Sexual Dimorphism of Greater Sciatic Notch among Nepalese Population by Three Dimensional CT Images of Pelvis.

Background Sex identification from the skeletal remains, is the first and the foremost step encountered by forensic experts. Hip bone being comparatively robust is resistant to damage and scores even in improperly preserved skeletons. It is also widely agreed that the greater sciatic notch (GSN) holds the greatest degree of sexual dimorphism. Objective To study the role of greater Sciatic Notch parameters in sex determination among Nepalese population by means of reconstructed Multi Slice Three-Dimensional Computed Tomography (MDCT) images. Method The CT images of individuals who underwent pelvic CT in the Department of Radiology, Dhulikhel Hospital were included in the study. Measurements of width, depth, angles and indices of greater sciatic notch were measured and calculated. Data were entered and analyzed using SPSS (Statistical Package for Social Sciences) version 25.0. Result There was a significant difference between means of all greater sciatic notch parameters (p > 0.001) between sex showing sexual dimorphism except depth (p=0.65). By using limiting point, 78.18% male and 83.64% female were correctly classified by using total width. Total angle, Posterior segment and Total width had sensitivity and specificity exceeding 80% and overall accuracy of 87% to 92% in all parameters except depth by receiver-operator characteristic curve analysis. Conclusion Application of 3D-CT virtual images in the present study helped us to easily quantify greater sciatic notch parameters. The important greater sciatic notch predictors for sex determination in Nepalese population were determined which would help forensic experts in ascertaining the sex of an unknown individual.

Mortality Patterns among Hospital Deaths.

Background Death occurring in hospital is medically certified by attending physicians with cause of death. In developing countries such as Nepal, limited resources are available related to the pattern of deaths that occur in hospitals, so that the health priorities can be selected wisely. Objective The objective of this study was to determine the pattern, frequency and causes of inpatient mortality in hospital. Method This was a retrospective study of all deaths occurred at the Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel from 1st January 2012 to 31st December 2013. There were 247 deaths and for each case, medical records were reviewed. Result There were 26,836 patients admitted during the study period and 247 (0.90%) of them died in hospital. Males accounted for 42.92% (n=106) deaths and female 57.08% (n=141). The average length of stay before death were less than 5 days (n=152). The majority of deaths were in Medicine department 52.64% (n=130) followed by Pediatrics 32.38% (n=80). Majority of deaths were at the extremes of life so that less than one month 12.95% (n=32) and over 60 years 36.84% (n=91). The main cause of death was respiratory disease 38.87% (n=96), followed by infectious 20.64% (n=51) and hepatobiliary disease 16.19% (n=40). Conclusion Registration data on causes for deaths occurring in hospitals require periodic validation prior to their use for epidemiological research or public health policy. Procedures for death certification and coding of underlying causes of death need to be streamlined to improve reliability of registration data. Estimation of cause-specific mortality from this research will inform the burden of disease and guide to intervene and reduce avoidable mortality in hospitals.

Eruption Pattern of Dentition and Its Medico-legal Significance.

Background The eruption pattern of temporary and permanent teeth are fairly constant with the growing age. So the age determination of an individual by examination of teeth is one of the accepted methods in legal system. A review of the literature shows there are differences in eruption pattern between different populations mainly due to variations in the constitutions and environment, so highlighting the importance of this study to the Nepalese population. Objective To assess the eruption age of temporary and permanent teeth in Nepalese population and compared the eruption age with other groups. Method This cross-sectional study, included 450 subjects, aged between six months to 25 years selected by simple random sampling method. The determinant variable such as age and number of teeth was recorded. Result Eruption of temporary and permanent teeth is slightly delayed in Nepalese population compared with others. First temporary tooth to erupt is lower central Incisor at around eight months and last to erupt is second molar at around 28 months. For permanent tooth, first molar erupts at around seven years and second molar erupts by 14 years. Eruption of third molar (wisdom tooth) varies from 18 to 25 years. Conclusion This study provides a model data on eruption age of teeth which is first study of its kind in Nepal. The findings of this study will help as a reference data for optimal use in clinical, academic and research activities especially in Nepalese population. Medico legally it helps in estimation of age along with other parameters.

Sex Determination From the Bicondylar Width of the Femur: A Nepalese Study Using Digital X-ray Images.

