Case Report: Accidental firearm injury during trophy hunting and the role of paramedics in managing such cases at rural health posts in Nepal.

Possession of a firearm without a certified valid license is against Nepalese law. Following a decade-long civil war, Nepal government issued stringent laws not allowing public to possess firearms without a valid reason, despite bearing a license. However, there are people who possess and use firearms for hunting purposes. The present case reports an accidental death of a teenage boy who used a musket for hunting. The present case highlights the fact that despite these stringent laws, illegal possession of arms for trophy hunting is still prevalent in rural Nepal. Furthermore, this study aims to highlight the importance of paramedics in early intervention, stabilization and transport of the sick and injured to the hospital in emergency situations. Also, recruitment of paramedics in the ambulance service might have prevented untimely death in this particular case.

Injury amongst Medicolegal Cases in Department of Forensic Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Victim of injuries presenting to a hospital is a medico-legal issue. So, with medical management, proper documentation of injuries should be done as a legal duty by all physicians attending such cases. The study aims to find the prevalence of injury amongst medicolegal cases in the Department of Forensic Medicine in a tertiary care centre. METHODS: A descriptive cross-sectional study was done amongst 328 medicolegal cases presenting at a tertiary center, from January 2019 to February 2021. Ethical approval was obtained from the Institutional Review Committee (Reference number: 2603202101). Convenience sampling was used to select study samples. After detailed history regarding the incidence, injuries were examined and documented in a performa. The data were entered in Statistical Package for Social Sciences version 18. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Among 328 cases presenting to hospital for medicolegal issues, 237 (72.25%) (67.40-77.09 at 95% Confidence Interval) had injuries, out of which 170 (71.73%) cases were due to physical assault, 64 (27%) cases due to accident; 2 (1.26%) were undetermined. Majority of victims of injury were adult males, with mean age of 32.41±13.96 years. In most accidental injuries internal organs were also injuries and life-threatening. CONCLUSIONS: The prevalence of injuries amongst medicolegal cases was found to be higher in our study in comparison to other studies done in similar settings. Most of the injuries were due to physical assault; however, the majority of road traffic injuries were life-threatening. These road traffic injuries could have been prevented by following a safe system approach to road safety.

Nepal - exploited by older married man - young unmarried mother accused of infanticide.

In Nepal, it is considered sinful for a woman to have sexual intercourse before marriage while the male is exonerated. The female will be branded a loose character outcast by family and society. Only a small percentage of women who feel the other way and stand mentally strong or who have family support come out to seek justice. Despite the stringent law, the loopholes in the justice mechanism re-victimise female victims. We report a case where a young unmarried pregnant woman who gave birth alone was charged with infanticide.

Searching for Kin Amidst Tragedy-Disaster Victim Identification Operations for US Bangla Flight 211.

The nature of air disasters includes factors that exacerbate challenges in the identification process. Of the 49 deceased in the US Bangla air crash in Kathmandu, Nepal, four were intact, 11 presented with burn injuries, another 11 presented with partial charring, and 23 were completely charred. Personal belongings were useful in the identification phases for all types of victims. Fingerprints were obtainable and useful in intact victims and victims with less severe burn injuries; medical and surgical information was useful in bodies with burn injuries; finally, dental findings were useful in cases of extensive charring. Other useful methods in the process included marks of identification, physical features, and exclusion. In certain resource-limited settings, especially in closed population disasters, where scientific identification (DNA, dental records, etc.) is not currently available, personal belongings, clothing, and physical findings analyzed by an identification team using a structured organization may be cautiously used as the primary means of identification.

Inter-caste lovers' suicide pact - Case report from Nepal.

Discrimination on cultural and ethnic grounds is a crime in Nepal. [Caste Based Discrimination and Untouchability (Offence and Punishment) Act, 2068 (2011) * * There are two different dates which reflect the Bikram Sambat which is the official Hindu calendar in Nepal. This calendar is 57 years ahead of Gregorian calendar. For example, 19 August 2017 AD is 03 Bhadra 2074 Bikram Sambat. Thus, the date 2068 is in Bikram Sambat, 2011 is per Gregorian calendar which is unofficial so kept in parenthesis. This text is available online from: http://www.ilo.org/aids/legislation/WCMS_190732/lang-en/index.htm . ]. However, cases of caste-based discrimination continue and have been reported in the newspapers. They occur because most families refuse to accept inter-caste marriages in Nepal as they fear they will become social outcasts. We present a tragic case where a young couple in their 20s made a pact to end their lives by jumping from Nepal's highest suspension bridge. Preliminary police investigation suggested their inter-caste relationship was the reason.

When Protocols Become Fairy Tales and Gods Remain Buried Under: Excerpts From the Diary of Forensic Experts at Ground Zero During the Mega Quake That Hit Nepal.

More than a year has passed since the mega quake hit Nepal. Although a lot is written about the lacunae in disaster preparedness, lessons learnt, and public health concerns after the aftermath, nothing much has been written about the fate of the deceased. Although saving takes priority after a disaster, the management of dead bodies also requires immediate attention because the process of identification becomes more difficult and expensive as time passes. This article shares the firsthand experiences of forensic experts at ground zero during the quake that may be useful to forensic experts responsible for handling such situations worldwide.

