punjab academy of forensic medicine & toxicology ... - pafmat

Punjab Academy of Forensic Medicine & Toxicology

JOURNAL OF

Volume:18,Number:01JanuarytoJunePublication:HalfYearly

ISSN:0972-5687

2018

APeerReviewedJournalon

ForensicMedicine,Toxicology,AnalyticalToxicology,ForensicScience,EnvironmentalPollution,

ForensicPathology,ClinicalForensicMedicine,Identi�ication,LegalMedicine,StateMedicine,

MedicalJurisprudence,MedicalEthics,ForensicNursing,ForensicOdontology,ForensicAnthropology,

ForensicPsychiatryandotherAlliedbranchesofMedicineandScience

dedicatedtoadministrationofJustice.

• Indexed with Index Copernicus (Poland), Scopus (Elsevier Products), IndMed (ICMR New Delhi), Safetylit, Worldcat Library & WHO Hinari

• Available online at Indian Journals.com and pafmat.com• UGC Approved (Sr. No. 97, Journal No.19445)

Place of Publication: Bathinda (Punjab) India

• JPAFMAT is also having PubMed/NLM catalogue number (NLM Unique ID: 101232466).

PUNJAB ACADEMY OF FORENSIC MEDICINE AND TOXICOLOGY

(Registration No. 139 / 1998-99, Chandigarh)

HO: Department of Forensic Medicine, Govt. Medical College Patiala (Punjab) 147001

PresidentDr. D. S. Bhullar

Vice PresidentDr. Rajiv Joshi

General SecretaryDr. Akashdeep Aggarwal

Editor-in-ChiefDr. Parmod Kumar Goyal

Finance SecretaryDr. Shilekh Mittal

Joint EditorDr. Amandeep Singh

Dr. Ashok Chanana

Dr. Ishwar Tayal

Dr. Dasari Harish

Dr. Preetinder S. Chahal

Dr. Puneet Khurana

Dr. Ajay Kumar

Dr. Amit Singla

Dr. Ashwani Kumar

Dr. Deep Rattan Mittal

Dr. O.P. Aggarwal

Dr. S.S. Oberoi

Dr. Balbir Kaur

Dr. Gurmanjit Singh

Dr. K.K. Aggarwal

Dr. R.K. Sharma

Dr. R.K. Gorea

Dr. Vijaypal Khanagwal

Executive Members

Advisors

GOVERNING COUNCIL (2017 - 2019)

Patron

Dr Jagdish Gargi

Advisors

Dr J. S. Dalal

Dr Harish Tuli

Dr Maj. Gen (Rtd.) Ajit Singh

President

Dr. R. K. Gorea

Vice President

Dr. D. S. Bhullar

Secretary

Dr. Sat Pal Garg

Treasurer

Dr. Nirmal Dass

Executive Members

Dr A S Thind,

Dr Jagjiv Sharma,

Dr Kuldeep Kumar,

Dr I. S. Bagga,

Dr Baljit Singh

FOUNDER GOVERNING COUNCIL OF PAFMAT

Special Invitee

Dr. Adish Goyal Dr. Mukul Chopra

J Punjab Acad Forensic Med Toxicol 2018;18 (1) ISSN : 0972-5687

Joint SecretaryDr. Didar Singh Walia

Web MasterDr. Dildar Singh

Assistant EditorDr. Satinder Pal Singh

From the Desk of Editor-in-Chief

I am pleased to present the first issue of the year 2018 of Journal of Punjab Academy of Forensic Medicine & Toxicology. I am

thankful to the authors and contributors for the scientific articles and research papers which are being published in this issue. I am

also thankful to the editorial team for supporting me in its publication and the members of the Academy for giving me the

opportunity to serve as Editor-in-Chief of the journal. My special thanks to Joint Editor Dr Amandeep Singh and Assistant Editor Dr

Satinder Pal Singh for their support and sincere efforts for timely publication and release of this issue.

The Journal publishes original research papers, review articles, case reports and review of books on Forensic Medicine and

Toxicology. The Journal highlights the achievements of the academy and its members. This journal is meant for achieving the aims

and goals of the academy to expand the academic activities, spread the knowledge and latest research in the field of Forensic

Medicine and Toxicology.

My request to all the members of academy to share interesting case reports/photographs of medico legal cases for publication

and benefit of readers. Even case photographs can be sent on whattsapp after hiding the identity.

Any suggestions and advice for further improving the standards and quality of the journal will be highly appreciated and may

be sent to me through email or my whattsapp no. 9876005211.


ISSN Numbers:

ISSN-L: 0972-5687, p-ISSN: 0972-5687, e-ISSN: 0974-

083X.

Indexed with:

IndexCopernicushttp://journals.indexcopernicus.com/karta.p

hp?id=4715

Scopus (SCI):

http://www.scimagojr.com/journalsearch.php?q=199001949

14&ip=sid&clean=0

Volume of Distribution:

300 copies.

Funding Bodies: Punjab Academy of Forensic Medicine &

Toxicology, Donations from Philanthropists and manuscript

handling charges

Address for submission of articles Online (Soft Copy):

[email protected]

Copyright:

No part of this publication may be reprinted or republished

without the prior permission of Editor-in-Chief of Journal of

Punjab Academy of Forensic Medicine & Toxicology.

Submission of all papers to the journal is understood to imply

that it is not being considered for publication elsewhere.

Submission of multi-authored paper implies that the consent

of each author has been taken. Researchers/Authors should

adhere to publication requirements that submitted work is

original, not plagiarized, ethical an has not been published

elsewhere.

Every effort has been made not to publish any inaccurate or

misleading information. However, the Editor-in-Chief, the

Joint Editor or any member of the editorial committee accept

no liability in consequences of such statements. For any further

information/query please contact with Editor-in-Chief.

Dr Parmod Kumar Goyal

1

2

*From the Desk of Editor-in-Chief 01

*Contents 2-3

* Editorial : Theory of Relative Justice 4-5

Imran Sabri, Sayed A. Quadri

*Original Research Papers

1. Correlation Study Between Fingerprint Patterns and Rh Blood Group 6-9

Smitha Rani, Balaraj BM

2. Chromatographic Separation of Ephedrine, Pseudoephedrine and Phenyl Propanolamine on 10-12

Silica Gel –G Layers Using Different Solvent Systems

Kavita Goyal, Neha Tomar, R. K. Sarin, S.K. Shukla

3. Lightning Deaths in Tigray Region, Northern Ethiopia 13-16

Rajeev Varma, Enyew Debash, Sesen Tsegaye, Dharmaraya Ingale

4. Informed Consent In A Medical Treatment – KAP Study 17-24

Nidhi Sachdeva, Vivek Srivastava, Ashok Najan

5. Profile of Medico Legal Cases at Netaji Subhash Chandra Bose Medical College 25-27 Jabalpur, Madhya Pradesh

Vivek Srivastava, Ashok Najan, Pradeep Kumar Markam, Shivoham Shukla

6. Gaps in Nursing Training on Biomedical Waste Management and Handling: 28-32

Situational analysis at a Tertiary Care Public Hospital

Ravinder Nath Bansal, Sonu Gupta

7. A Study of Completed Suicide Among Women in the Reproductive Age Group From 33-37

Coastal Karnataka

Haneil Larson D'Souza, Prashantha Bhagavath, Francis NP Monteiro, Tanuj Kanchan

Suresh Kumar Shetty, Jagadish Rao P.P, Pavanchand Shetty H

8. An Alternative Method for Extraction and Cleaning of Bones From Buried Cadavers 38-40

Monika Gupta, Parmod Goyal, Navita Aggarwal

9. For Ethical Doctors: Does selection process for Medical students require a change? 41-43

Mrinal Kanti Jha, Jagadish Biswas, Tilak Bose, Shyam Sekhar Choudhury

10. Multiple Linear Regression to Determine Stature Using Hand and Feet Dimensions Among 44-49

Central Indian Population.

