0.05) of age and combined drug classes CCB+ACE I and CCB+BB+D was noted. The overall prescription rate for diuretics was 40.24% and that for monotherapy was meagre 5.15% (M 1.23%±; F 3.92%). Diuretics were always prescribed in triple drug combinations. Interpretation & Conclusions- CCBs were the most commonly prescribed agents. A deviation existed between antihypertensives prescribed and current international guidelines thus calling upon greater awareness.

Fatal road traffic accidents, study of distribution, nature and type of injury.

During one year study period medico legal autopsies were conducted on 950 cases of fatal road traffic accidents at the mortuary of SRN Hospital, MLN Medical College, Allahabad. M/F ratio 3:1. 33.68% of cases were in the age group of 25-44 years. Pedestrians were most vulnerable accounting for 35.79% of total fatalities followed by motorized two wheelers 30.53%. Heavy Vehicles were found to be mostly involved 58.52% of cases and most accidents 83.05% occurred on highways. Majority of cases sustained multiple injuries. Primary impact injuries were recorded in 455 cases and pedestrians 36.26% were mostly affected followed by pedal cyclists 20.88%. 505 cases sustained secondary impact injuries and pedestrians and motor cyclists were primarily involved. Of 697 secondary injuries, 29.99% were sustained by motorcyclists followed by pediastrians 22.67%. Mostly lower extremities 27.39% and pelvis 25.99% received the primary impacts; the head and neck 55.62% the secondary impacts, while secondary injuries were mostly located in the lower extremities 28.38%. Largest number of injuries were recorded in lower extremities 804 number, followed by head & neck 748 number. Vehicle occupants mostly sustained thoracic injuries. In majority of cases, the site of initial impact of the responsible vehicle was frontal (45.14%) followed by rear (25.83%) and side (7.01%). In 179 cases (22.02%) site of responsible vehicle were not known.

Histopathological changes in cases of aluminium phosphide poisoning.

Of a total of 205 poisoning deaths in our hospital in 2003, 83 cases were due to Aluminium phosphide poisoning and were further analyzed. Most vulnerable age group was 21-40 years and M:F ratio was 2:1. On naked eye examination, almost all the vital organs were found to be congested. On microscopic study, the liver showed central venous congestion, degeneration, haemorrhage, sinusoidal dilation, bile stasis, centrilobular necrosis, Kupffer cell hyperplasia, infiltration by mononuclear cells and fatty change. Microscopy of the lungs revealed alveolar thickening, oedema, dilated capillaries, collapsed alveoli and haemorrhage. In the kidney, changes were degeneration, infiltration, tubular dilation and cloudy swelling. Changes in the brain included congestion and coagulative necrosis and in the stomach, congestion and haemorrhage. Easy availability of this cheap and highly toxic substance was responsible for the sudden spurt of poisoning with aluminium phosphide.

Seroepidemiology of hepatitis A in Delhi.

A prospective study was done to determine the age specific prevalence of antihepatitis A antibodies (anti HAV Abs) among children in Delhi. Four hundred and twenty children aged 0-12 years attending outpatient department for vaccination or any minor illness were studied. Sera was tested by ELISA for anti HAV Abs using a commercial kit (Hepvase A 96 TMB). Thirty samples of cord blood were similarly analyzed. All samples of cord blood were positive for anti HAV Abs. Prevalence of anti HAV Abs was 80% by 5 years of age. The most vulnerable age group was 0.5-1.5 years (anti HAV Ab positivity). Cord blood had 100% positivity. Univariate and multivariate analyses taking anti HAV antibody positivity as dependant variable demonstrated that age and father's education (socioeconomic status) significantly affect prevalence of anti HAV Abs. Sex, water supply, history of jaundice in self or family did not have any significant effect on anti HAV antibody positivity. Prevalence of anti HAV antibodies is 80% by 5 years of age. Further studies in different strata of society and different regions in the country are required to assess the need and age for vaccination.

Serum TNF-alpha and free radical scavengers in neonatal septicemia.

