Deaths Due to Road Traffic Injuries- A Forensic Autopsy Study

Background: Injuries due to road traffic injuries (RTIs) depend upon various factors that include human, vehicle and environmental factors that plays a vital role before, during and after a fatal vehicular accident. Road traffic injuries involve high human suffering and monetary costs in terms of ultimately deaths, injuries and loss of potential income. Aims and Objective: The aims and objective of study was to study the incidence of death due to road traffic injuries, demographic profile including various contributary factors of victims and vehicles and to analyse the magnitude of deaths.Material & Methods:The present retrospective and cross sectional study was conducted in Forensic Medicine & Toxicology Department, Government Medical College, Amritsar. All the autopsies conducted on road traffic injuries victims during the period from Jan, 2016 to Dec, 2020 were studied. Results:Majority of cases taken up for study were males (80%) followed by females (20%), majority cases belonged to the age group of 21 -30 years (34.72%). The majority of cases (70.61 %)that met with road traffic injury happened at evening time period. Head injury was the cause of death in 42.45% cases followed by 33.88% cases having multiple injuries.Conclusions:Motorization though has enhanced the lives in this era but that has come up with some price. High priority is demanded towards the alarming rate of human loss due to RTIs. Awareness at every level including the strict formation of policies that would prevent such RTIs in future.

A Forensic Autopsy Study of Dead Foetuses and Newborns

Background: The term abandonment refers to babies or foetuses which are found abandoned at various unwanted places such as gutter, rubbish dumps, railway tracts and bushes. It does not refer to live born babies left in places, such as hospitals where care can be given by someone other than the mother. Aims and Objectives: To find out the distribution of death cases of newborns/feotuses and to trace its probable reason and its relationship with female foeticide.Methods:A retrospective study of all the medico-legal autopsies of foetuses and newborns was conducted in Forensic medicine and Toxicology department, Government Medical College, Amritsar (Punjab) from Jan 1, 2014 to Jul 31, 2021. During this period, 46 cases of fetal and newborn deaths had been studied.Results:The dead bodies of known foetuses/newborns is 43.5% cases while total unknown cases were 56.5% cases. 32.6% cases were non viable foetuses while 10.8% cases died as a result of prematurity. All the unknown cases (56.5%) were found from the abandoned places like street, bushes, canal side, water bodies that mainly includes pond and railway tract.Conclusion:Despite, the problem is present in every corner of the nation, there is dearth of research studies on this issue. Stringent measures and strict checks are required against antenatal sex determination. The motive behind the abandonment of foetuses can be any, but this grave issue needs urgent attention.

A prospective study of metformin versus myoinositol plus d-chiroinositol combination therapy in polycystic ovarian syndrome

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Insulin resistance and resultant hyperinsulinemia contribute to hyperandrogenism in these patients. Weight loss or pharmacologic interventions that lower insulin levels reduce androgen levels. This study was planned to evaluate efficacy of metformin versus myoinositol plus d-chiroinositol combination therapy in PCOS patients and its effects on clinical, hormonal and radio diagnostic dimensions.Methods: This was a prospective study for nine months. 50 newly diagnosed PCOS patients from the Department of Obstetrics and Gynaecology, Government Medical College (GMC), Amritsar, were randomly divided into 2 groups. One group was given metformin 500 mg twice daily and another myoinositol plus d-chiroinositol 1000 mg twice daily for 9 months. Follow up was done at 3, 6, 9 months. At each visit, ultrasonography and hormone levels were evaluated. Informed consent was taken. The approval of the Institutional Ethics Committee, GMC, Amritsar was also obtained.Results: The percentage change in free testosterone levels (22.46±6.47) and insulin levels (34.24±15.02) show statistically significant decrease in group 2 (p<0.001). There was statistically significant (p<0.05) fall in AMH levels (22.41±7.78) in group 1. There was no statistically significant difference between the 2 groups in ovarian volume on ultrasonography, random blood glucose levels, luteinizing hormone (LH), follicle-stimulating hormone (FSH) levels, estrogen and progesterone levels.Conclusions: It was observed that both treatments are equally effective in the treatment of polycystic ovarian syndrome with better tolerability in myoinositol and d-chiroinositol group.