Anudeep Singh

11. Determination of the Sequence of Strokes Made from the Same Color and Type of the Ink 50-53

Manisha Mann, Sudhir Kumar Shukla, Seema Rani Pathak

12. A Study On Waste Disposal Management In A Tertiary Care Hospital 54-57

Pratik V Tarvadi

13. Wound Dating By Gross And Histopathological Examination of Abrasions- 58-62

An Autopsy Based Study

Prashanthi Krishna Dharma Ramasamy Devaraj, Thanka J, Sampath Kumar, Selva Arasi

14. Reprotoxic Effects of Noon tea on Drosophila Melanogaster 63-65

Lovleen, Altaf Hussain, Bhupendra Koul


JOURNAL OF

ISSN:0972-5687


Contents


JOURNAL OF

ISSN:0972-5687


Contents

15. Epidemiological Profile, Pattern of Skull Fractures and Intracranial Haemorrages in 66-68

Fatal Road Traffic Accident Victims: An Autopsy Study

Munish Kumar, Sukhdeep Singh, Yatiraj Singi

*Case Reports

1. Accessory Lobes of Liver - A rare malformation noticed during autopsy 69-70

Vijay Arora, Arun Gautam

2. Pericardial Rupture without Cardiac Injury or Herniation 71-72

Vikram Palimar, Kaushal Kishore, Sajan Babu, Chandni Gupta

3. Elongated Styloid Process (Eagle Syndrome) - A rare finding at autopsy 73-74

Yogesh Kumar Vashist, Sakshi Sharma, Bhagwat Rajput, Anil Garg, Rahul Chawla, Gaurav Sharma

*Review Article

1. Role of Forensic Odontologists in Child Abuse Detection and reporting : A Review 75-77

Pooja Puri, SK Shukla, I. Haque

2. Nanotechnology And Its Applications In Forensic Sciences- A Boon To Legal Justice 78-83

Jaskaran Singh, Neeta Raj Sharma, Chelsea Marie Joseph, Dattatraya Khisse, Savreet Kaur,

Pratibha Rani, Divya Sahu

*Correspondence

1. Suggestion for MPT act, “abortion on demand”? 84

Lalit Kumar

2. Recommendations Sent to Government of Punjab for Bringing Necessary Amendments in the 85-87

Punjab Anatomy Act.

Priti Chaudhary, Parmod Kumar Goyal

*Instructions to Authors 88

*Life Membership Form 89

*Book Review 90

*Life Members PAFMAT 91-92

3

Editorial

INTRODUCTION :

A famous quote by William E. Gladstone is “Justice [1]Delayed is Justice Denied” . But what if the justice is not

done at all, or justice has been done in favour of accused which

obviously is injustice to the victim. Justice is defined according

to dictionary.com as “the quality of being just; righteousness, [2]equitableness, or moral rightness.” . Justice and injustice are

relative terms, as justice for one may be injustice to the other

party. Absolute justice as per Merriam Webster dictionary is [3]“free from imperfection” . It can be interpreted that absolute

justice is a perfect trait, and, since only God is perfect hence

only He can deliver it. As human beings could be imperfect in

their judgment, it can impact criminal justice administration

and absolute justice cannot be assured in true sense. In this

article we will look into a few imperfections prevalent in our

existing criminal justice administration system. “The Theory

of Relative Justice” implies that “we are living in a world of

Relative Justice” which need not be necessarily absolute

justice.

Utilitarianism, on the other hand, deals with the concerns of

majority and cannot be regarded as justice, however it could be

labeled as an ethical term. Ethics and law differ in that ethics

are social guidelines based on moral principles and values

while laws are rules and regulations that have specific penalties [6 ]and consequences when violated . The practice of

Utilitarianism has been debatable as legal understanding may

differ.

A 14 year old boy arrested in a country on complaint of school

staff who suspects him to make a clock bomb later turns out to

be a case of racial prejudice. This incidence was covered by [7]media which highlighted profound private information . Had

there been a similar incidence occurred with a student of

different background, the fate could have been otherwise.

Other similar incidences are reported albeit the names of the

accused/victim. In the above mentioned case the victim has

been accused as criminal. Now the question arises that who is

the criminal in actuality? or whom can we blame ? the media,

the school staff, the police or the society. In reality all of them

are fulfilling their duties. Then who is the real culprit? In this

instance it can be said that “Doctrine of Relative Justice” has

prevailed. In order to protect the rights of majority population,

we have compromised the rights of the minority.[8]A certain country bans a particular dress , while another

[9]makes it mandatory . In this situation, a particular dress is

legal in one country but illegal in other. Therefore a country

may take legal action against people wearing that dress while

another country legally enforces the wearing of that dress.

Absolute justice states that everyone should have the freedom

to wear the dress of their choice. The society however

sometimes defines its dress code according to the norms set by

J Punjab Acad Forensic Med Toxicol 2018;18(1) ISSN : 0972-5687

4

Theory of Relative Justice1. Imran Sabri, Assistant Professor, Division of Forensic Medicine*

2. Sayed A. Quadri, Assistant Professor, Division of Microbiology, Department of Biomedical Sciences*

*College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia

Corresponding Author

Dr. Imran Sabri,

Assistant Professor, College of Medicine, King Faisal

University, Al-Ahsa, Kingdom of Saudi Arabia

Contact : +966565554107

Email : [email protected], [email protected]

KEYWORDS : Justice, Relative Justice,Theory

Article History:Received: 17 January 2018Received in revised form: 29 May 2018Accepted on: 29 May 2018Available online: 1 July 2018

ABSTRACT :

Justice is defined according to dictionary.com as “the quality of being just; righteousness, equitableness, or moral

rightness”. Justice and injustice are relative terms, as justice for one may be injustice to the other. “The Theory of Relative Justice”

implies that “we are living in a world of Relative Justice”. In order to protect the rights of majority population, we have

compromised the rights of the minority. If it were to happen that the minority becomes the majority “The Theory of Relative

Justice” will still prevail. “The Doctrine of Relative Justice” is an applied approach in which the benefits of majority population are

of paramount consideration and perhaps application of Relative justice may not be a bad choice. “The Theory of Relative Justice”

can be considered independent of majority and minority status. Practicing relative justice may be considered a better approach than

practicing no Justice. Absolute Justice may seem to be a utopian dream to some; however it is desirable and achievable.

it and the rights of individual stand violated. Now in the afore

mentioned instance certain nations may actively discourage

the full covering of the body or face and in a similar way, rules

governing sports activities may restrict use of clothing's. These

issues could also be considered as violation of the rights of

individuals and hence doctrine of relative justice is also

applicable here.