Tumor necrosis factor-alpha (TNF-alpha) and free radicals have been implicated in the pathogenesis of neonatal septicemia and its complications. This case control study was conducted between November 1996 to July 1997 to determine the levels of TNF-alpha and free radical scavengers viz. superoxide dismutase (SOD) and glutathione peroxidase (GPX) in the serum of 30 septic neonates and 20 healthy controls. Patients with neonatal sepsis registered significantly higher levels of TNF-alpha, SOD and GPX in comparison to controls (p < 0.05). The neonates with septic shock had five fold increase in TNF-alpha levels (2262 +/- 605.8 pg/ml) as compared to those without shock (738.8 +/- 728.8 pg/ml). There was no statistically significant difference in levels of antioxidant enzymes between neonates with shock and without shock. The levels of TNF-alpha and antioxidant enzymes were not affected by the type of organism isolated in blood culture.

Association of genetic markers with coronary heart disease (myocardial infarction)--a case-control study.

A case-control study was carried out on patients of myocardial infarction selected from coronary care unit of Lok Nayak Jai Prakash Narayan Hospital, Delhi. The study was carried out to determine the association of haptoglobin (Hp), transferrin (Tf) and complement component 3 (C3) polymorphism with myocardial infarction. The frequency of allele Hp1 was found to be 0.159 in cases studied and 0.058 in controls. The frequency of gene TfC was found to be 0.987 in cases of study and 0.992 in controls. Similarly, frequency of CS3 gene was found to be 0.985 and 0.990 in cases studied and controls respectively. The comparison between cases studied and controls with respect to TfC and CS3 polymorphism was found to be statistically non-significant while the comparison between cases studied and controls for Hp polymorphism was found to be statistically significant (chi 2 = 21.88, p < 0.01).

Prevalence of fragile X(A) syndrome in mentally retarded children at a genetics referral centre in Delhi, India.

The usefulness of the clinical score based on Turner 5-trait scale prior to undertaking cytogenetic or molecular tests for the diagnosis of the fragile X(A) syndrome was evaluated. Mean clinical score in fragile X positive patients was significantly higher than in fragile X negative patients (7.06 +/- 1.85 vs 2.98 +/- 1.6, P < 0.0001). Of 1206 children with mental retardation 360 (29.8%) boys fulfilled defined clinical criteria to be screened for fragile X syndrome by chromosomal studies. Twenty three (6.38%) of them were found to be positive for fragile X syndrome using cytogenetic techniques. Molecular confirmation in 21 affected boys (two were lost to follow up) showed full mutation in 19 (5.27%). Two patients showed a normal 5.2 kb band on southern blot. This frequency (5.27%) of fragile X(A) patients among children with non-specific mental retardation is comparable to the results of studies in the West. Routine use of the clinical score, and the selection of patients with a score > or = 5 for diagnostic tests would reduce the laboratory load, especially in countries with limited facilities.

Detection of anti-PPD IgG antibody and PPD-induced delayed type hypersensitivity in anterior uveitis patients.

Present study relates to the results of anti-PPD IgG, anti-A60 and antinuclear antibodies and PPD-induced delayed type hypersensitivity (DTH) in 17 anterior uveitis, (AU) patients. Results of anti-PPD IgG assay revealed detection of higher mean antibody level (O.D. 0.11 +/- 0.06) compared to healthy controls (O.D. 0.04 +/- 0.03), other eye disease controls (O.D. 0.05 +/- 0.003) and leprosy controls (O.D. 0.03 +/- 0.03). Anti-A60 IgM antibody assay revealed insignificant differences in mean antibody levels between various groups. Four of 17(23.5%) AU patients and 1(5.8%) subject each, belonging to other eye disease and healthy control groups had raised anti-nuclear antibody index. Findings of PPD skin test revealed detection of moderate to strong (2 to 4+) reactivity in 14 (82%). AU patients. Conversely, 13(76%) healthy controls and 8(47%) other eye disease controls gave mild (1+) reactivity. Results of this study suggested possible role of hypersensitivity to mycobacterial antigens in pathogenesis of anterior uveitis.

