The Adverse Effects of Wealth on Cardiovascular Health: A Scientific Statement of the International College of Cardiology.

Background and Aims: Increase in economic status may be associated with increased consumption of Western type of foods and sedentary behaviour. In the present review, we discuss that increase in wealth may be associated with adverse effects on health behaviour Study Design and Methods: Internet search and discussion with colleagues. Results: Review of studies indicate that with increase in wealth, there is increased consumption of high fat, ready prepared foods and decrease in physical activity in most of the countries resulting in obesity and metabolic syndrome, leading to cardiovascular diseases (CVDs) and other chronic conditions. Many experts during the United Nations High Level Meeting in Sept 2011, misinterpreted the WHO estimates and proposed that, of total deaths, 22·4 million arise in the poorest countries, and 13.7 million in high-income and upper-middle-income countries and therefore poverty may be the major cause of deaths due to non-communicable diseases (NCDs). A recent study shows that 57.0 % of deaths in adults (aged 25-64 years) were due to CVDs and other chronic diseases, 25.5% due to communicable diseases and 15.9% due to injury and accidents. The deaths due to NCDs were highly prevalent among higher social classes compared to lower social classes who had greater deaths due to communicable diseases. It is interesting to know from new data from United States, that there is ‘Wealth’ without cardiovascular health in America. The whole world is likely to have the same scenario in the near future. Conclusions: Increase in wealth may be associated with altered health behaviour; greater consumption of unhealthy foods, tobacco consumption, mental load and sedentary behaviour resulting in increased risk of deaths due to CVDs and other chronic diseases which may change with knowledge about health education. Wealth may cause extension in life by buying of expensive drug therapy, intervention and surgery which are known to add income and employment in the west.

Exhumation: A 10-year retrospective study.

Exhumation is done for number of reason and includes establishment of identity, to know cause and manner of death, belated suspicion of an unnatural death or for medical insurance problems. It is infrequently done in India and due to cultural practice of cremation by burning to ashes the data are lacking. Compared with conventional autopsy done immediately after death, exhumation poses many problems. The present study was aimed to collect data regarding exhumation, to collect morphological findings in comparison with maximum postmortem interval and to analyze them in an attempt to formulate “catalogue of expectation” to supplement the published literature. Total 24 forensic exhumations performed at three centers of this region from 1999 to 2008 were evaluated retrospectively. Total 24 cases were analyzed and amongst them 12 were men and 12 were women and their age ranged from 3 years to 75 years (mean age 26.95). In the present series, the cause of death at exhumation could be clearly determined in 16 cases (66.6%). Amongst others, the burial practice and postmortem interval are major determining factors for possible outcome at exhumation.

Study of deaths in industrial areas around Aurangabad city.

We retrospectively studied the death cases brought for medico-legal post-mortem examination at mortuary, Government Medical College, Aurangabad in last one year i.e. 2010. All the cases from these areas (Police station MIDC Waluj, MIDC Cidco, MIDC Chikhalthana, and MIDC Paithan, etc.) were included in the study and the results are analyzed. Deaths from industrial areas accounted for 6.85% of total autopsies. It is observed that the most common cause of death in industrial area is road traffic accident probably due to higher frequency of transportation. Males outnumbered the females and they suffered injuries most in their fourth decade of life. Maximum incidences occurred in the month of October, that too on Friday between times 12:00 pm to 6:00 pm. Maximum cases were accidental in manner and brought dead to Government Medical College, Aurangabad. The most common cause of death was vehicular accidents involving head. This is the first time such a study has been carried out locally. The proportion of accidental deaths in industrial areas relative to that of non industrial area may be attributed to the poor enforcement of safety measures in these areas.

Original research paper an autopsy study of socio-etiological aspects in dowry death cases.

Violence affects lives of millions of woman worldwide, in all societies, one of the most heinous and shocking forms among them is DOWRY DEATH, is one among the various reasons for suicidal (i.e. abetted suicide) and homicidal deaths of women in India, other being marital infidelity, sexual jealousy etc. This study done at Kempegowda Institute of Medical Sciences and Research Hospital, Bangalore South, was conducted during the period July 2006 to January 2008, aims and objectives were to know the magnitude, socio etiologic profile and methods used for committing suicide/homicide, and various other factors affecting the alarming rise in incidence of dowry death and also to lend valuable suggestion to concerned authorities to prevent this heinous social evil of our society. Most of the victims were aged between 18 to 25 years of age, maximum of the victims died within three years of married life, most commonly between 1 to 2 years of married life. Hanging is the most common method used for dowry deaths.