An assessment of factors responsible for diarrhoea deaths of under five children in rural and urban settings of India

Background: Very little scientifically based information is available on cause-specific mortality rates of diarrhoea among all regions and populations wherein an inequitable proportion exits in low-income households, which have fewer resources and less knowledge to manage burden than high-income households. The strategic purpose of the study is to identify gaps in care seeking in order to make changes in approach to address these gaps either directly by working with the community and by doing area specific advocacy to improve service delivery through government channels.Methods: The study was conducted in nine locations (6 rural and 3 urban) of India. The ethical and confidentiality parameters of conducting verbal autopsies were followed and random sampling methodology was adapted.Results: Respondents of our study attributed 22% deaths to diarrhoea. From the study, it is revealed that children who passed stool for 5 or more number of times in a day are more likely to die 1.5 times than the children who passed stool for 3 times a day. Children having diarrhoea for 5 days or more than 5 days are more likely to die 1.6 times in comparison to the children who have had diarrhoea for 3 days. Approximately seven of the ten children died within five days of treatment.Conclusions: Information on diarrheal diseases, its determinants in India and preventive and control strategies in light of recent developments need to be reviewed for better planning and organization of health services within the community.

A comparative study to assess the safety and efficacy of etoricoxib versus aceclofenac in osteoarthritis

Background: Osteoarthritis (OA) is most common form of arthritis; also referred as degenerative joint disease or “wear and tear” arthritis. Cyclooxygenase-2 (COX-2) inhibitors are effective for pain and inflammation in OA and gained importance over conventional non-steroidal anti-inflammatory agents (NSAIDs), as causes significantly less toxicity, particularly, in gastrointestinal tract. The objective of the present research was to study the short-term comparative clinical efficacy of aceclofenac and etoricoxib in patients with osteoarthritis and to compare the safety profile of the two drugs i.e. aceclofenac and etoricoxib.Methods: The present study was a prospective, open label, parallel, intention to treat 80 patients out of 102 screened for osteoarthritis in the Department of Orthopaedics, Guru Nanak Dev Hospital attached to the Government Medical College, Amritsar. Patients were randomly divided in two groups with 40 patients each. Group A patients received Tab etoricoxib 60mg once daily and Group B patients received Tab. Aceclofenac 100mg twice daily. Patients were followed up after three weeks and at six weeks for clinical efficacy and safety.Results: Both the groups found to have significant improvement in signs and symptoms of osteoarthritis. However, aceclofenac was superior to etoricoxib in terms of change in visual analogue scale score, osteoarthritic severity index, patients’ and physicians’ global assessment while, etoricoxib was superior in terms of WOMAC osteoarthritic index and safety parameters in terms of ADR.Conclusions: Etoricoxib was better than conventional NSAIDs for the symptomatic management of osteoarthritis in terms of safety profile and clinical efficacy.

A randomized placebo controlled trial of metformin alone and metformin plus fixed dose combination of cyproterone acetate and ethinyl estradiol in hirsute women with polycystic ovarian syndrome

Background: Polycystic ovarian syndrome is a common endocrine disorder seen in reproductive age group. Hirsutism, oligomennorhea and infertility being the most common chief complaint. Oral contraceptives have shown their efficacy in hirsute females. Metformin, an insulin sensitizer, have also shown some beneficial effects in improving metabolic abnormalities. Aim of this study is to compare the efficacy of metformin alone and metformin with fixed dose combination of cyproterone acetate and ethinyl estradiol in hirsute women with PCOS.Methods: 60 females of PCOS with chief complaint of hirsutism were enrolled. Patients were randomized to either metformin and Diane -35 (35 microgram ethinyl estradiol plus 2mg cyproterone acetate) or metformin and placebo for 9 months. Ferriman Gallwey score and body mass index was calculated at baseline, 3months, 6months and 9 months. FSH/LH/Prolactin/Testosterone/Fasting glucose and Fasting insulin levels were measured at the baseline and at the end of treatment.Results: Majority of females enrolled in the study were in third decade of life. Metformin and Diane- 35 showed higher reduction in Ferriman Gallwey score but Body mass index was reduced in both the groups. There was no significant difference seen between the groups with respect to biochemical profile.Conclusions: This data show that a combination of metformin and contraceptive pill may be more effective in treating hirsutism than metformin alone. Beneficial effects of therapy were seen in relation to BMI as well. Hence, combination therapy is better therapeutic option for treating hirsutism in PCOS.

