Cause-of-Death data in public health planning – an overview.

It is well known that more than half of the world’s deaths pass by undocumented as to cause1. Whilst the appropriate focus of health services may well be the care of the living, consistent and reliable cause-of-death data also constitute a crucial and major resource for health planning and prioritization, and their lack in many settings is a major concern towards filling these data gaps 2,3.

Severe post thermal burn cicatricial ectropion with corneal ulceration: an illustrative case.

Management of postburn cicatricial ectroption of the upper lid is always a challenge for the oculoplastic surgeon, as they are often associated with exposure keratitis and ulceration. Traditionally, split thickness grafts have been described for upper lid reconstruction and tarsorrhaphies have been discouraged. We present a case of corneal ulceration associated with postburn cicatricial ectropion presenting 10 years following the initial trauma. The patient underwent full thickness skin grafting and tarsorrhaphy to release the ectropion with resolution of corneal ulceration. We believe that full thickness skin grafts and tarsorrhaphy are effective in correcting upper lid cicatricial ectropion, without functional compromise.

Teaching, training and practice of forensic medicine in India - An overview.

Forensic medicine & Toxicology, an important and integral part of medical education, has been a silent spectator to its ups and downs in the recent past. Having had its glory at times, playing pivotal role at places in aiding criminal justice, it has unfortunately failed to sustain the impetus and its importance. Furthermore, Medical Council of India (MCI) - the national medical supreme body, has come down heavily on this specialty in general and on its curriculum in particular at the undergraduate level, pushing it down to the cross roads. The increasing legal awareness among the masses, frequent unsavory remarks on the doctors by the judiciary, bringing medical profession under the purview of the Consumer Protection Act in contrast to the decreasing of importance of the subject in the medical curriculum coupled with casual approach to the subject both by the teacher and the taught have all culminated into a situation where fate of the subject befits the words of Sir Winston Churchill, "This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

Violation of children's rights: Can forensic medicine help.

"Today's child is tomorrow's citizen" so goes a popular saying, stressing the need for proper care and protection of the children. India has ratified the UN convention on the Rights of Child, which came into force on 2nd September 1990 and our own National Policy for Children was adopted way back in 1974. However, if we look at the outcome of all the measures that have been taken "on paper" the record is dismal. Child abuse goes unabated in our country, right in front of the eyes of the Law. The present study was undertaken to assess whether our specialty - Forensic Medicine - can bring to focus the atrocities perpetuated on children. During the 5-year period of the study, 155 cases were examined medicolegally in the Emergency department of the Govt. Medical College Hospital, Sector 32, Chandigarh; of which 6% were referred for medicolegal autopsy. Physical abuse accounted for 70% cases and sexual for 30%; the police brought 61% of the children to the hospital. Boys were more at risk in cases of physical abuse, however of the cases of sexual abuse, 23% were boys. Maximum cases of abuse - both physical and sexual occurred at the home/ eighborhood of the victim. It was concluded that the society as a whole, including the Govt. NGOs, Parents, teachers, elders etc. has the responsibility for the proper upbringing of the child and until and unless all of us shoulder the responsibility with sincerity, the children will continue to be abused.

Management of toxicological emergencies at different health care levels: A comparative study.

The proliferation of numerous poisonous substances due to rapid development in science and technology, coupled with the vast growth in industrial and agricultural sectors has substantially increased the incidence of poisoning in recent times. Today, a number of chemical substances, which were originally developed to protect agricultural products from rodents and pests, are at the forefront of suicidal ingestions. The aim of this retrospective comparative study is to analyze the characteristics of toxicological emergencies reporting at three different levels of health care centers-primary, secondary and tertiary - in order to find out the problems faced at each level with reference to their management, and to highlight the need to redress such problems to reduce the ever-increasing deaths due to poisoning.

Trauma score: A valuable tool for documentation of autopsy reports of trauma victims.