Original research paper study of unnatural deaths in females a medicolegal study at rural medical college, Loni.

The present study was undertaken in the Department of Forensic Medicine & Toxicology, Rural Medical College, Loni, Ahmednagar, Maharashtra. Aims and objectives to study the incidences of unnatural deaths in females with special reference to “DOWRY DEATHS” in which cases medico legal autopsies was conducted. Data of total 310 cases were collected for this study purpose from police panchnama, post mortem reports and through interrogation of the parents, relatives, friends, neighbors accompanying dead body. Majority of the female deaths were in the age group 26 to 30 years (24.56%) followed by age group 21 to 25 years (21.93%). In majority of the victims burns (50%) was the common cause of death followed by poisoning (17.1%) and vehicular accidents (16.45%). Majority of the married female victims (44.19%) died within seven years of marriage.

Evaluation of errors and its etiological relevance with variables associated with death certificate.

Tendency to commit serious & trivial errors while certifying death still looms large. So some one may say, there is only one certificate in the world which is full of errors and that is death certificate! This study is done to evaluate errors in medical & non-medical part and to assess causes of errors of COD. Total 353 death certificates from teaching hospital were evaluated to detect different errors. Causes of errors of COD were scrutinized & confirmed after examining COD statements extensively. 21% death certificates were incompletely written. 99% certificates were incorrectly written. P value of correct & complete certificates with that of incorrect & incomplete certificates was found insignificant. Commonest error was use of ‘with’ instead of ‘due to’ & mention of ‘MOD’ at I a. Causes of these errors (99%) were Lack of training & diagnostic difficulty. Several errors were found in non-medical part which highlight ‘routine attitude’ of certifier. To change this scenario team work is needed. Team of doctors need to certify & supervise death certificates closely. Possibility of legal action against often erring certifying doctor may be appraised publically.

A study on appraisal of effectiveness of the MCCD scheme.

Medical Certification of Cause of Death [MCCD] scheme was proposed by WHO as an imperative tool to obtain scientific and reliable information in terms of causes of mortality. It was accepted by the Government of India with suitable incorporations made in The Registration of Births and Deaths Act, 1969[1]. A cross sectional study was done with an objective to appraise the completeness and accuracy in filling up of these certificates as per the prescribed guidelines and subsequently assess the success of the MCCD training scheme. Information was collected on the various components of the cause of death certificate in all cases brought for autopsy over a period of two year and statistical analysis done. Results of the study reflected that there was a conflict of opinion and understanding as to the meaning of the terms „causes of death‟, „modes of death‟, and „manners of death‟ among the doctors. Extra effort needs to be put forth to educate and generate awareness regarding complete and accurate filling of the forms and to make them understand the very purpose of MCCD scheme, else it won’t serve the very purpose for which it was introduced. Also the lacunae in the scheme that exist need to be addressed.

Trends of poisoning in Faridkot region of Punjab- A retrospective study of one year.

Since immemorial times, poisonous substances have been reported to be adversely affecting human life, both in terms of morbidity and mortality. Evolution in fields like agriculture, industry etc has made wide and easy availability of various poisonous substances. The present study is a retrospective study of one year which is related to poisoning cases that were admitted in the emergency department of G.G. S. Medical College, Faridkot from 1st January 1996 to 31st December 1996. The analysis of the data revealed that out of 78 patients admitted in the hospital, 31 patients died. The maxi-mum incidence was seen in the age group of 21-30 years with males outnumbering the females. The commonest poison used was organophosphorus group of compounds.