Role of Dynamic Contrast Enhanced MRI in Evaluation of Focal Hepatic Lesions

Background: CMost of the focal hepatic lesions in day to day practice can be diagnosed by cross sectional contrast enhanced studies. The present study evaluates the role of dynamic contrast enhanced MRI for detection & characterization of these lesions commonly found in our area. Methods: It’s a perspective study of 50 patients with all age groups who were suspected clinically to have focal hepatic lesions or diagnosed so by ultrasonography or computed tomography. The patients underwent MRI including dynamic contrast enhanced sequences, which included i.v. administration of the contrast material (Gadopentate dimeglumine). The results of the MRI were confirmed by various confirmatory methods depending upon the lesion in question. Results & Conclusions: Overall sensitivity of MRI in detection of focal hepatic lesions was 100% while its specificity was 98%. Comprehensive MR imaging examination yields characteristic enhancement patterns that can be used to diagnose or at least narrow the differential diagnosis for most of these lesions

Review of virus diseases in the nervous system.

Viruses are important to the study of molecular and cellular biology as they provide simple systems that can be used to manipulate and investigate the functions of cells. The study and use of viruses have provided valuable information about aspects of cell For example, viruses have been useful in the study of genetics and helped our understanding of the basic mechanisms of molecular genetics, such as DNA replication, transcription, RNA processing, translation, protein transport, and immunology. This Review focused on the neurological complications of the human herpes viruses (HHVs), and discusses optimal virological tests to identify the etiological agent, along with state-of -the art treatment for these disorders.

Dimethyl fumarate: a novel drug for multiple sclerosis.

Dimethyl fumarate (DMF) is a novel oral immunomodulatory and neuroprotective drug that was approved by FDA for relapsing forms of multiple sclerosis (MS). The initial use of DMF was for the treatment of psoriasis where its long-term use was safe and efficacious, and it also got German approval for the same. It was found that the anti-inflammatory actions of DMF contributed to its efficacy in psoriasis. This anti-inflammatory action of DMF created interest using DMF in other auto-immune or inflammatory diseases, including MS. DMF acts by decreasing production and release of inflammatory molecules. DMF also activates the nuclear factor-erythroid 2 related factor pathway which induces the transcription of various genes, including anti-oxidative ones, reduces oxidative neuronal death and helps maintain myelin integrity. Thus, DMF acts via two pathways: by down-regulating oxidative stress and corresponding cellular injury, as well as by inhibiting pro-inflammatory cytokines. DMF is an orally administered, enteric-coated microtablet preparation. There was a 44-53% reduction in annualized relapse rate with the use of DMF in patients with relapsing form of MS. The most common adverse reactions reported are flushing, abdominal pain, diarrhea, and nausea, which are more prominent during initial treatment and usually decrease over time. No serious adverse events were seen during the phase II and III trials, including no increased risk of opportunistic infections or cancer. DMF seems to approach the ideal combination of safety, efficacy and welltolerability to other approved oral therapies for MS.

Effect of Aegle marmelos (L.) Correa on alloxan induced early stage diabetic nephropathy in rats.