Trauma related morbidity and mortality is an age old reality, however, with the passage of time, advances in medical science and technology, man has succeeded to control / minimize the extent of damage caused by trauma. Vehicular accidents continue to be the commonest presentation of trauma related mortality and morbidity, the other causes being mechanical violence, industrial accidents, etc. According to the World Health Organization, accident is an event, independent of human will power, caused by an external force that acts rapidly and results in bodily or mental damage. Objective of the present study was to analyze the suitability of Anatomic Injury Scoring system particularly Injury Severity Score (ISS) on autopsy among the cases of road traffic accidents with the aim of improving the autopsy data in trauma related deaths, thus assisting policy planning for better trauma care systems.

Ligature mark on neck: How informative.

Many a times, a ligature mark may be the only evidence available in cases of asphyxial deaths due either to hanging or strangulation. A through examination of the ligature mark and analysis of the information provided by it, is therefore, a must to arrive at the most probable cause of death and differentiate between hanging and the ligature strangulation. A retrospective study was conducted at the Department of Forensic Medicine and Toxicology, Government Medical College & Hospital, Chandigarh, between 1997 to 2004 to assess the information provided by a ligature mark in such cases. We found that deaths due to hanging constituted 3.4% of the total unnatural deaths subjected to medicolegal autopsy; young adults, of the age group 21 to 25 years accounted for the maximum cases, 27%; and the male: female ratio was 2:1. Chunni was the most common ligature material used. Majority of the victims preferred multiple knots (61%) and fixed knots (58%) and a single loop (93%). The mark was obliquely placed (98% cases) above the larynx (85% cases). In all the cases of ligature strangulation, the mark was transverse, below the level of thyroid cartilage. Imprint over the groove when present, corresponded with the ligature material used in all the cases. It was concluded that a thorough, scientific examination of the ligature mark, though not conclusive, but is the most important part of the postmortem examination of deaths due to hanging and ligature strangulation.

Unnatural deaths in northern India a profile.

A ten-year retrospective study was carried out on the cases of unnatural deaths subjected to medicolegal autopsies from 1994 to 2003. The main objectives of the study were: a) To ascertain the various aspects of unnatural deaths, b) To analyze the probable reasons for the same & c) To find remedial measures to bring down the incidence. The incidence of unnatural deaths was found to be persistently increasing. Maximum number of such deaths 1342 (47%) belonged to the age group of 21 - 30 years. Male: female ratio was 2.2: 1. Rural population was more prone to poisoning whereas the urban became victim of road-traffic accidents. Males preferred poisoning and hanging whereas females preferred self-immolation (burns) to end their awn lives. Suggestions relating to road safety, decreasing the stress of the modem mechanical life-style, educating the public in general and regarding the availability, use and storage of poisonous substances in particular have been put forward, while highlighting the social evil of dowry system prevailing in India.

Plasma cortisol response to 1-24 adrenocorticotropin in patients with treated/untreated sellar & suprasellar mass lesions.

BACKGROUND & OBJECTIVES: One microgram short synacthene test is widely recommended as a screening test for evaluation of hypothalamo-pituitary-adrenocortical axis in patients with secondary adrenal insufficiency. Information on adequacy of cortisol response to this dose at different periods of the day in patients with hypothalamic-pituitary disorders is not available. Hence, this study was designed to assess the adequacy of cortisol response to 1 microg 1-24 adrenocorticotropin (ACTH) at 0800 h and 1600 h in patients with sellar and suprasellar mass lesions. METHODS: Thirty five consecutive patients with sellar and suprasellar mass lesions with mean age of 43.0+/-14.4 yr and 36 healthy controls with mean age of 32.3+/-9.0 yr were studied after obtaining informed consent. Maintenance doses of glucocorticoids in these patients were discontinued appropriately. On day 1, prestimulated and stimulated plasma cortisol samples at 0800 h and at 30 and 60 min following i.v. bolus of 1 microg 1-24 ACTH were collected. While on day 3, plasma cortisol samples were similarly collected at 1600 h. Cortisol estimation was done by a sensitive and specific radioimmunoassay. Stimulated plasma cortisol of 500 nmol/l or higher was defined as a normal response. RESULTS: In healthy controls, the prestimulated and peak cortisol levels at 0800 h (377.5+/-93.3 and 729.1+/-183.2 nmol/l) were higher (P<0.001 and P<0.01) than those at 1600 h (230.1+/-75.7 and 665.8+/-138.6 nmol/l). All subjects had a cortisol response of 500 nmol/l or higher in response to 1 microg 1-24 ACTH both at 0800 and 1600 h. In the patients' group, the prestimulated plasma cortisol at 0800 h (250.3+/-169.7 nmol/l) was higher (P<0.001) than that at 1600 h (166.3+/-128.9 nmol/l), while the peak cortisol response was comparable (P>0.05) in the morning as well as in the evening (490.9+/-309.4 vs 464.8+/-318.4). In 27 patients (77%) the morning and evening stimulated cortisol response to 1 microg 1-24 ACTH was consistent (normal in 13 and subnormal in 14) but was discrepant in the remaining 8 (23%). In 7 of these 8 patients, cortisol response was normal at 0800 h but not at 1600 h, while in only one, normal response was seen at 1600 h but not at 0800 h. INTERPRETATION & CONCLUSION: The demonstration of normal peak cortisol response to 1 microg 1-24 ACTH at 0800 h but not at 1600 h in substantial number of patients with sellar and suprasellar mass lesions suggests preference to morning for performing this test.