causes of death among patients with tuberculosis in Khuzestan, Iran

To assess the cause of death in tuberculosis patients. It is a retrospective descriptive study conducted in Khuzestan province in the south west of Iran, from 2002 to March 2006. Medical records of tuberculosis patients over the 5-year period were reviewed and death data were analyzed. Inclusion criteria were documented TB, diagnosed based on National Tuberculosis Program [NTP], extracted data were analyzed in SPSS11.5 system and by descriptive statistics. One hundred and twenty five deaths [3.15%] with mean age of 48.96 +/- 10.03 years were detected. The frequency rate for cigarette smoking, diabetes, chronic renal failure, MDR-TB, imprisonment, HIV infection and injection drug usage were 31.2%,16%, 6.4%,6.4%,22.4%,13.6% and 22.4%, respectively. Eighty four deaths [67.2%] were directly attributed to tuberculosis, among them overwhelming TB disease, haemoptysia, and MDR-TB accounted as the cause of death in 77.4%, 13.1%, 9.5% and 6.4% respectively. Forty one [32.8%] deaths were due to other medical problems, which included AIDS, cardiovascular diseases, bacterial super infection and cancers i.e. 21.9%, 19.5%, 17.1% and 12.2% respectively. This study showed that overwhelming TB disease, haemoptysis, cardiovascular diseases, bacterial super infection and cancers are the main cause of death. Smoking, imprisonment, injection drug usage and diabetes are frequent risk factors for TB mortality

The fire is both “a blessing & scourge to the mankind”.

Man has always needed fire either to prepare his food to satisfy his hunger or to induce warmth during winters. Simultaneously he is constantly exposed to the hazards of burns, which begins right from the day one of his life, when the maternity nurse gives him the first hot water bath. That is why it is said, “The fire has been both a blessing and scourge to the mankind”. The present study was conducted in department of forensic medicine PDU Medical College, Rajkot during the period from Nov. 2004 to Oct. 2005 with a view to study the profile of burn cases brought for the post mortem examination. All the data related to age, sex, marital status, type and manner of burns with area involved, and survival time were recorded with detailed autopsy examination and subsequently analyzed statistically. We reached at a conclusion that majority of the victims were married females of younger age group between 20-40 years, with an extensive accidental flame burns.

Homicidal deaths by firearms in Peshawar: an autopsy study

Medico legal autopsies can be valuable sources of information about the distribution of causes of reported deaths, particularly in homicidal cases. The present study provides information regarding the homicidal deaths due to firearm injuries in the district of Peshawar, NWFP, Pakistan. This descriptive study was conducted over the period of the year 2004. Data were collected from the autopsy records of the Department of Forensic Medicine, Khyber Medical College Peshawar and included all reported unnatural deaths from urban and rural areas of district Peshawar on whom autopsies were conducted in the department. Homicidal deaths constituted 77.7% [492/633] of all autopsies for the year 2004. Of 492 homicidal deaths, a vast majority of 452 [91.87%] were caused by firearm injuries. Among these, the male to female ratio was 5.5:1. The most common firearm weapon [418/452, 92.5%] were high velocity rifled weapons [Kalashnikov, rifles, pistols], followed by low velocity rifled weapons [18/452, 3.98%] and shotguns [16/452, 3.54%]. A total of 956 injuries were found in various body areas, giving an average of over two injuries per person. The head, face and neck sustained the highest injuries [257, 26.9%], followed by the chest [248, 25.9%] and abdomen [149, 15.6%]; the extremities, buttocks and genitalia together sustained 302 [31.6%] injuries. The vast majority of reported homicides in Peshawar are caused by firearm injuries, which bring up issues related to possession of firearms and changes in cultural attitudes towards use of firearms, if a decrease in firearm-related homicides is desired

Trauma cases admitted to the surgical intensive care unit-progress and outcome

A review of the trauma admissions to the Surgical Intensive Care Unit [SICU] at King Khalid University Hospital, Riyadh during the period from 30 October 1984 to 29 October 1989 was made. A total of 181 cases constituting 15.7% of the total surgical admissions to the unit during that period were recognised. The main cause of the trauma was road traffic accidents [83.4%]. The male to female ratio in this group was 6.3:1. Thirty patients died in the SICU, 16 died within 24 hours of admission to the unit and the remaining 14 developed multiple organ failure prior to death. Positive cultures from different sites were obtained from 50% of them. Recommendations are made to improve the management of similar cases

Disease pattern and fatality among patients treated at DHQ hospital, Faisalabad

A pilot study was undertaken to assess the pattern of diseases, fatality and some other ratios among the patients treated at District Headquarters Hospital, Faisalabad during 1984. Out of 4,506 in-patients, maximum admissions 1,196 [26.54%] were of gastrointestinal diseases followed by 795 [17.64%] cases of injuries. Overall fatality was found to be 6.35%. The highest case fatality was found in the infectious diseases group, while maximum of the total deaths [20.98%] occurred due to injuries. Consistency in provisional and final diagnosis was found in 86.20% of total cases. The annual turnover was 41 patients per bed per year