DISCUSSION:

Justice for one may be injustice to other, in the cases mentioned

above. Justice, Law, Ethics, Social Norms etc are applied in

relative context in the society. How is it possible that we have

different laws for same crime or different criminal justice

administration system for different sections of the society?

This could only happen if criminal justice administration

system is biased on the bases of religion, caste, skin color,

seeking dominance, region etc.

“The Doctrine of Relative Justice” is an applied approach in

which the benefits of majority population are of paramount

consideration and perhaps application of Relative justice may

not be a bad choice, as at least we are giving justice to the

majority population while restricting the rights of the minority.

If it were to happen that the minority becomes the majority

“The Theory of Relative Justice” will still prevail.

CONCLUSION:

It could be concluded that “The Theory of Relative Justice” is

prevalent across the world. Absolute Justice seems to be

merely a textbook term and doesn't seem to be practiced. “The

Theory of Relative Justice” can be considered independent of

majority and minority status. Practicing relative justice may be

considered a better approach than practicing no Justice.

Absolute Justice may seem to be a utopian dream to some;

however it is desirable and achievable.

Ethical approval : None/Not Applicable

Funding : None/Self-Funded

Conflicts of interest : No conflicts of interest.

REFERENCES :

1. "William E. Gladstone Quotes." BrainyQuote.com.

X p l o r e I n c , 2 0 1 8 . 2 9 M a y 2 0 1 8 .

https://www.brainyquote.com/quotes /william_e_gladsto

ne_101551

2. Dictionary.com [Internet] Justice [Cited on April 1, 2018]

. Available from

http://www.dictionary.com/browse/justice

3. Merriam Webster Dictionary Internet] Absolute [Cited on

April 1, 2018] . Available from https://www.merriam-

webster.com/dictionary/absolute .

4. John Rawls. A Theory of Justice By John Rawls-Revision

Edition . Massachusetts . Harvard University Press 1999.

Available from

h t t p s : / / b o o k s . g o o g l e . c o m . s a / b o o k s ?

id=kvpby7HtAe0C&printsec=frontcover#v=onepage&q

&f=false

5. Henry R, West. [Internet] Utilitarialism [Cited on May 29,

2018]. Available from

https://www.utilitarianism.com/utilitarianism.html

6. What Is the Difference Between Ethics and Law?

[Internet]. Available from

h t t p s : / / w w w. r e f e r e n c e . c o m / g o v e r n m e n t -

p o l i t i c s / d i ff e r e n c e - b e t w e e n - e t h i c s - l a w -

1b772dd7ebc7cd74# [Cited on April 1, 2018].

7. Ashley Fantz, Steve Almasy and AnneClaire Stapleton,

CNN. Muslim teen Ahmed Mohamed creates clock,

shows teachers, gets arrested [Internet] September 16,

2015. [Cited on April 1, 2018] Available From

https://edition.cnn.com/2015/09/16/us/texas-student-

ahmed-muslim-clock-bomb/ .

8. Lizzei Dearden. China bans burqas and 'abnormal' beards

in Muslim province of Xinjiang [Internet] May 30, 2017

[ C i t e d o n A p r i l 1 , 2 0 1 8 ] Av a i l a b l e f r o m

http://www.independent.co.uk/news/world/asia/china-

burqa-abnormal-beards-ban-muslim-province-xinjiang-

veils-province-extremism-crackdown-freedom-

a7657826.html

9. The Economist. [Internet] Saudi Arabia's dress code for

women.[Cited on April 2, 2018] Available from

h t tp : / /www.economis t . com/b logs /economis t -

explains/2015/01/economist-explains-20.


5

Original Research Paper


Dr. Smitha Rani

Assistant Professor

Department of Forensic Medicine and Toxicology,

J.S.S Medical College, , JSS Academy of Higher

Education and Research, Sri Shivarathreeshwara Nagar,

Bannimantap, Mysore-570015, Karnataka, India.

Telephone no: 09886673946

Email: [email protected]

KEYWORDS : Rh Blood Group, Fingerprint Print Pattern, Identification.

Article History:Received: 23 March 2018Received in revised form: 29 April 2018Accepted on: 29 April 2018Available online: 01 July 2018

INTRODUCTION :

Identification means determination of the individuality of a

person based on certain physical characteristics unique to that [1]individual . It is the most important component in medico

legal practice. Identity of a person may be absolute (complete)

or partial (incomplete). Complete identification is the absolute

determination of the individuality of the person. Incomplete or

partial identification is the ascertainment of only a few facts

whereas the other facts are unknown.

The various comparative techniques for identification are

dental patterns and restorations, finger, palm and foot prints,

superimposition technique, neutron activation analysis, [2]anthropometry and trace evidence comparisons . Among the

various comparative data techniques listed above, Personal

identification through fingerprints has long been recognized

and is regarded as the greatest contribution to the police force.

Study of fingerprints as a method of identification is also

known as Dactylography or Dactyloscopy or Henry – Galton [3]system of identification . The finger print patterns are

distinctive and permanent in individuals. The pattern is

different even in identical twins.

Similar to fingerprints, blood as trace evidence is an extremely

important entity of medico legal practice. In Forensic Science

and Medicine, the ABO and Rh blood group system have been

a major focus, since the record of this blood group system is a

very prevalent one. A, B and O (H) antigens on erythrocytes are

J Punjab Acad Forensic Med Toxicol 2018;18(1) ISSN : 0972-5687 DOI: 10.5958/0974-083X.2018.00001.8

6

ABSTRACT :

Introduction: Establishment of identity is an important component of medico legal practice. Among the various comparative data

techniques available for identification, fingerprints has long been regarded as the greatest contribution to the police force.

Objective:To establish a possible relationship between fingerprint pattern and Rh blood group.

Methods: The present cross-sectional study was carried out on 500 (250 male & 250 female) subjects of Indian origin above the age

of 18 years, who were selected randomly from the students & staff members from various educational institutions of JSS Academy

of Higher Education and Research, Mysuru.

Results: 93.8% subjects in the study were Rh positive, of which 31.8% belonged to blood group O, 29.8% belonged to blood group

B, 24.8% belonged to blood group A and 7.4% belonged to blood group AB. Among Rh negative individuals, blood group B and O

had same frequency amounting to 2.2%. 1.8% subjects belonged to Blood group A and none of the subjects in the study were AB

negative. Fingerprint pattern analysis showed that, loops were the most common pattern in the study followed by whorls and arches

respectively among both Rh positive and Rh negative individuals. A non significant association was observed between fingerprint

pattern and Rh blood group.

