Sociodemographic and clinical profile of aluminium phosphide poisoning in Jaipur, Rajasthan.

Aluminium phosphide pellets are inexpensive and widely available for grain fumigation and preservation. Their free availability has led to an epidemic-like situation in some parts of India due to its intentional (suicidal or homicidal) or accidental ingestion. There is a steady year-wise increment in the number of deaths due to this poison, and it is the single most frequent suicidal agent in Jaipur, Rajasthan. Eighty nine patients with acute aluminium phosphide poisoning were studied in SMS Hospital Jaipur, during the period September 2009 to September 2010. Out of these, 74 patients died (83.15%). The sociodemographic and clinical profile of aluminium phosphide poisoning are discussed in this paper.

A review of second medical opinion cases and its attribute to medical negligence: A retrospective study.

Today the number of cases of medical litigation is increasing and already it has become a great problem for surgeons, anaesthetists and obstetricians. The general practitioners and physicians are also facing the problem and in coming years the profession may turn into a nightmare. SMS Medical College is the biggest and oldest medical teaching institution in Rajasthan. The department of Forensic Medicine handles all types of medico legal works and there is a separate established Medical Board under the chairmanship of the Head of the department. Here we receive second opinion cases from different law enforcing agencies including the hospital and public administration. In this paper we have reviewed the second opinion cases with a primary focus on medical negligence cases in the time period of 2005 t 2009. Total 55 cases were identified out of which 42 were dead and 13 were alive. Maximum numbers of cases were observed in the age group of 21-30years. The number of female cases outnumbered the number of males. Maximum numbers of cases were related to surgical practice (OG-21, Surgery-8, Ortho-6, Neurosurgery-3, ENT-2, Opthal-1 and Urology-1).

Correlation of CT scan with postmortem findings of acute head trauma cases at SMS Hospital, Jaipur.

Epidemiological information is of great importance in the allocation of resources for the treatment and in formulating policy designed to reduce the incidence, morbidity and mortality of head injuries. In our country much epidemiological data regarding head injuries are not available, hard to find or inaccurate. The reasons for this are several there is no centrally run health care system in the country and head injury cases are managed by a wide variety of Government, Municipal and Private hospitals. The National Health Statistics compiled in the vital statistics in our country give incomplete information regarding head injuries while it is possible to determine mortality from cancer or heart diseases or number of other illness from vital statistics but same is not true for head injuries. Accidental deaths are catalogued as to etiology (for example, death from falls, motor vehicle etc.) and there is no information available as to the part of the body injured. The present study is an attempt to analyse epidemiological aspects of acute head trauma and evaluate the correlation of finding by various diagnostic modalities.

Age assessment from radiological cranial suture closure in fourth to seventh decades (A Jaipur based study).

Reasonably a correct estimation of age in important in Legal, Medical, Social and Administrative matters i.e. regularization of temporary employee, retirement from service or superannuation, re-employment in services, settlement of pension cases, distribution of old age pension, potency certification, for relaxation in imprisonment on the grounds of old age and good behavior of a prisoner, to provide senior citizen benefits etc. In the dead person the age estimation at the time of autopsy is done to help the Investigating Officer. In India and other countries the task of scientific confirmation of disputed age issue of civil and criminal nature is the domain of Forensic Expert. This study is done to determine the age of individual in the fourth decade to seventh decades by correlating radiological finding of various views of skull along with the other physical findings. Maximum Number of cases was in the age group of 51-55 yrs (17%). Female to male ratio was 1:2.2, 66% cases were urban and 34% were rural, 72% Hindu and 73% were from Middle class.

Heat induced morphological changes in the brain.

In severe conflagration the terminal state of the body often does not reflect the condition at the time of death. Some-times death might have occurred before any heat reaches the body and the death might have been caused by inhalation of smoke. It is difficult or rather impossible for the forensic expert to determine the extent of ante-mortem damage caused by flames. The classical distinction of “red flare or vital reaction” are usually absent in such cases. Destruction of the victim by fire is one of the oldest methods used by murderers to conceal their crime, and hence every death by burning require the most meticulous medico-legal scrutiny. Here we report an unusual cases of heat induced morphological changes in brain in a 60 years male, who was addicted to alcohol and smoking and found burnt on his bed in a locked room from inside. Typical vital reaction was not appreciable anywhere on the body so as to frame the opinion in favour in ante-mortem burns but on of dissection of skull certain unusual gross pathological finding was observed which helped in framing the opinion in favour of “Death due to accidental antemortem flame burns”.

Fracture of the temporal bone: A tomographic v/s autopsy study.

