ABSTRACT
Context: Gender determination is considered an important step in reconstructing the biological profile of unknown individuals from the forensic context. Assessment of sex differences from human remains will be of immense help as it would narrow down fields of search to 50 %. Aims: To evaluate the accuracy of various dental parameters used for the gender determination. Settings and Design: The aim of the present study was to investigate the accuracy of various methods employed in gender determination or personal identification such as mesiodistal width of molars, mesiodistal width of canine, mandibular and maxillary canine index in age group of 15 to 65 years. Methods and Material: A total of 200 patients were selected comprising of both the genders in the age group of 15-65 years belonging to various parts of Nagpur. The mesiodistal crown width of mandibular and maxillary permanent molar and canine teeth and the intercanine distance was measured and the values were noted. Statistical analysis used: the data was analysed using SPSS 18 software. Results: The mean of mesio distal width of maxillary and mandibular molar in males and females is suggestive of gender dimorphism in maxillary molars which was statistically significant. The maxillary inter-canine distance was greater in males and was statistically significant. Conclusions: The dental parameters can be used as a tool for accurate gender determination in forensic investigations.
ABSTRACT
Postoperative hemorrhagic complications is still one of the major problems in cardiac surgeries. It may be caused by surgical issues, coagulopathy caused by the side effects of the intravenous fluids administered to produce plasma volume expansion such as hydroxyl ethyl starch (HES). In order to thwart this hemorrhagic issue, few agents are available. Fibrinolytic inhibitors like tranexamic acid (TA) may be effective modes to promote blood conservation; but the possible complications of thrombosis of coronary artery graft, precludes their generous use in coronary artery bypass graft surgery. The issue is a balance between agents that promote coagulation and those which oppose it. Therefore, in this study we have assessed the effects of concomitant use of HES and TA. Thromboelastogram (TEG) was used to assess the effect of the combination of HES and TA. With ethical committee approval and patient's consent, 100 consecutive patients were recruited for the study. Surgical and anesthetic techniques were standardized. Patients fulfilling our inclusion criteria were randomly allocated into 4 groups of 25 each. The patients in group A received 20 ml/kg of HES (130/0.4), 10 mg/kg of T.A over 30 minutes followed by infusion of 1 mg/kg/hr over the next 12 hrs. The patients in group B received Ringer's lactate + TA at same dose. The patients in the Group C received 20 ml/kg of HES. Group D patients received RL. Fluid therapy was goal directed. Total blood loss was assessed. Reaction time (r), α angle, maximum amplitude (MA) values of TEG were assessed at baseline, 12, 36 hrs. The possible perioperative myocardial infraction (MI) was assessed by electrocardiogram (ECG) and troponin T values at the baseline, postoperative day 1. Duration on ventilator, length of stay (LOS) in the intensive care unit (ICU) were also assessed. The demographical profile was similar among the groups. Use of HES increased blood loss significantly (P < 0.05). Concomitant use of TA reduced blood loss when used along with HES. r value was prolonged at 12 hours in all the groups and α angle was reduced at 12 hours in all the groups, where as MA value was reduced at 12 th hour in the HES group compared to the baseline and increased in TA + HES group. These findings were statistically significant. No significant change in Troponin T values/ ECG, duration of ventilation and LOS ICU was observed. No adverse events was noticed in any of the four groups. HES (130/0.4) used at a dose of 20 ml/kg seems to produce coagulopathy causing increased blood loss perioperatively. Hemodilution produced by fluid therapy seems to produce Coagulopathy as observed by TEG parameters. Concomitant use of TA with HES appears to reverse these changes without causing any adverse effects in patients undergoing OPCAB surgery.