Patterns of acute poisoning- Five year study from National Poison Control Centre, Karachi, Pakistan.

OBJECTIVE: To identify patterns in cases of acute toxicity reported at an urban poison control centre. METHODS: The cross-sectional, retrospective study was conducted at the National Poison Control Centre, Karachi, and comprised data from January 1, 2017, to December 31, 2021. Data was collected from the institutional database which is part of the Jinnah Postgraduate Medical Centre, Karachi. Data of all patients diagnosed with acute poisoning was included. Data was analysed using SPSS 22. Results: Of the 4,936 cases reported, 2,449(49.6%) were males and 2,487(50.3%) were females. Pesticide was the most common cause of toxicity 1254(25.4%). Regarding outcomes, 351(7.1%) patients expired, 3,585(72.6%) were discharged after appropriate treatment, 366(7.4%) were given outpatient and psychiatric referrals, and 634(12.8%) patients left against medical advice. CONCLUSIONS: The most common agent causing toxicity was pesticides, and overall mortality across the study period was 7.1%.

Knowledge and societal perceptions regarding autopsy amongst different educational backgrounds in Karachi, Pakistan.

OBJECTIVE: To find out awareness levels about legislation/authorisation and objectives of autopsy among common people, and to assess correlation between opinions and academic levels. METHODS: The cross-sectional questionnaire-based study was conducted from March 2019 to September 2019 after approval from Ziauddin University, Karachi, and comprised adult subjects from the community having various academic backgrounds. Data was collected on their knowledge, perceptions and concerns regarding autopsy. Data was analysed using SPSS 20. RESULTS: Of the 260 individuals approached, 106(40.8%) were males and 143(55%) were females, while 11(4.2%) did not specify their gender. Overall, 123(47.3%) were aged 18-25 years. After 7(2.7%) dropouts, the total number of respondents was 253(97.3%). Of them There were 208(82%) subjects who marked "Yes" to knowing the meaning of autopsy, and 115(55.3%) of them had high academic level, while 93(44.7%) had low educational level. Also, 93(44.7%) participants correctly knew the purpose behind an autopsy. Regardless of the academic level, 135(21.7%) subjects marked "Organ removal" as their concerns regarding an autopsy, while 114(18.3%) marked "Disfigurement of body". CONCLUSIONS: Although majority of the subjects had a positive perception of autopsy, in-depth questioning revealed a clear lack of correct knowledge on the matter.

Forensic features and genetic legacy of the Baloch population of Pakistan and the Hazara population across Durand line revealed by Y-chromosomal STRs.

The Hazara population across Durand line has experienced extensive interaction with Central Asian and East Asian populations. Hazara individuals have typical Mongolian facial appearances and they called themselves descendants of Genghis Khan's army. The people who speak the Balochi language are called Baloch. Previously, a worldwide analysis of Y-chromosomal haplotype diversity for rapidly mutating (RM) Y-STRs and with PowerPlex Y23 System (Promega Corporation Madison, USA) kit was created with collaborative efforts, but Baloch and Hazara population from Pakistan and Hazara population from Afghanistan were missing. In the current study, Yfiler Plus PCR Amplification Kit loci were examined in 260 unrelated Hazara individuals from Afghanistan, 153 Hazara individuals, and 111 Balochi individuals from Baluchistan Pakistan. For the Hazara population from Afghanistan and Pakistan overall, 380 different haplotypes were observed on these 27 Y-STR loci, gene diversities ranged from 0.51288 (DYS389I) to 0.9257 (DYF387S1), and haplotype diversity was 0.9992. For the Baloch population, every individual was unique at 27 Y-STR loci; gene diversity ranged from 0.5718 (DYS460) to 0.9371(DYF387S1). Twelve haplotypes were shared between 178 individuals, while only two haplotypes among these twelve were shared between 87 individuals in Hazara populations. Rst and Fst pairwise genetic distance analyses, multidimensional scaling plot, neighbor-joining tree, linear discriminatory analysis, and median-joining network were performed, which shed light on the history of Hazara and Baloch populations. The results of our study showed that the Yfiler Plus PCR Amplification Kit marker set provided substantially stronger discriminatory power in the Baloch population of Pakistan and the Hazara population across the Durand line.

Aspartic Acid Racemization with Correlation to Age: AForensic Perspective.