The present study was conducted in the Dep’t. of Forensic Medicine & Toxicology, SMS Medical College Jaipur (Raj), in the period from 15 Dec. 2001 to 4 April 2002. With the aim to find out the correlation of X-ray (Skull), CT scan (Head), Surgical intervention findings with the autopsy findings in the cases of acute Head trauma. Total of 140 cases of acute head trauma were selected irrespective of age, sex, religion caste etc. who had been admitted in Neurosurgery dep’t. And X-ray, CT scan head and /or surgical intervention had been done, subsequently died & autopsy was performed. X- ray skull gave batter information on fracture of skull than CT Scan, particularly when the fracture is located on the vault or base of skull and is of linear variety [1]. 27 cases of fracture of the temporal bone were specially studied, out of these 140 cases. All these cases had the features of triad, indicating of fracture of petrous part of temporal bone i.e. CSF Otorrhoea 14(51.1%), 7th nerve palsy 9(33.3%), serve middle ear bleeding 18(66.6%) & conducting hearing loss 5(85%). The plain X-ray demonstrated the fracture of temporal bone in 21 cases (79%) and the CT Scan demonstrated their in 24 cases (88%) Longitudinal fractures are common in 18 cases (66%) and procedure of choice for their demonstration is lateral tomography, Transverse fracture alone was uncommon (2 cases) and can only be demonstrated in anterior posterior tomographic projections and is usually associated with occipital fractures. CT Scan Examination give better information in detection of fracture of temporal bone as well as the type of fracture [2] which is essential for planning the surgical intervention or treating the patient conservatively in order to avoid the complications like, persistent CSF otorrhoea, posterior meningitis or even death.

Mode of death shifting from coma to syncope sports utility vehicle (SUV) accidents.

Road traffic accident is a major cause of death assuming epidemic proportion worldwide. After America, India has the largest network of roads. The total length of the road is about 33, 44,000km, out of which national highways occupies only 2% of total road length, whereas they bear 20% of the traffic load. One of the main reasons of the overcrowding of the roads is the tremendous rise in number of vehicles due to increasing distance from residence to workplace, intensive marketing campaign of newer sports utility (SUV) cars by depicting them in movies, media advertisements and easy finance availability has developed a craving to possess these sports utility vehicles in youths (both in males and females). These sports utility vehicles are nowadays becoming the rapid killer of the victims met with road traffic accidents (pedestrians, pedal cyclist and motor cyclist). The present study is based on prospective and retrospective cases of road traffic accidents involving SUV’s, since January 2005 to December 2006. The present study has shown that young adults predominantly males in their most productive year of life (21-30 years) are especially prone to road traffic trauma2. Pedestrians constitute the largest group of victims 78 cases (65%) followed by cyclist 18 cases (50%), spot death unavoidable in 83 cases (55.33%) and the thoraco-abdominal trauma found in 97 cases (80.83%)2,4. The findings of study under score the continue need for preventive strategies; aim to reduce trauma related mortality, particularly those regarding road traffic safety. The study also suggest that the large proportion of death were preventable, if underlying lesion or sequelae of injuries had been promptly addressed but unfortunately the front design of these sports utility vehicles is responsible for causing thoraco-abdominal trauma, leading to rapid death by causing haemorrhagic shock generated from involvement of the structures of thoraco-abdominal region.

Fracture of the temporal bone: A tomographic v/s autopsy study.

The present study was conducted in the Department of Forensic Medicine & Toxicology, SMS Medical College Jaipur (Raj), in the period from December 15, 2001 to April 4, 2002. With the aim to find out the correlation of X-ray (Skull), CT scan (Head), surgical intervention findings with the autopsy findings in the cases of acute Head trauma. Total of 140 cases of acute head trauma were selected irrespective of age, sex, religion caste etc. who had been admitted in Neurosurgery dep’t. And X-ray, CT scan head and /or surgical intervention had been done, subsequently died & autopsy was performed. X- ray skull gave batter information on fracture of skull than CT Scan, particularly when the fracture is located on the vault or base of skull and is of linear variety. [1] Twenty seven cases of fracture of the temporal bone were specially studied, out of these 140 cases. All these cases had the features of triad, indicating of fracture of petrous part of temporal bone i.e. CSF Otorrhoea 14(51.1%), 7th nerve palsy 9(33.3%), serve middle ear bleeding 18(66.6%) & conducting hearing loss 5(85%). The plain X-ray demonstrated the fracture of temporal bone in 21 cases (79%) and the CT Scan demonstrated their in 24 cases (88%) Longitudinal fractures are common in 18 cases (66%) and procedure of choice for their demonstration is lateral tomography, Transverse fracture alone was uncommon (2 cases) and can only be demonstrated in anterior posterior tomographic projections and is usually associated with occipital fractures. CT Scan Examination give better information in detection of fracture of temporal bone as well as the type of fracture [2] which is essential for planning the surgical intervention or treating the patient conservatively in order to avoid the complications like, persistent CSF otorrhoea, posterior meningitis or even death.