Ligature mark on the face - forensic implications.

In deaths due to hanging and strangulation, the position, course and direction of the ligature mark, the kind of knot used and injuries to the neck structures help in deducing the cause and manner of death. Two cases of suicidal hanging are reported where the unusual positioning of ligature and presence of the ligature mark on the face raise doubts concerning the circumstances of death. The presence of a ligature mark on the face is an unusual and rarely reported phenomenon that can have serious medico-legal implications.

Fat infiltration of left ventricle - a rare cause of sudden cardiac death.

Cor adiposum is a rare disorder of the heart, where the normal heart tissue is replaced by fibro-fatty infiltrates. We report one such case of a middle-aged female who was declared dead shortly after a syncopal episode. At autopsy, the pericardium was intact and firmly adhered to the heart. Histopathology revealed fatty infiltrates extending into the left ventricle of the heart. A post-mortem diagnosis of Cor adiposum was made which is an uncommonly reported cause of sudden cardiac death.

Bear-inflicted injuries - a report from Nepal.

Upper Mustang in the Northern Himalayan range of Nepal is the home of brown bears (Ursusarctos). Low-plant biomass as a result of scanty rainfall in Upper Mustang is a reason for habitat overlap of humans and wild animals. Humans who enter into the wild to collect firewood and graze cattle are liable to wild animal attacks. Such attacks, especially by brown bears, are readily identified by the type of injuries. These are more commonly confined to head and neck regions. Cutting, gnawing and tearing by sharp teeth and claws produces specific pattern of injuries, which are devastating but seldom fatal. This article reports a rare case of brown bear injury inflicted upon a man from the Upper Mustang region in Nepal.

Faith healers, myths and deaths.

Science and myth have been closely linked and argued upon by philosophers, educationalists, scientists, enthusiasts and the general public. Faith healing, when added as an adjuvant or alternative aid to medical science, will not necessarily be confined to mere arguments and debates but may also give rise to series of complications, medical emergencies and even result in death. We present an unusual case where reliance on faith healing led to the death of a young man.

Gastro-intestinal ascariasis--an unusual autopsy case report.

Ascaris lumbricoides or roundworms' propensity to produce large number of eggs that are resistant to extremes of environmental conditions have made them one of the highly prevalent and geographically well distributed nematodes among poor socio-economic regions throughout the world. We present an unusual case of fatal gastro-intestinal ascariasis where general neglect, and firm and prolonged reliance on traditional healing methods led to aggregation of roundworms to such an extent that otherwise seems improbable in modern times and, hence, is worth reporting.

A study of cranial variations based on craniometric indices in a South Indian population.

BACKGROUND: Human skull has been the most extensively studied bone for establishing the taxonomies at evolutionary levels. Crania are also the most commonly used skeletal elements in population studies because they are known to be more genetically driven and less affected by environmental factors. The craniofacial indices are considered as clinical anthropometric parameters used in the investigation of craniofacial skeletal deformities and brain development. The present research is an attempt to study the cranial indices in the South Indian population. METHODS: The sample for the study included 118 dry adult crania. All the osteometric measurements were taken using standard anthropometric instruments, and 3 indices, namely, cranial index, orbital index (OI), and index of foreman magnum (FMI), were calculated. Cranial index is calculated as (maximum cranial breadth / maximum cranial length) × 100, OI as (orbital height / orbital breadth) × 100, and FMI as (transverse diameter / anteroposterior diameter) × 100. The crania were further classified based on these indices. RESULTS: The cranial index ranged between 66.67 and 85.71 (mean, 78.57 [SD, 4.11]), the OI ranged between 68.89 and 102.63 (mean, 84.23 [SD, 6.64]), and the FMI ranged between 68.57 and 96.88 (mean, 79.71 [SD, 6.98]). Cranial index did not show any significant correlation with the OI (r = -0.162, P = 0.081) or the FMI (r = -0.045, P = 0.626). A statistically significant correlation was, however, observed between OI and FMI (r = -0.232, P = 0.012). CONCLUSIONS: The current study developed population-specific classification of crania using cranial indices. This craniometric baseline data pertaining to the craniofacial indices may be useful in presurgical planning and the postsurgical evaluation. It may also assist the forensic anthropologists in the categorization of human skulls, which may be an important component in identification of highly decomposed dead bodies and skeletal remains. More such studies need to be conducted to understand the effect of environment and genetics on the cranial shapes in different population groups.

Cardiac pathology in fatal electrocution.

Electrocution is mostly unintentional and occurs in domestic environment or in form of an occupational hazard. Electrical burns sustained in domestic environment or otherwise are associated with significant morbidity and mortality. The present report describes the pathological changes in the heart as observed in a case of fatal electrocution.

Grooves on the hepatic surface.

The photo case reports the incidental autopsy observations of the grooves/accessory sulci present on the surface of the liver, and highlights on its implications.

Colchicine poisoning: a case report and review of literature.

Colchicine, a natural pseudo-alkaloid found in plants such as the Colchicum autumnale and Gloriosa superba has tremendous medicinal properties, but if misused by an unqualified person can result in fatal consequences. We report a case of colchicine poisoning in an adult man as a result of consumption of the herb G. superba by a 50-year-old man and review the literature.