Conclusion: The association between Rh blood group and fingerprint pattern was not significant. Hence the result of this study

infers that Rh blood group is not an effective tool in predicting the primary fingerprint pattern of the individual when Rh blood group

is known.

Correlation Study Between Fingerprint Patterns and Rh Blood Group1. Smitha Rani, Assistant Professor*

2. Balaraj BM, Professor*

*Department of Forensic Medicine and Toxicology, JSS Academy of Higher Education and Research, Mysuru, Karnataka,

India.

present since birth and can be determined from soft tissues,

hair, nails, dental tissues and bone and in about 80 % of the

individuals. They can be demonstrated in all body fluids except

the cerebrospinal fluid.

Aside from the antigens of the ABO system, those of

the Rh system are of the great clinical importance. The “Rh

factor”, named after Rhesus monkey because it was first

studied using the blood of this animal, is a system composed

primarily of the C, D and E antigens, although it actually

contains many more. Unlike the ABO antigens, the Rh system

has not been detected in tissues other than the red cells. D is far

the most antigenic component, and the term “Rh-positive”

means that the individual has agglutinogen D. The “Rh-

negative” individual has no D antigen and forms the anti-D

agglutinin when injected with D-positive cells. The Rh typing

serum used in routine blood typing is anti-D serum. 85% of the

Caucasians are D-positive and 15% are D-negative; over 99%

of the Asians are D-positive. Unlike the antibodies of the ABO

system, anti-D antibodies do not develop without the exposure

of a D-negative individual to D-positive red cells by

transfusion or entrance of fetal blood into maternal [4]circulation .

Both Fingerprint pattern and blood group are

genetically determined. The inheritance of dermatoglyphic

features is said to be polygenic, where individual gene

contribute a small additive effect. Even the genetic basis for

inheritance of blood groups is well established. Fingerprint

pattern and blood group have been extensively but separately

studied. Hence the present study is aimed at studying the

correlation between these two important comparative data

techniques to serve the process of positive identification.

MATERIALS AND METHODS :

After approval by institutional ethics committee, 500 subjects

(250 male and 250 female) of Indian origin and above 18 years

of age were analyzed. Subjects with leprosy, electrical injury,

radiation exposure and those with recent blood transfusion

which cause permanent impairment of finger print pattern

were excluded from the study.

Convenience sampling technique was adopted. Informed

written consent was obtained prior to taking the prints and

determining the blood group. The study was undertaken in the

Department of Forensic Medicine & Toxicology, JSS Medical

College, JSS Academy of Higher Education and Research,

Mysuru,Karnataka, India.

Blood Group Determination :

Blood samples were collected by finger prick with a sterile

lancet, after cleaning the puncture site with 70% ethyl alcohol.

Rapid slide test was done as an assay procedure to determine

the blood group using SPANCLONE monoclonal antibodies

(Blood grouping antisera).

Fingerprint Recording :

The subjects were asked to wash and dry their hands to remove

dirt and grease. Inkless fingerprint pad, square in shape,

measuring 2 inch x 1.5 inch was used to obtain the fingerprints.

The subject was asked to keep his / her arm relaxed and not to

try to help in rolling the fingers as this may cause smearing.

Then the finger bulbs were rolled on the fingerprint pad – “the

thumbs were rolled towards the subject's body and the fingers

were rolled away from the body, i.e. thumb in fingers out

method” (Figure 1).

Figure 1: Ink being smeared on the fingertip by rolling the

finger on inkless fingerprint pad.

And then the rolled impressions of each finger were obtained in

the allotted space for that finger on the Proforma (Figure 2).

Single inkless finger print pad was used to record 800 rolled

impressions.

Figure 2: Inked fingertip being rolled on the proforma to

obtain fingerprint.

Statistical Analysis:

The data obtained was analyzed statistically using SPSS

(Statistical Programme for Social Sciences, version 16.0)

computer software package. Descriptive statistics,

contingency co-efficient test were applied and p-value <0.05

was considered as significant.

7


RESULTS :

Distribution of cases according to Rh blood group

469 (93.8%) subjects in the study were Rh positive, of which

159 (31.8%) belonged to blood group O, 149(29.8%) belonged

to blood group B, 124(24.8%) belonged to blood group A and

37 (7.4%) belonged to blood group AB. Among Rh negative

individuals, blood group B and O had same frequency

amounting to 2.2%. 9 (1.8%) subjects belonged to Blood group

A and none of the subjects in the study were AB negative.

Pattern of fingerprints

Fingerprint pattern analysis showed that, loops were the most

common pattern ( 54%) followed by whorls (39%) and arches

(7%) in the study group .

Distribution of various fingerprint patterns in Rh blood

group

Loops amounted to 59%, whorls 39 % and the Arches 7 % in

the Rh positive individuals. Among the Rh negative subjects,

the frequency of loops, whorls and arches were 59.7%, 37.4%

and 2.9% respectively.

Table No. 1 : Shows correlation between fingerprint

pattern and Rh blood group, which shows P value of more

than 0.05%. Hence, it can be inferred that a non significant

association exists between fingerprint pattern and Rh

blood group.

DISCUSSION :

Fingerprints and blood groups are popular methods of

identification in the field of anthropology worldwide. In the

present study, an attempt was made to study the distribution of

fingerprint pattern in different Rh blood group and to ascertain

the association between pattern of fingerprints and Rh blood

group.

The present study reveals that loop was the most

frequently observed pattern of fingerprint followed by whorl

and arch in both males and females. Gender dimorphism was

not observed. The findings observed was similar to the studies

conducted on Indian population by various researchers in the

[5-7]past .

The studies conducted in North Africa, Southern [8-10]Nigeria, Kenya and Tanzania revealed similar findings .

However, our findings do not coincide with the study

conducted in New Zealand which revealed more abundant

whorls (55.6%) than loops (43.6%) in males and much higher

frequency of whorls (65.6%) and lower frequency of loops [11](33.7%) in females .

The universal distribution of pattern of fingerprint

among various studies conducted in India in the past is higher

frequency of loops, moderate of whorls and low of arches in [12-15]both Rh positive and Rh negative individuals .

In this study, the percentage of loop was highest in

Rh-negative (59.7%) and lowest in Rh-positive (59%) which is [16]dissimilar to findings recorded by Mehta and Mehta ,

[13] [12]Kshirsagar et al and Bharadwaj et al . Whereas the

frequency of whorls was highest in Rh-positive (39%) and

lowest in Rh-negative individuals (37.4%), which correlated [16]with the findings of Mehta and Mehta and was contrary to the

[13] [12]findings of Kshirsagar et al and Bharadwaj et al . The

percentage of arches was highest in Rh-positive (7%) and

lowest in Rh-negative (2.9%) which was in discord with the [12, 13, 16]findings of all the three aforementioned studies .