Possible role of mononuclear phagocytes in clearance of immune complexes in pulmonary tuberculosis.

Phagocytic activity of peripheral blood mononuclear cells (PBMC) was investigated in 30 patients with pulmonary tuberculosis. The test was done using neutral red. Higher percentages of phagocytic cells were detected with PBMC of tuberculosis patients as compared with controls. An inverse relationship was observed between neutral red positive cell counts vs. relative percentages of several proteins (IgG, C3 and C4) in PEG precipitates in tuberculosis patients. It was interpreted that phagocytes might have mopped up the CICs via their surface Fc receptors.

Possible role of streptokinase-induced delayed hypersensitivity and eosinophilia in pathogenesis of ankylosing spondylitis.

Present study relates to the results of investigations on 16 patients with Ankylosing spondylitis (AS). Age of the patients ranged from 16 to 44 (median 25) years. Male female ratio was 4.3:1. Sacroileitis was detected in all the patients. Seven patients each had stage 1 and 2 disease. Two other patients had stage 3 disease. Lower mean Hb per cent was detected among patients as compared to control groups. Twelve of 16 (75 per cent) patients had eosinophilia. HLA-B27 antigen was detected in 10 of 16 (62.5 per cent) patients. Streptokinase-induced delayed sensitivity was detected in 10 of 16 (62.5 per cent) patients. Anti-streptolysin 'O' antibodies were detected in 2 of 16 patients' sera. Moderate negative correlation was found between the size of induration of skin test and haemoglobin concentration (P < 0.05). Possibly, delayed hypersensitivity might induce both eosinophilia as well as anaemia among AS patients.

Subclinical group A streptococcal throat infection in school children.

Seven hundred and forty nine apparently healthy school children aged 5-15 years were investigated for throat infection with Group A streptococci (GAS) during December 1990 to May 1991. The prevalence of beta hemolytic streptococci (BHS) was 18.8%; most organisms belonged to Group A streptococci (13.7%). The prevalence of BHS in throat was significantly higher (p < .001) in girls as compared to boys. Immune response to extracellular antigens was studied in 53 children who had GAS strain in their throat, 54.7% had elevated titers of antistreptolysin O or antideoxyribonuclease B or both indicating subclinical infection with GAS. Thus it is recommended that serological examinations should be done along with throat culture to identify subclinical Group A streptococcal throat infection.

Relative role of B and T lymphocytes in pathogenesis of a murine herpes virus.

Pathogenesis of a murine herpes virus was investigated in inbred strains (BALB/c, CBA, AKR and C57BL/10) of mice. After intranasal inhalation, virus was found to replicate primarily in the lungs, followed by haematogenous spread to the target organs (adrenal glands and ganglia). AKR (H-2k) were found to be most susceptible to virus infection while CBA (H-2k) mice appeared to be relatively resistant. Infection of B-cell depleted BALB/c mice resulted in detection of lower lung virus titres in B-cell depleted animals as compared to normal intact mice. Moreover, 3 of 12 normal mice in untreated group died of virus infection while deaths did not occur in the B-cell depleted group. Results of T-cell subset depletion experiments in BALB/c mice revealed maximum mortality in the group depleted of both Lyt-2+ and L3T4+ subpopulations. Infectious virus titres were also higher in lungs of T-cell depleted animals.

Chemo-immunotherapy and immunological study in carcinoma of larynx and laryngopharynx.

Eighteen of 25 patients had squamous cell carcinoma in the supraglottic region. Anergy to skin test antigen (DNCB) and T-cell mitogen (PHA) was observed in 17 patients with laryngeal and laryngopharyngeal malignancies. Chemo-immunotherapy did not improve the skin reactivity to either agents. However, a rise in absolute T-cell counts was observed following combined therapy. Moreover, T-lymphopenia was detected in the patient group prior to therapy as compared to mean T-cell counts in normal control subjects.