OBJECTIVE: To estimate age through aspartic acid racemization of human dentin for forensic analysis, and to calculate the margin of error between chronological age and estimated age by racemization method. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Dental Outpatients' Department, Ziauddin Hospital, Karachi, from 2011 to 2014. METHODOLOGY: Patients from dental orthodontics department were selected. Verbal expressed consent was taken from the participants. Preliminary data was entered in a specially designed performa having name, chronological age, gender, socio-economic status. Land D ratio of aspartic acid were quantified in dentin for each tooth by High-Pressure Liquid Chromatography technique. Results of 100 samples with known age were used during study to estimate co-efficient of racemization. Regression equation was derived by plotting 85 samples of known age and KR as independent and dependent variables and least square equation was derived - Age = -4.391 +347.396 (co-efficient of racemization). RESULTS: The estimated co-efficient of determination was 0.74, meaning thereby that the regression equation was 74% correct for estimating age. The calculated correlation between chronological age and co-efficient of racemization was 0.834, which is interpreted as a very strong and positive correlation. The co-efficient of racemization increased with the age. The mean chronological age (38.44 ±13.22) years were statistically similar to the mean calibrated age (37.52 ±12.36) years. The median of actual and calibrated age was found to be 3.4 with inter-quantile value of 13. No statistically significant difference was observed among gender (p=0.837), or socioeconomic status (p=0.35). CONCLUSION: Racemization of human dentin could be used as one of the reliable method for estimating age. HPLC is a reliable technique to estimate the co-efficient of racemization because it is highly reproducible, cost-effective and convenient. However, the procedure should be optimized and standardized within all laboratories for quality assurance.

Radiological Mean Age of Fusion of Medial End of the Clavicle: AParameter of Age.

OBJECTIVE: To determine the mean age of fusion of medial end of clavicle by radiography. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Departments of Forensic Medicine, Dow Medical College and Ziauddin University, Karachi, from June 2010 to May 2011. METHODOLOGY: The subjects for this study were selected from various government colleges of Karachi. The subjects were analyzed for age and further confirmation was done by interviews where birth records and other physical parameters of age were also assessed. X-rays chest PA view was taken focusing on the medial end of clavicle; and were examined by a consultant radiologist and complete fusion of the medial end was noted. P-value less than 0.05 was considered significant. RESULTS: The mean age of fusion of medial end of the clavicle was found to be 21 ±1.43 years. Significant difference was observed in male to female age of fusion 21.14 ±1.41 years versus 20.65 ±1.94 years (p > 0.05). Similarly, statistically significant differences were observed between lower to middle income class and higher income class of all society. No difference was observed among various ethnic groups. CONCLUSION: Socio-economic factors, such as diet and nutrition, directly affect bone growth and hence bones' age. The results of fusion of the medial end of the clavicle are not affected by ethnicity; however, it is significantly affected by gender. More studies should be conducted in various parts of the country to make a natural standard in setting up uniform criteria for assessing age at or above 21 years.

An autopsy-based study of death due to road traffic accidents in metropolis of Karachi.

OBJECTIVE: To study the demographic distribution of the victims of road traffic accidents that were presented for medico-legal autopsy in Karachi, identify fatal injuries, the identity of road users autopsied and the month-wise variation in performing autopsies. METHODS: Descriptive cross-sectional study of autopsies conducted at the mortuaries of Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Abbasi Shaheed Hospital between March 1,2008 and February 28, 2009. Bodies brought in by police for partial/external autopsy were excluded. Data was collected on pre-designed proformas and was statistically analysed using SPSS 15. RESULTS: Of the total 2090 autopsies performed in Karachi, 581 (27.8%) cases were victims of RTA. Of these RTA victims, 324 (55.8%) autopsies were of those between the ages of 19 and 40 years. There were 510 (87.8%) males and 71 (12.2%) females with a ratio of male: female being 7:1.This ratio was 4.2:1 for those aged 0-18 years and 11:1 for those aged 19-40 years (p = 0.05). Death was due to injury to the head in 386 (66.4%) victims, to the chest in 84 (14.5%) cases, multiple traumatic injuries in 50 (8.6%) and pelvis in 17 (2.9%) cases. The majority of the victims on whom autopsy was performed were pedestrians (n = 389, 67%) followed by motorcyclists (n = 122, 21%). On an average 48.4 +/- 7.46 autopsies were performed every month, and there was no statistically significant variation in autopsies on this count. CONCLUSION: There was a male preponderance, but the significant differences in two age groups need to be correlated with the incidence of RTAs in each sex in that age group and the compliance levels of getting females autopsied.

Death in the home: domestic violence against women in Khyber Pakhtunkhwa.