Two researchers in Indiastudied a sample size of 181

males and 147 females to establish the correlation between

dermatoglyphics and Rh blood group, observations made in

the study showed that the distribution of fingertip patterns

among Rh positive and Rh negative blood group was not [17]significant . This is comparable with the present study.

CONCLUSION :

The study concludes that the most frequent pattern of

fingerprint in Indian population was loop followed by whorl

and arch. There is no significant association between

distribution of fingerprint patterns and Rh blood group. Hence,

the above finding indicates that these characteristics are

independent of each other and may be used independently in

the process of identification.

REFERENCES :

1. Parikh CK. Identification. In, Parikh's Textbook of

Medical Jurisprudence, Forensic Medicine and thToxicology for classrooms & courtrooms.6 ed. New

Delhi: CBS publishers; 2006:2.2-2.14.

2. Vij K. Identification. In, Textbook of Forensic rdMedicine and Toxicology, Principles and Practice. 3

ed. New Delhi: Elsevier; 2005:60.

3. Nandy A. Identification of Individual, Identification

from trace evidences and their other evidential

8

PATTERN TOTAL

RH

TOTAL

Positive

Negative

Loop

2531

54 %

185

59.7 %

2716

54 %

Whorl

1827

39%

116

37.4 %

1943

39%

Arch

332

7.0%

9

2.9 %

341

7%

4690

100 %

310

100 %

5000

100 %


values. In, Principles of Forensic Medicine including rdToxicology.3 ed. Kolkata: New Central Book

Agency (P) Ltd; 2010: 89.nd4. Ganong WF. Review of Medical Physiology.22 ed.

Singapore: The McGraw-Hill Companies;2005:537-

39.

5. Gangadhar M R, Rajashekara R K. Finger

dermatoglyphics of Adikarnatakas: a scheduled caste

population of Mysore city, Karnataka. Man India

1993;83(1&2):183-93.

6. Nithin MD, Balaraj BM, Manjunatha B, Mestri SC.

Study of fingerprints classification and their gender

distribution among South Indian population. Journal

of Forensic and Legal Medicine 2009;16:460-463.

7. V Maled, V Khode, D Maled, A Jain, S Male, K

Ruikar. Pattern of Fingerprints in different ABO and

Rh blood groups. Journal of Indian Academy of

Forensic Medicine 2015;37 (2) : 124-26.

8. Fayrouz INE, Farida N, Irshad AH. Relation between

fingerprints and different blood groups. Journal of

Forensic and Legal Medicine 2012;19:18-21.

9. Igbigbi PS, Msamati BC. Palmer and digital

dermatoglyphic traits of Kenyan & Tanzanian

subjects. West Afr. J Med 2005;24(1):26-30.

10. Jaga B N, Igbigbi P S . Digital and palmar

dermatoglyphics of the Ijaw of Southern Nigeria. Afr.

J Med Sci. 2008;37(1):1-5.

11. Ching Cho. A finger dermatoglyphics of the New

Zealand Samoans. Korean J Bio Sci 1998;2:507-511.

12. Bharadwaj A, Saraswat PK, Agrawal SK, Banerji P,

Bharadwaj S. Pattern of fingerprints in different ABO

blood groups. Journal of Forensic Medicine &

Toxicology 2004;26(1):6-9.

13. Kshirsagar SV, Burgul SN, Kamkhedkar SG.

Maharastra A. Study of fingerprint patterns in ABO

blood group. J Anat Soc India 2003;52:82-115.

14. Mahajan AA. Dermatoglyphics and ABO Blood

Group. Thesis Submitted for MS Anatomy,

Aurangabad; 1986.

15. Shivhare PR, Sharma SK, Ray SK, Minj A, Saha K.

Dermatoglyphic Pattern in Relation to ABO, Rh

Blood Group and Gender among the Population of

Chhattisgarh. Int J Sci Stud 2017;4(11):61-65.

16. Mehta AA, Mehta AA. Palmar dermatoglyphis in

ABO, Rh blood groups. Int J Biol Med Res

2011;2:961-64.

17. K s h i r s a g a r S V, G u n d r e S D . S t u d y o f

dermatoglyphics in Rh blood group. Anatomica

Karnataka 2012;6(1):70-73.

Acknowledgement :

Authors thank all subjects who volunteered to participate in

the study .

Funding : Nil

Conflict of Interest : Nil

9


J Punjab Acad Forensic Med Toxicol 2018;18(1) ISSN : 0972-5687 DOI: 10.5958/0974-083X.2018.00002.X

Chromatographic Separation of Ephedrine, Pseudoephedrine and Phenyl Propanolamine on Silica Gel –G Layers Using Different Solvent Systems

1. Kavita Goyal, Assistant Director, Chemistry Forensic Science Laboratory, G.N.C.T, New Delhi

2. Neha Tomar, Research Associate, Amity Institute of Forensic Sciences, Amity University, Noida

3. Dr. R. K. Sarin, Director RFSL, Amravathi, Andhra Pradesh

4. S.K. Shukla, Professor and Head, Amity Institute of Forensic Sciences, Amity University, Noida


Corresponding AuthorDr. Neha Tomar, Research Associate, Amity Institute of Forensic Sciences, Amity University, Noida Contact No. : +91 81303-21327E-mail : [email protected]

KEYWORDS : Ephedrine, Pseudoephedrine, Phenyl, Propanolamine, Silica Gel-G Layers, Thin Layer Chromatography

Article History:Received: 16 April 2018Received in revised form: 15 June 2018Accepted on: 15 June 2018Available online: 1 July 2018

INTRODUCTION:

Over the years,the use of Ephedrine, Pseudoephedrine and

Phenylpropanolamine [Figure 1-3] in drugs have been

increasing. These drugs are easily available as over the counter

medicine acting as bronchodilators and have been found in

combination with paracetamol, antihistamines etc. for

treatment of various ailments in human and have direct impact

on Central Nervous System. On account of its numerous

effects, there is an increase in manufacture of synthetic drugs

where they are being prepared or modified for various illicit

uses. These drugs are widely produced in clandestine

laboratories and used by athletes. The illicit use of these drugs

lies in their being used as Precursor Chemicals for the

preparation of Amphetamines and Amphetamine Type

Stimulants (ATS). These are similar in structure to

[1]amphetamines and methamphetamines . Ephedrine increases

post-synaptic noradrenergic receptor activity by directly

activating post-synaptic α-receptors and β-receptors.The bulk

of its effect comes from the pre-synaptic neuron being unable

to distinguish between real adrenaline or noradrenaline from [2]ephedrine . The illicit use of these drugs is responsible for

large number of criminal cases being referred to forensic

science laboratories for analysis of samples. Such cases pose a

serious challenge forensic chemists to choose an appropriate

and easy protocol for rapid and accurate detection and

determination of these drug. Thin layer chromatography is a

versatile, fast, easy, robust and economical technique and thus

was chosen for separation and identification of these drugs.