Diabetic nephropathy (DN) has a complex pathogenesis and poor prognosis due to the lack of therapeutic interventions. The present study investigates the effect of A. marmelos leaf extract (AME) on early alloxan induced DN. The treatment with AME was found to significantly decrease the fasting blood sugar, total cholesterol, blood urea, creatinine and renal TBARS and increased the levels of renal reduced glutathione and catalase significantly as compared to the diabetic control group. The maximum dose-dependent protection was observed at a dose of 200 mg kg-1. Histological examination revealed marked reversal of the morphological derangements with AME treatment as indicated by a decrease in glomerular expansion, tubular dilatation and inflammatory cells. The present results conclude that AME treatment has a significant ameliorative effect on early changes induced in the kidneys by alloxan and improves the outcome of DN.

Purification of Colocasia esculenta lectin and determination of its anti-insect potential towards Bactrocera cucurbitae.

The present study reports the purification of a lectin from Colocasia esculenta (L.) Schott corms and evaluation of its anti-insect potential towards Bactrocera cucurbitae (Coquilett). The lectin was found to be specific towards N-acetyl-D-lactosamine (LacNac), a disaccharide and asialofetuin, a desialylated serum glycoprotein in hemagglutination inhibition assay. Asialofetuin was used as a ligand to purify Colocasia esculenta agglutinin (CEA) by affinity chromatography. The purity of CEA was ascertained by the presence of a single band in reducing SDS-PAGE at pH 8.3. The affinity purified CEA was employed in artificial diet bioassay of second instar larvae (64-72 hr old) of the B. cucurbitae at concentrations ranging between 10-160 µg ml-1. The lectin significantly (p<0.01) decreased the percent pupation and emergence with respect to control. Effect on various enzymes was studied by employing LC50 (51.6 µg ml-1) CEA in the artificial diet bioassay of second instar larvae. All the enzymes tested namely esterases, phosphatases (acid and alkaline), superoxide dismutases, catalase and glutathione-S-transferase showed a significant (p<0.01, p<0.05) increase in their enzyme and specific activities. These results showed that CEA affected normal growth and development and presented stress to the larvae, activating their detoxification and anti-oxidant systems. Thus, the lectin seems to be a useful candidate for the control measures of B. cucurbitae under the integrated pest management (IPM) system.

Neuroprotective Effect of Convolvulus pluricaulis Methanol Extract on Hydrogen Peroxide Induced Oxidative Stress in Human IMR32 Neuroblastoma Cell Line.

Aims: The present study aimed to evaluate and ascertain the protective role of methanolic/ethanolic/water extracts of Convolvulus pluricaulis against H2O2 induced cytotoxicity in IMR32 Neuroblastoma cell line as model system and identify the factor responsible for the protective effect. Study Design: Experimental study. Place and Duration of Study: Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar & Department of Biotechnology, DAV College, Amritsar, PuCPab, between August 2010 and March 2012. Methodology: Firstly, cytotoxic dose of H2O2 and non-toxic dose of methanolic, ethanolic and water extracts of C. pluricaulis (CP-MEx, CP-EEx and CP-WEx respectively) was determined by MTT assay. Protective effect of CP-MEx, CP-EEx and CP-WEx was determined using quercetin as a positive control. The expression of IMR32 cytoskeletal marker, Neurofilament (NF-200) and stress markers, Heat shock protein (HSP70) and (glucose regulated protein 75, Grp75) Mortalin studied by immunofluorescence and RTPCR results. The level of antioxidant enzymes catalase, superoxide dismutase, glutathione peroxidase, direct scavenger of free radicals, Glutathione and lipid peroxidation were analysed by their standard procedures. Results: The results showed that quercetin, CP-MEx, CP-EEx and CP-WEx displayed cytoprotective activity in IMR32 cells. Out of tested extracts CP-MEx significantly decreased hydrogen peroxide-induced cell death. Significant decrease in NF-200, HSP70 and Mortalin expression was observed in CP-MEx+H2O2 treated cultures as compared to H2O2 treated. Catalase, superoxide dismutase, glutathione peroxidase, Glutathione levels significantly increased in Quercetin and CP-MEx treated cultures. Lipid peroxidation was significantly decreased in both Quercetin and CP-MEx treated cultures. Conclusions: The present work establishes the protective effect of CP-MEx on IMR 32 Human Neuroblastoma cell line which is as much as by quercetin. The cytoprotective effect of CP-MEx was due to induction of antioxidant machinery of the cell hence holds therapeutic value in the treatment and/or prevention of neurodegenerative disorders of oxidative stress.