BACKGROUND: Domestic or Interpersonal Violence (IPV) remains a major global problem often resulting in morbidity and mortality. The present study was conducted to determine the scope of deaths related to domestic violence in the Khyber Pakhunkhwa province, Pakistan. METHODS: Data were collected on all reported female fatalities due to domestic violence for the years 2009-2011 from the records of the department of Forensic Medicine, Khyber Medical College Peshawar for analysis. RESULTS: A total of 305 deaths were reported, showing an increasing trend of 115 deaths for 2009-10 and 190 deaths for 2010-2014. The majority, 182 (59.7%) belonged to the rural areas and 123 (40.3%) to urban areas of the province. Victims were generally of the younger age groups (17% below age 16 and 42.3% between 17-32 years). Homicide was the manner of death in 293 (96.1%) while the most common causative agent was firearm injury (235, 77.1%). Head and neck injuries were most common (52.6%) followed by the chest and abdomen (31.6%) while multiple sites and extremities accounted for 15.8% of injuries. CONCLUSION: Young and adult females of KPK province of Pakistan are susceptible to homicidal deaths due to domestic violence, perpetrated through firearm injuries to the head and neck regions.

Physical trauma--a leading cause of medico legal cases at DHQ Hospital Abbottabad.

BACKGROUND: Trauma is one of leading cause of suffering to mankind. No study has yet been done to see the incidence, pattern of injury, outcome and declaration according to Qisas and Diyat in the city of Abbottabad. The objectives of the study were to determine the frequency of age and sex with type of lesion and causative weapon after trauma in a medico-legal clinic and to find the impact on the commonest target organs in the study area. METHODS: This cross-sectional study was conducted at District Headquarter Hospital, Abbottabad between 1st January 2004 and 31st December 2004. Cases presenting for medico legal examination in Medico-legal Department of DHQ Hospital Abbottabad. Patients were selected on basis of purposive sampling technique. Physical trauma group was sub-divided into firearms, sharp, blunt and road traffic accident. This group was further classified according to age, sex, area of body involved, type of weapon, seasonal prevalence, and whether injuries were declared according to Qisas and Diyat ordinance. RESULTS: A total of 759 cases of physical trauma reported for medico-legal examination. Out of 759 cases of physical trauma, 3.4% cases of firearm weapon, 7.9% cases of sharp weapon, 16.2% of road traffic accidents, and 72.5% of blunt weapon presented in the medico-legal clinic. Male preponderance with 97% was noted. Two-third of victims were between 10 and 39 years of age. The months of May-July and October-December showed slightly elevated number of cases. The head and neck was the most commonly involved area. No case was certified according to Qisas and Diyat Ordinance. CONCLUSION: Physical trauma constitutes the leading cause to the mankind which makes about 91.6% of cases. Males between 10 to 39 years of age are most likely to be victims. The face and head is the most affected area.

Medico-legal assessment of sexual assault victims in Lahore.

OBJECTIVE: The objective of the study was the medico-legal assessment of sexual assault victims in Lahore, and to know the characteristics of the assailants in these cases. METHODS: This study included all 123 female cases of alleged sexual assault that presented for medical examination at the office of the surgeon medico-legal Punjab at Lahore during 2002. RESULTS: Around 64% of the victims were between 10-19 years of age, 76% presented for medical examination after a delay of more than 72 hours. The assailant was known to the victim in 57% cases. Two or more assailants were involved in 30% cases. The victims had changed clothes and washed their bodies before the medical examination in 83% cases. Physical evidence of violence on the body was present in only 15% of the victims and evidence of recent injury to the genital tract was present in 18% individuals. However a positive semen analysis was reported in 98.35% of the samples. CONCLUSIONS: Sexual assault was more common in younger females. Late presentation for examination was due to the embarrassment of being exposed. A positive semen analysis was the definite factor for confirmation of the assault.

Homicide in Abbottabad.

BACKGROUND: Homicide is one of the oldest crimes in human history. Although a large number of dimensions have been added to this crime, the age-old factors like revenge, rage, jealousy and honour persist even today. This study was conducted jointly at the attached hospitals of Women Medical College and Ayub Medical College. Abbottabad to know the various dimensions of the victims of homicide. METHODS: The present study encompasses all 40 cases of homicide, which presented for autopsy at DHQ hospital and Ayub Medical Complex Abbottabad during the year 2002. The manner of death was categorized as homicide on the basis of police inquest and the autopsy findings. RESULTS: The homicide rate in Abbottabad was found to be 4.22/100,000 per year. Males were the primary targets usually in their prime of youth with 40% victims between 20-29 years. Firearms formed the major weapon of offence. Most victims died before reaching the hospital. Deaths were more common during the daytime and in summer months. CONCLUSION: Homicide rate is on the lower side in Abbottabad amongst places where firearm possession is not strictly controlled, but can be further reduced. Limiting firearm possession alone can go a long way in this goal.