10

ABSTRACT:

Ephedrine, Pseudoephedrine and Phenylpropanolamine are available in combination with antihistamines, Guaifenesin,

Dextromethorphan and paracetamol. These drugs have been widely used for illicit purpose and sometimes multiple doses of these

drugs are taken by athletes for quick relief as therapeutic medicine that crosses the maximum recommended dose and gives positive

test results in dope test analysis. Clandestine laboratories use these medicines as a precursor to manufacture numerous illicit drugs.

Such cases pose a challenge to forensic scientists due to their quick elimination from human body, lack of suitable detection

protocol, complicated and similar chemical structures. The present paper presents Chromatographic separation of Ephedrine,

Pseudoephedrine and Phenylpropanolamine using 27 solvent systems. The drugs were best separated and detected in n-butyl

acetate: Acetone: 1- Butanol: 5 M Ammonia: Methanol (hRf 80, 91, 54) and Ethyl Acetate: Butanone: Formic Acid: Water (hRf

37, 30, 45)

Figure 1: Ephedrine Figure 2: Pseudoephedrine Figure 3 : Phenylpropanolamine


Standard / Sample solutions: The standard drugs were

procured from Indian Pharmacopoeia and the samples were the

seized drugs referred by the investigating agencies to Forensic

Science Laboratory. 100 samples were separated and identified

using various solvent systems. The standard/ sample was

dissolved in 5ml distilled water, made slightly basic (pH 9) and

extracted in Chloroform: Ether (3:1), thrice, taking 10ml each

time, to ensure maximum recovery of the drug. The collected

organic solvent fraction layers were collected, air-dried and [3-4]used for spotting . All other chemicals used and were of

Analytical grade. Deionized water was used in all necessary [5]steps .

Preparation of Solvent System/ Mobile Phase: 27 different

solvent systems were prepared and studied as per details given

in Table. An attempt was made to observe the separation of

Ephedrine, Pseudoephedrine and phenylpropanolamine.

TLC Plates: TLC pre-coated plates silica made by Merck

silica gel G 60 F, layer thickness 0.25mm, was used for

spotting [Figure 4].

Figure 4 : TLC with ninhydrin and iodoplatinate

reagents

11

Table : hRF values of Ephedrine, Pseudoephedrine and Phenylpropanolamine in different solvent systems

S. No.

1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.21.22.23.24.25.26.27.

Ethanol : Methanol: Ammonia(25 %) - 85:10:5 v/v/vChloroform: Ethyl Acetate : Toluene : Methanol : Acetic Acid- 39:39:77:39:6Toluene : Ethyl Acetate: Methanol: Formic acid- 10 : 3:1:2Ethyl Acetate : Butanone :Formic Acid: H O - 10:1:1:12

Chloroform: Methanol- 40 :1n- Hexane : Ethyl Acetate - 9:1Chloroform: Methanol- 7:1n-butyl acetate : acetone : 1- Butanol: 5 M Ammonia: Methanol- 40 : 20 : 20 :10 : 10Toluene : Ethyl Acetate: Methanol- 8:1:1Chloroform Cyclohexane : Acetic Acid- 4:4:2 :

Methanol: Ammonia - 100:1.5Chloroform: Methanol - 9:1Acetone MethanolMethanol : 1- Butanol - 60:40Chloroform: Acetone - 80:20Ethyl Acetate: Methanol: Ammonia --85:10:5Ethyl Acetate Ethyl Acetate : Ethanol- 90:10Chloroform Methanol: Propionic acid - 72:18:10 :

Cyclohexane : Toluene : Diethyl amine - 75 :15:10Chloroform Ammonia :2- propanol - 5:15:80 :

Ethyl Acetate : Methanol: Ammonia - 7:1.5:1Methylene chloride: Ammonia: 2- Propanol – 5:15:80n- hexane: Toluene: 1,4 dioxane–3:3:11,4 dioxane: Methanol: Chloroform: Ammonia – 6:2:2:1 Ethyl acetate: n- heptane – 1:1

Solvent Systems Phenypropanolamine

Ephedrine Pseudoephedrine

482001450502185404074604000000003031011903

5575005600

302001370203218005103205011065012739011708

4968002600

321802300302229105103504630902012336001358

4371002400

Sample Application: Micro capillary tubes were used for

spotting the sample solution to chromatographic plate for

analysis.

Development Tank : Ascending technique is used for TLC

separation with the respective solvent system in the

development tank. The top of the development tank was

covered with an air tight lid to allow saturation of solvent

vapours for fifteen minutes. The plate was placed in odevelopment chamber at room temperature (25 C).

The spotted TLC plates were developed in the solvent system

shown in Table for 10 cm from the spotting point. The spots

were visualized under UV light of 254 nm/366 nm followed by

spray of chromogenic reagent. hRf values were calculated

using the formula:

hRF= Distance travelled by solutex100/ Distance travelled

by mobile phase.

Preparation of visualizing reagent:.Chromogenic Reagent,

acidified potassium iodoplatinate reagent was used to visualize

the plates after developing in the above mentioned 27 solvent

systems. The developed spots were of coffee brown coloured

spot. The spots were matched and tallied with standard of

Ephedrine, Pseudoephedrine and phenyl propanolamine.

RESULTS AND DISCUSSION :

Selected solvent systems n-butyl acetate: Acetone: 1- Butanol:

5 M Ammonia: Methanol (40 : 20 : 20 :10 : 10) was found to

provide the best separation of these three drugs, as it gives clear

oval shape dense spot separating all the three drugs. Another

better solvent system for separating these drugs is Ethyl

Acetate: Butanone: Formic Acid: Water (10:1:1:1 v/v/v/v).

Third being Ethyl Acetate: Methanol: Ammonia (7:1.5:1

v/v/v).

Separated spots were well visualized under UV light at 254 nm

and finally using chromogenic reagent acidified potassium

iodoplatinate reagent giving coffee colored spot. The spots

from the extracted residues tallied with the spots of controlled

drug sample of Ephedrine, Pseudoephedrine and Phenyl

propanolamine.

CONCLUSION :

TLC is simple, accurate, reproducible,low-cost and fast

method. Also, it is a very versatile technique due to the

availability of a wide range of possible developing systems. As

the similarity in structure and molecular weight pose a

difficulty in identification of these drugs (without

derivatization) by using sophisticated instrumentation viz,

GC-MS, the mobile phases were developed for easy and

confirmatory determination. The present method can be

routinely used for the analysis of Ephedrine, Pseudoephedrine

and Phenylpropanolamine and it will be valuable method in

drug profiling.The method will be of high use, valuable and

most suitable for Crime Laboratory Analyst and Forensic

Chemist receiving cases with increased attention from

judiciary.

Conflict of Interest: Nil

REFERENCES:

1. Fulton , C. (1969). Modern microcrystal tests for drugs. New

York : Wiley Interscience.

2. Swarbrick, J. (1986). Clarke's Isolation and identification of

drugs. In A. C. Moffat, Clarke's Isolation and identification of

drugs (p. 1248). London: Pharmaceutical Press.

