Clinico-epidemiological features of viper bite envenomation: a study from Manipal, South India.

INTRODUCTION: Snakebite is an important and preventable health hazard. Viper bites are more common than other poisonous snakebites in human beings. The present study aimed to collate the victim profile of viper bite cases in the region and to determine the pattern, manifestations, complications and the associated risk factors of these bites. METHODS: This was a prospective study of viper bite cases admitted to Kasturba Hospital, Manipal, India between August 2003 and November 2005. The demographic and clinical details of each case were obtained from the patients, their relatives and the patients' hospital records, and analysed. RESULTS: A total of 31 viper bite cases were reported during the study period. The victims were predominantly male and aged 25-55 years. The highest number of cases occurred during daytime in the months of September and October, which coincided with the harvesting season, and involved the lower limbs. 94% of the snakebite victims were farmers, suggesting that this was an occupational hazard. Envenomation was observed in patients with scratch marks, suggesting the importance of keeping the victim under observation in all alleged snakebite cases, even in the absence of clear fang marks. The mortality rate in our study was 6.5%. CONCLUSION: Immobilising and transporting snakebite victims to the hospital and prompt administration of anti-snake venom remain the best way to reduce morbidity and mortality. It is also important to practise correct first aid measures, as otherwise they may cause more harm than good.

Myocardial infarction and concurrent chest injuries: two case reports.

Two cases of sudden death due to myocardial infarction which were associated external injuries on the chest are discussed here. Injuries were in the form of abraded contusions on the anterior part of chest. Both the cases were declared dead on arrival to the casualty section (Accident and Emergencies Department). In these cases, mention of injuries was not made in the inquest report. In both the cases, suspicion of foul play or the trauma induced myocardial infarction were ruled out by inquiring into the incidents by the autopsy surgeon. The cases highlight the importance of detailed history by the autopsy surgeon in cases of sudden death with associated injuries on the front of the chest.

Sex differences from fingerprint ridge density in the Indian population.

Determination of individuality is one of the prime concerns in forensic investigation. The study of fingerprints is widely used in providing a clue regarding identity. The present study was undertaken to study the sex differences in fingerprint ridge density in the Indian population. The study done on 100 males and 100 females revealed that significant sex differences occur in the fingerprint ridge density. The present study shows a statistically significant difference in fingerprint ridge densities of male and female fingerprints in people of Indian origin. A mean fingerprint ridge density of 12 ridges/25 mm(2) or less is found to be more likely to be of males and a mean ridge count of more the 12 ridges/25 mm(2) is more likely to be of female origin.

Sex differences from fingerprint ridge density in Chinese and Malaysian population.

The fingerprints are very typical for a human being. The present study was undertaken to study the gender differences in fingerprint ridge density in Chinese and Malaysian population. The study done on 200 subjects (100 males and 100 females) of Chinese origin and 100 subjects (50 males and 50 females) of Malaysian origin revealed that significant gender differences occur in the finger ridge density. Fingerprint mean ridge density of 12 ridges/25 mm(2) or less is found to be more likely to be of males and a mean ridge count of more the 13 ridges/25 mm(2) is more likely of female origin in Chinese subjects. Fingerprint mean ridge density of 11 ridges/25 mm(2) or less is found to be more likely to be of males and a mean ridge count of more the 13 ridges/25 mm(2) is more likely of female origin in Malaysian subjects.

Middle finger length--a predictor of stature in the Indian population.

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 present study was conducted on 500 north and south Indian subjects in Manipal, India, to establish the stature of an individual using the middle finger length. Measurements were analysed statistically to establish the relationhip between a person's middle finger length and their stature. The study shows that the middle finger length bears a significant relation to stature and can be an important tool for stature estimation. Significant differences in measurements and formulae for males and females were found. These differences were insignificant when values were compared between subjects of the same sex in north and south Indians and also between the dominant and non-dominant hand.

Estimation of stature from cranial sutures in a South Indian male population.