Background One of the important components of forensic identification is sex determination. The prediction of sex becomes easy with a complete skeleton. The problem arises with mutilated and incomplete skeletal remains. The skull and pelvis are preferred for sex prediction, but not uncommonly, long bones are brought for forensic examination. The femur out stands as the most dimorphic long bone. The literature on sex determination from the femur in different population groups is in abundance. The forensic anthropology literature suggests that longitudinal dimensions are often less discriminating than the breadth and circumference of long bones. Many researchers have suggested that the bicondylar width of the femur is the most dimorphic dimension. Objective To evaluate the sexing potential of the bicondylar width of the femur in the Nepalese population using digital X-ray images. Method A sample of 200 digital X-ray images of the knee belonging to 100 males and 100 females was used to measure the bicondylar width of the right femur. These digital X-ray images were those of Nepalese patients who visited the Department of Radiology at the affiliate hospital of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal for diagnostic and treatment purposes. Result The resent study reveals a statistically significant difference for the bicondylar width of the femur between males and females. A regression equation was derived with sectioning point 77.84. Using the regression equation the prediction of sex was 68% with an overlapping of 32%. Having a low prediction in comparison to other studies in different populations, 95% confidence interval for the mean was used to get a range of measurements of the bicondylar width for males and females. The range stated in the present study is 79.47 mm to 82.20 mm for males and 73.75 mm to 75.93 mm for females. Conclusion The bicondylar width of the femur cannot be individually recommended for sex determination in the Nepalese population, but could be considered if analyzed along with the other morphometric traits for sex determination.

Lip prints: an identification aid.

BACKGROUND: Lip prints are the normal lines and furrows in the form of wrinkles and grooves present in the human lip between the inner labial mucosa and outer skin having certain individual characteristics like fingerprints. OBJECTIVE: The aim of the study was to highlight the importance of lip prints in sex determination related to forensic investigation for identification. METHODS: Study was conducted on 150 medical students which include 75 males and 75 females of Kathmandu University School of Medical Sciences, Dhulikhel, Kavre on 2011. Lip prints were collected and analyzed as per Suzuki classification. RESULTS: There was significant difference between male and female lip print patterns. Type II was most common combining both. Type I and I ' was more common in male where as Type I was rare in female. Type II in fourth quadrant was seen in almost all female and also the commonest. Similar patterns in all four quadrants were common findings in female. CONCLUSION: The study showed that each lip print is unique and the sex of the person can be predicted on the basis of patterns present in prints.

Estimation of stature from foot length in adult Nepalese population and its clinical relevance.

BACKGROUND: Stature is the height of the person in the upright posture. It is an important measure of physical identity. Interrelationships among different body measurements may be used to estimate one from another in case of missing body parts. OBJECTIVE: Stature is an important indicator for identification. There are numerous means to establish stature and their significance lies in the simplicity of measurement, applicability and accuracy in prediction. The current study dealt with developing a regression equation for stature estimation from foot length and to find out the correlation between body height and foot length of Nepalese people. METHODS: The present study was carried out to establish the regression equation and correlation coefficient between individual height and mean foot length. It was conducted on 440 students of age group 17 to 25 years studying in Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Body height and foot length were measured in centimeter. RESULTS: There was significant correlation between height and foot length (r = 0. 703, p < 0.01).The regression equation for height and foot length was found to be Y = 3.179 X + 87.65, where X is the foot length and Y the height. CONCLUSIONS: This study will help in medico-legal cases in establishing identity of an individual and this would be useful for Anatomists and Anthropologists to calculate stature of adult Nepalese based on foot length.

Study of poisoning cases in a tertiary care hospital.

BACKGROUND: Poisoning is one of the leading causes of morbidity and mortality in Nepal and also a major public health problem worldwide. A thorough review of the risk factors helps to decrease the incidence and mortality. The study evaluates the cases admitted in Dhulikhel Hospital, Kavre, Various parameters like age, sex, marital status, time of ingestion, month of occurrence, agent responsible for incidence; type of poisoning, psychosocial problem, outcome and duration of treatment are analyzed. OBJECTIVES: The objectives of this study are to determine the pattern and severity of poisoning cases admitted to Dhulikhel Hospital. METHODS: A hospital based study was carried out in the patient admitted to Dhulikhel Hospital with the history of poisoning for the period of one year between April 2011 to March 2012. Various parameters were analyzed and compared with other study. RESULTS: There were 137 cases during the one year duration and maximum case belonged to second and third decade of life. Most common manner of poisoning was suicidal and the incidence was mainly during evening hours. Organophosphorus was the most commonly abused substance. Most of the cases had arrived hospital after one hour of exposure and duration of hospital stay in many cases were less than four days. CONCLUSION: Based on these findings preventive measures like precaution taken at various levels, restriction in free sale of the poisons and promoting Poison Information Centers along with public awareness and proper psychosocial management to decrease the incidence and mortality in poisoning cases can be suggested.