3. Martin WR, Sloan JW, Sapira JD, Jasinski DR. Physiologic,

subjective, and behavioral effects of amphetamine,

methamphetamine, ephedrine, phenmetrazine, and

methylphenidate in man. Clinical Pharmacology &

Therapeutics. 1971. 245-258.

4. Wishart D, Feunang Y, Guo A, Marcu L, Grant J, Sajed T, et al.

Drug Bank 5.0: a major update to the Drug Bank database for

2018. Nucleic Acids Research.

5. Makhija SN, Vavia PR. Stability indicating HPTLC method for

the simultaneous determination of pseudoephedrine and

cetirizine in pharmaceutical formulations. Journal of

pharmaceutical and biomedical analysis. 2001. 663-67.

6. Zakrzewska A, Parczewski A, Kaźmierczak D, Ciesielski W,

Kochana J. Visualization of Amphetamine and Its Analogues in

TLC. Acta Chimica Slovenica. 2007 Mar 1;54(1).

7. Wills S. (1997). Drugs of Abuse. The Pharmaceutical Press, pp.

62-75.

8. Sinnema A, Verweij AM. Impurities in illicit amphetamine: a

review. Bull. Narc. 1981 .37-54.

9. Puthaviriyakorn V, Siriviriyasomboon N, Phorachata J, Pan-ox

W, Sasaki T, Tanaka K. Identification of impurities and statistical

classification of methamphetamine tablets (Ya-Ba) seized in

Thailand. Forensic Science International. 2002. 105-113.

10. Makino Y, Kurobane S, Miyasaka K, Nagano K. Profiling of

ecstasy tablets seized in Japan. Microgram Journal. 2003. 169-

76

11. Adamowicz P, Chudzikiewicz E, Lechowicz W. Illicit “ecstasy”

tab lets in South ern Po land: a two-year re view. Problems of

Forensic Sciences. 2003. 100-106.

12. Lim , M., Ng, K. H., & Lee, T. K. (2003). Abuse of amphetamine-

type stimulants in Singapore. Forensic Science International,

136.

13. Verweij, A. M. (1992). Impurities in illicit drug preparation: 3,4-

(metylenedioxy)- amphetamine and 3, 4-( metylenedioxy)-

methyl amphetamine. Forensic Science Review, 137-46.

14. Sharma SP, Purkait BC, Lahiri SC. Qualitative and quantitative

analysis of seized street drug samples and identification of

source. Forensic science international. 2005. 235-40

12


Lightning Deaths in Tigray Region, Northern Ethiopia

Rajeev Varma Manukonda, Assistant Professor, Department of Forensic Medicine and Toxicology, Govt Medical College,

Ambikapur, Chhattisgarh.

Enyew Debash*, S esen Tsegaye*

DharmarayaIngale, Professor and Head, Department of Forensic Medicine and Toxicology, Karuna Medical College,

Palakkad, Kerala.

*Resident, Department of Forensic Medicine and Toxicology, Ayder Comprehensive Specialized Hospital, College of Health

Sciences, Mekelle University, Mekelle, Ethiopia.



Dr. Rajeev Varma Manukonda

Assistant Professor,

Govt Medical College, Ambikapur, Chhattisgarh. 497001

E-mail: [email protected]

KEYWORDS : Thunderbolt lightning, Lightning deaths, Safety precautions, Litchenburg figures, Blast effect,

Mechanism of lightning.

Article History:Received: 17 March 2018Received in revised form: 25 March 2018Accepted on: 25 March 2018Available online: 1 July 2018

INTRODUCTION :

“Lightning kills 25 amid extensive drought in East Africa:

Sudan Tribune, 27th July 2011.” This news in one of the online

news channels initiated the thought of studying deaths related

to lightning in Tigray region of northern Ethiopia. The global

incidence of lightning is studied in some parts of the world but

no such studies have been done on the Tigray region of

northern part of Ethiopia. The African continent as such

receives the highest lightning strikes with Congo basin toping

the list.

The Optical Transient Detector (OTD) is a space-based

instrument used to detect and locate lightning discharges to

Earth. Statistical analysis to the data collected by OTD

revealed that Earth receives nearly 1.4 billion flashes annually

which are roughly 39-49 flashes per second. Analysis of the

data collected by OTD also revealed an interesting fact that the

ratio of flashes to land and water is nearly 10:1 which means

that the land experiences 10 times more flashes than water

bodies. Ethiopia being a land locked country, is particularly

vulnerable to lightning. The Congo basin, which includes

Democratic Republic of Congo and Rwanda, is considered to _2 _1have peak mean annual flash density of 80 fl km yr highest in

the African continent. Ethiopia has a mean annual flash density _2 _1 [1]of 33.1 fl km yr is not further down the list .

13

ABSTRACT :

Introduction: An individual found dead in an isolated place with torn clothing, disrupted footwear, evidence of burn marks on the

body, lacerations and fractured bones will really present a confusing picture to the investigation authorities and the autopsy surgeon

as to the involvement of foul play. Similar picture can be present in a person struck with thunderbolt lightning. Though the manner

of death is suggestive of homicide. It is in reality due to lightning stroke which is accidental in 100% of cases. The present study is

undertaken to understand the various presentation of victims of lightning and to achieve the other mentioned formulated study

objectives.

Objectives: To study the prevalence of deaths due to lightning during the study period, demographic profile of victims, the various

injuries sustained and mechanisms involved in lightning stroke and the various safety precautions to be undertaken during an event

of thunderstorm.

Methods: A Cross-sectional study design for the study of deaths due to lightning. Data collected in a data collection sheet

developed considering the various study variables.The data collected is analyzed with SPSS statistical software 16.

Results :Majority of the victims are farmers (87%) in the age group of 31-50 years (78.2%) with a male predominance ratio of 7:1.

Conclusion: The importance of lightning deaths should be understood and research in this much neglected field should be

intensified. A clear understanding of mechanism of lightning and varied presentations of these injuries is essential to arrive at a

conclusion in a rather confused autopsy picture.People should be educated about the hazards of lightning and the safety precautions

discussed should penetrate the deepest core of the society.

Some of the news relating to lightning strokes which shook the

African continent and grabbed media attention are listed [2]below :

l Kenyans Alarmed as Lightning kills 20 people within one thweek : Julalo, 05 July 2011.

l Lightning Kills 19 in Gombe, Yobe, Bauchi - Man Loses thTwo Wives, Two Children : Vanguard, 29 June 2011.

thl Lightning Kills 3 Children The New Times, 28 June 2011.

l Lightning kills 7 school children in Darfur : Gulf News, th17 August 2010.

MATERIALS AND METHODS : After approval from

institutional ethical review board, present retrospective study

was conducted on 23 cases of lightning fatalities over a period

of two years from September 2015 to August 2017 at

Department of Forensic Medicine and Toxicology of Ayder

Comprehensive Specialized Hospital. Detailed history was

collected from investigating officers and family members. The

circumstances relating to the death were carefully analyzed.