The aim of this study was to investigate the possibility of estimating height from length of coronal and sagittal sutures of the skull for the positive identification of the height in forensic investigations concerned with fragmentary skeletal remains. The study was conducted on 87 male bodies subjected to medicolegal autopsy in the Department of Forensic Medicine, Kasturba Medical College, Manipal, South India and the Department of Forensic Medicine, Kasturba Medical College, Mangalore, South India. Length of coronal suture was measured from left pterion at the junction of sphenoparietal with the sphenofrontal suture, along the coronal plane, over the coronal suture to the pterion on the right side. Length of sagittal suture was measured from bregma along the sagittal plane over the sagittal suture to the lambda. The data collected were subjected to statistical methods. Significant correlation was found between height and coronal suture length in males, when compared to sagittal suture. The correlation coefficient between height and coronal suture was 0.363. The correlation coefficient between height and sagittal suture was 0.090. Linear regression equations for stature estimation were derived from coronal suture length in male population. Coronal suture length gives more accurate results in estimating stature than sagittal suture. However, in cases where identification is required by means of only skull, this method could prove useful.

Skeletal asymmetry.

Bilateral variations in dimensions of upper and lower limb bones are attributable to difference in mechanical stress and strain that the bones are subjected to during bone growth, and is referred to as directional asymmetry. This skeletal asymmetry in the upper limbs is usually prominent on the dominant side while in lower limbs on the other side, possibly due to supportive contra lateral muscle contractions, that influence the bone growth. This contra lateral dominance in upper and lower limbs is known as cross-symmetry pattern. During skeletal remains examination, variations in different dimensions of long bones of an individual can result in erroneous opinion regarding number of individuals, especially in case of mass disasters. A case report of skeletal remains examination with review of relevant literature is presented where the different dimensions of right and left limb elements are measured and compared.

Estimation of stature from hand dimensions of north and south Indians.

The present study was undertaken to predict the stature of a person using hand length and breadth. The study includes 500 right-hand dominant medical students aged between 20 and 30 years, from northern and southern parts of India, studying in Kasturba medical college, Manipal, India. Hand length was measured 'between the distal wrist crease and the tip of middle finger (HL-1)' and 'between the mid-point of inter-styloid line to the tip of middle finger (HL-2)'. Hand breadth was measured between radial side of the second metacarpophalyngeal joint and ulnar side of the fifth metacarpophalyngeal joint (HB). No significant difference was present in hand dimensions between north and south Indians. When compared between both hands, right-hand dimensions were larger than the left hand, with statistically significant difference in HL-2 and HB. Linear regression equations using hand length is more helpful in estimating stature than the hand breadth. The correlation coefficients ranged from 0.673 to 0.665 and 0.740 to 0.732 in north Indian males and females, respectively. Whereas in south Indians, it ranged from 0.752 to 0.732 and 0.701 to 0.691 in males and females, respectively. Multiple regression equations give better results than linear regression equations. HL-2 gives more accurate results in stature estimation than the HL-1.

A comparative analysis of suicide and parasuicide.

A prospective study was conducted to analyse the spectrum of suicide attempters and completers at Kasturba Hospital, Manipal, India, over a period of three years (January 2001 to December 2004). The present study comprised a total sample population of 246 cases, of whom 90 died and 156 survived the attempt (1:1.73). Men outnumbered women in the deceased group and women surpassed men in the survivor group. The mean age for the deceased group was 42 years compared with 30 years for the survivor group. Prior attempted suicide in the deceased group was 6.6%. Eighty-three percent of the total population studied opted for 'chemical methods', where insecticides topped the list (64.6%) in both the deceased and the survivor group. Among those who preferred 'physical methods', 50% died and 50% survived. In the current study, 17% of the subjects had received a psychiatric consultation, of whom 91.3% were diagnosed in the spectrum of 'depressive disorders.' Knowledge about the legalities of suicide was lacking in 65% of victims and their kin.

Profile of unnatural deaths in Manipal, Southern India 1994-2004.

Pattern of unnatural deaths is a reflection of the prevailing social set up and mental health status of the region. In an attempt to understand the magnitude and pattern of unnatural deaths in Manipal, Southern India, a 11-year retrospective study was carried out in the Department of Forensic Medicine, Kasturba Medical College, Manipal. The study revealed a rise in road traffic fatalities (37%) that constituted the majority of autopsies carried out followed by death due to poisoning and burns. Male preponderance was quite evident (2.5:1) except for death due to burns where ratio was reversed (1:2.9). People in 3rd decade were most prone to such fatalities. Of the total medicolegal autopsies conducted in this period, the manner of death was unnatural in 98% of the cases and 71% of them were accidental in nature.