A critical analysis of stab wound on the chest A case report.

Penetrating Injuries on the chest may be homicidal, suicidal or accidental in nature. There are certain features that are quite reliable pointers to the nature of these injuries. However differentiation is difficult particularly when the characteristics of stabbing are perplexed and information related to circumstances of the incident is misguiding. The present case projects the importance of careful examination of the stab wounds on the chest particularly when the information provided to the autopsy surgeon is ambiguous.

Multiple wounds by a single bullet: A case report.

A 19 year old boy with multiple entry and exit wounds was brought to the hospital where he succumbed to his injuries. According to the relatives he suffered a gun shot injury due to careless handling of firearm by his father. On autopsy it was found that a single bullet resulted in multiple wounds. The objective of this paper is to highlight the importance of careful examination of firearm wounds and to keep in mind the possibility of correlation between distantly present wounds.

A preliminary report on basal & stimulated plasma cortisol in patients with acquired immunodeficiency syndrome.

BACKGROUND & OBJECTIVES: Structural and/or functional alterations in adrenal glands have been reported in human immunodeficiency virus (HIV) infection. However, no information has been reported from India. Hence a study was undertaken to assess the basal and circadian variations in plasma cortisol, and cortisol response to bolus ACTH in patients with AIDS. METHODS: Basal and stimulated plasma cortisol levels at 0800 h and 1600 h and, at 30 and 60 min following an intravenous bolus of 250 micrograms ACTH (short synacthen test, SST) were estimated in 15 patients with AIDS (CD4 < or = 200/microliter) and 12 healthy controls. The nature of the opportunistic infections and/or associated disease in each patient was also studied. RESULTS: The patients had higher median basal plasma cortisol levels as compared to the controls at 0800 h (540 nmol/l vs 415 nmol/l, P < 0.005) and at 1600 h (420 nmol/l vs 285 nmol/l, P < 0.003). Five patients (33%) exhibited abnormal circadian cortisol rhythms. All subjects in the control group and all but one (6.6%) in the patients group had normal peak plasma cortisol response (> or = 550 nmol/l) to SST. The lone patient with subnormal cortisol response had no feature of adrenal insufficiency. On the contrary, 3 patients clinically suspected to have adrenal insufficiency, had normal plasma cortisol response. INTERPRETATION & CONCLUSIONS: These findings suggest that most patients with AIDS have elevated basal plasma cortisol levels with abnormal circadian rhythm in some and normal adrenocortical reserve irrespective of the symptoms/signs of adrenal insufficiency.

Falciparum malaria.

We analysed cases of hematologically proved cases of Plasmodium falciparum malaria encountered from July 1984 to Dec 1985 in a military hospital. The age range was 3 days to 10 years. Majority presented with classical symptom of fever (92.7%). Others presented with gastrointestinal (7.3%), hepatic (4.5%), central nervous system (7.3%) and respiratory (3.6%) symptoms. Anemia was found in 36.4%. Hepatosplenomegaly was present in majority of the cases. The rare findings were polyarthritis, rash, urticaria and cerebellar features. All cases responded to chloroquine or quinine. No resistance to drugs was found and there was no mortality.