Anti-insect potential of lectins from Arisaema species towards Bactrocera cucurbitae.

Bactrocera cucurbitae (Coquillett), also known as melon fruit fly, is one of the major insect pests of cucurbits in several parts of Asia, Africa and Pacific. In the present investigation, effect of lectins from two sources i.e. Arisaema intermedium Blume and Arisaema wallichianum Hook f. (Family-Araceae) has been studied on the development of second instar larvae of melon fruit fly. The lectins were incorporated separately in artificial diet at a concentration of 10 to 160 µg ml-1 and fed adlibitum to the second instar larvae. Both the lectins were found to prolong the development period and significantly inhibited the pupation and emergence in a dose dependent manner. Total development period was found to be prolonged by 3.5 and 2.3 days in case of larvae fed on artificial diet containing A. intermedium (AIL) and A. wallichianum (AWL), respectively. LC50 values calculated on the basis of adult emergence came out to be 32.8 and 29 µg ml-1 for AIL and AWL, respectively. Both the lectins tested, were found to increase the activity of esterases as larvae proceeded from 24 to 72 hr of treatment. The activity of acid phosphatase decreased significantly in larvae reared on diet containing LC50 of AIL, while in case of AWL significant decrease was observed only at 72 hr of treatment. Alkaline phosphatase activity decreased significantly on treatment with both of these lectins. These results showed that AIL and AWL have promising anti-insect potential. So, lectin gene/s from either of these species can be cloned and subsequently can be employed to develop transgenics to control melon fruit flies specifically and insect pests in general. This approach could be used as a part of Integrated pest management (IPM) strategies.

Effects of Indian coral tree, Erythrina indica lectin on eggs and larval development of melon fruit fly, Bactrocera cucurbitae.

Present study was undertaken to investigate the influence of D-galactose binding lectin from Erythrina indica Lam. on the eggs and second instar larvae (64-72 hr) of melon fruit fly, Bactrocera cucurbitae (Coquillett). The lectin from E. indica seeds was extracted and purified by affinity chromatography using asilofetuin linked porous amino activated silica beads. The effects of various concentrations (0, 125, 250, 500 and 1000 .g ml-1) of lectin were studied on freshly laid eggs (0-8 hr) of B. cucurbitae which showed non-significant reduction in percent hatching of eggs. However, the treatment of second instar larvae (64-72 hr) with various test concentrations (0, 25, 50, 100 and 200 .g ml-1) of lectin significantly reduced the percent pupation and percent emergence of B. cucurbitae depicting a negative correlation with the lectin concentration. The LC50 (81.g ml-1) treatment significantly decreased the pupal weight. Moreover, the treatment of larvae had also induced a significant increase in the remaining development duration. The activity of three hydrolase enzymes (esterases, acid and alkaline phosphatases), one oxidoreductase (catalase) and one group transfer enzyme (glutathione S-transferases) was assayed in second instar larvae under the influence of LC50 concentration of lectin for three exposure intervals (24, 48 and 72 hr). It significantly suppressed the activity of all the enzymes after all the three exposure intervals except for esterases which increased significantly.

Effects of plant lectin from cobra lily, Arisaema curvatum Kunth on development of melon fruit fly, Bactrocera cucurbitae (Coq.).

The lectin from tubers of cobra lily, Arisaema curvatum Kunth was purified by affinity chromatography using asialofetuin-linked amino activated porous silica beads. The concentration dependent effect of lectin was studied on second instar larvae (64-72 hr) of Bactrocera cucurbitae (Coq.). The treatment not only resulted in a significant reduction in the percentage pupation and emergence of the adults from treated larvae but it also prolonged the remaining larval development period. A very low LC50 value, 39 mgl(-1) of lectin was obtained on the basis of adult emergence using probit analysis. The activity of three hydrolase enzymes (esterases, acid and alkaline phosphatases), one oxidoreductase (catalase) and one group transfer enzyme (GSTs: Glutathione S-transferases) was assayed in second instar larvae under the influence of the LC50 of lectin at increasing exposure intervals (0, 24, 48 and 72 hr). The Arisaema curvatum lectin significantly decreased the activity of all the enzymes except for esterases, where the activity increased as compared to control at all exposure intervals. The decrease in pupation and emergence as well as significant suppression in the activities of two hydrolases, one oxidoreductase and one GST enzyme in treated larvae of B. cucurbitae indicated that this lectin has anti-metabolic effect on the melon fruit fly larvae.

Macular ischaemia as a marker for nephropathy in diabetic retinopathy.

PURPOSE: To determine whether diabetic macular ischaemia is associated with ischaemic heart disease (IHD), hyperlipidaemia, hypertension (HTN) and nephropathy. METHODS: Prospective case-control study from January to December 2001, involving 102 type 2 diabetic patients (aged 40-80 years), 59 with unilateral / bilateral macular ischaemia and 43 concurrent controls. Diabetic retinopathy was graded and macular ischaemia assessed by fundus examination, central fundus photography and fluorescein angiography. Systemic examination and laboratory investigations were done to evaluate systemic diseases. The associations were analysed by Chi-square test and Student's t-test. The significance of the variables as independent risk factors was tested by logistic regression analysis. RESULTS: Macular ischaemia was not associated with IHD (P=1.00); HTN (P=1.00) and hyperlipidaemia (P=0.30). Nephropathy was significantly associated with macular ischaemia (P=0.025; odds ratio [OR]: 2.62; 95% confidence interval [CI]: 1.16-5.9). The association remained significant after controlling for age, gender, duration of diabetes, severity of retinopathy, HTN, IHD and hyperlipidaemia. Further, the association with nephropathy was not affected by the presence of macular isachaemia in one or both the eyes (P=0.39). CONCLUSION: Macular ischaemia may serve as a marker for nephropathy in type 2 diabetes mellitus irrespective of the severity of retinopathy.

Familial exudative vitreoretinopathy (FEVR). Clinical profile and management.

PURPOSE: To report our experience with the diagnosis and management of Familial Exudative Vitreoretinopathy (FEVR) in a predominantly older Indian population.. METHODS: This prospective interventional non-comparative case series included 38 patients of FEVR and their 23 family members. The diagnosis was established by clinical examination, fluorescein angiography and family screening. Prophylactic photocoagulation/cryotherapy or surgical treatment was done depending on the severity of the disease. RESULTS: The mean age of the patients was 23.6 years. The fundus/fluorescein angiographic findings in 116 eyes of our 61 patients (6 eyes phthisical) were as follows: forty eight (41.4%) eyes had only peripheral avascular zone, 8 (6.9%) eyes had peripheral new vessels, and 35 (30.1%) eyes had retinal detachments (RD)--10 (8.6%) exudative, 5 (4.3%) tractional and 20 (17.2%) rhegmatogenous. Prophylactic photocoagulation or cryotherapy was done in 34 eyes for retinal holes, local exudative detachments and bleeding new vessels. All the eyes retained stable vision over a mean follow-up of 16 months. Only 14 RDs were suitable for surgery: scleral buckling, vitrectomy or both. The reattachment rate was 85.7% (12 of 14) and the best-corrected visual acuity (BCVA) improved to 5/60 or better in 50% of these eyes over a 2-year follow-up. CONCLUSIONS: FEVR appears to be more common than reported. Timely diagnosis and intervention is essential in view of the lifelong progression of the disease, late exacerbations, frequent involvement of family members, and poor surgical results. A high index of suspicion, family screening and early prophylaxis are recommended to prevent avoidable blindness from this underdiagnosed disease.