The cases which are concluded to have died due to lightning,

are included in the study. Cases in which conclusion is not

arrived are excluded from the study. A data sheet was prepared

with various study variables for data collection. Collected data

was analyzed with SPSS 16 software. Data was cross checked

to keep missing data to zero percent.

RESULTS : A total of 356 autopsies were performed during

the study period, out of which 23 deaths were due to

thunderbolt lightning. Among these cases male are 20 (87%)

and females are 3 (13%). Majority of the victims (47.8%)

belong to 31-40 years age group followed by 41-50 years. 31-

50 years accounted for majority of the victims (78.2%).

Majority of the victims were farmers (87%) (Table 1).

Table 1 : Age Wise Distribution of Cases

Month Wise Distribution of Cases :

Seventy four percent of the deaths occurred during the

Ethiopian summer months (June, July and August) followed

by 22% of deaths during the autumn season (March, April and

May). Sixty one percent of the deaths occurred in the middle of

the week during Wednesday.

Time Wise Distribution of Cases :

Majority of the death (52%) occurred between 12 pm to 6 pm

followed by 35% of deaths occurring between 6am-12 pm and

6 pm -12 am.

Blast Effect : Twenty one cases (91%) showed blast effect as a

result of lightning (Figure1).

Out of the 18 cases in which the lightning struck the thorax and

shoulder, 17 cases (94%) showed blast effect. Lightning struck

over the thorax and shoulder in 18 cases. In rest 5 cases, could

not be ascertained, the area of struck, with 100 percent

accuracy.

Injuries Sustained : Fourteen cases (78%) out of 18 where the

lightning struck the thorax showed abrasions on various parts

of the body. Eighty three percent (19 cases) of the cases

showed contusions. Fifteen cases (83%) out of 18 where the

lightning struck the thorax showed contusions on various parts

of the body. Only six cases (26%) showed lacerations and there

is no significant association between the point of entry of

lightning into the body and lacerations. Seventeen cases out of

23 (74%) had no lacerations. All the cases (100%) showed

burns ranging from superficial to deep burns.

Internal Findings : All the cases (100%) in which the point of

entry of high voltage lightning is head and neck showed

multiple fractures of the cranium. Majority of the cases (74%)

showed no specific findings internally. Twenty six percent of

the cases which showed specific internal findings ranged from

petechial hemorrhages on the heart, lungs and brain to

fractures of bones. Seventy four percent of the cases did not

show any specific internal finding(Table 2).

DISCUSSION : The male predominance in this study (87%)

can be understood by the fact that males form the major

working group in Ethiopia and are constantly involved in

14

0-10 Yrs.

21-30 Yrs.

31-40 Yrs.

41-50 Yrs.

51-60 Yrs.

Total

Frequency Percent ValidPercent

CumulativePercent

2

1

11

7

2

23

8.7

4.3

47.8

30.4

8.7

100.0

8.7

4.3

47.8

30.4

8.7

100.0

8.7

13.0

60.9

91.3

100.0


Figure 1 : Blast Effect on Footwear

Total

Count Total

1

1

2

16

5

21

17

6

23

Specific finding

Absent

Present

Blast Effect

Absent Present

No. ofCases

outdoor activities. Most of the victims (78%) belong to the

third and fourth decade of life.

Eighty seven percent (87%) of the victims were farmers and

most of them were struck by lightning while they were farming

land or herding cattle. Most of the Ethiopian population

inherits land and cattle farming and herding cattle is the major [5]occupation in rural areas of Tigray .

74% of deaths occurred during June-August followed by 22%

of deaths during March-May. June-August are the typical

Ethiopian summer months known as Kiremt or Meher during

which Ethiopia experiences heavy rain fall and thunder storms.

March-May are the Ethiopian autumn season known as Tseday

with occasional showers. Most of the people will be working

outdoors especially in open fields farming land or herding [6-7]cattle during these seasons .

83% of the deaths happened during weekday with 60%

occurring on Wednesday. Most people of Ethiopia work five

days a week from Monday to Friday. During the weekends i.e.,

Saturday and Sunday people will be spending time mostly

indoors with friends and family and attending church. Similar [3-4]results were found in other studies .

Lightning struck between 12 pm to 6 pm resulting in majority

of deaths (52%). The rains in northern Tigray typically follow

a timely pattern mostly showering at a particular time of the

day. Though for the purpose of the study 24 hrs of a day are

divided in to four groups with interval of six hours, 100% of the

cases observed between 12pm to 6 pm occurred between 12pm

to 3pm.

91% of the cases showed blast effect which includes disruption

of clothing, tears in shoes and blunt injuries on the body due to

being blown away. The location where the lightning struck the

body showed a strong association with blast effect. 94% of the

victims who were struck on thorax and shoulder showed blast

effect. Sudden expansion of the explosive air around the track

of current is responsible for this type of blast effect. All the

victims who were struck by lightning in an open field showed [8]blast effect .

Various types of injuries caused by blunt force impact such as

abrasions (78%), contusions (83%), lacerations (26%) and

fractures were observed on external and internal examination.

The injuries were caused by the explosive force of the shock

wave produced by the high voltage electric current of

lightning. In the absence of specific findings, lack of proper

history and eye witnesses and presence of evidence of blunt

trauma will create a very confusing picture.

All the cases where the point of impact was the head showed

fractures of the cranium. Once the lightning strikes the head,

the wave crosses the scalp which does not offer much

resistance to reach a much resistant cranium. On the cranium

the electric current will spread in search of pathway which

offers least resistance. The cranial orifices allow the current to

enter the cranial cavity with ease. If the force of electric wave

exceeds the threshold of elasticity of the cranium, the bone

fractures. All the bones of the cranium should be properly

examined for fractures. Special attention should be directed

towards the cranial orifices where the probability of finding [8]hairline fractures is more .

100% cases showed burns ranging from superficial to deep

burns. Ninety nine percent of these cases showed superficial

burns. Because lightning contact is for a very short period of

time, in the order of milliseconds. Extensive tissue damage

with second and third degree burns will not be present. Second

and third degree burns can only happen if the clothing of the

victim catches fire or any metal objects which are in contact

with the victim gets heated up due to transfer of tremendous

amount of energy from lightning. In the latter case it is more of

an imprint burn mark. All the burn injuries should be

thoroughly examined as in most of the cases it might be the [9,10]only finding . The classical Litchenburg figures were

observed in 26% of the cases in our present study.

Majority of the cases (74%) showed no specific findings

internally. Out of these cases without any specific internal

finding, 94% of cases showed blast effect on the body. These

numbers observed in the present study highlight the fact that

the external findings such as blast effect, superficial burns and

blunt injuries could be the only possible finding at autopsy and

should not be missed. The aqueous nature of internal organs

and presence of many electrolytes provide a less resistant

diffuse pathway for electric current preventing the occurrence [11,12]of any gross finding of thermal damage .

[8] MECHANISM OF LIGHTNING STROKE :

Lightning occurs when there is discharge of electricity

between clouds, when this charge jumps between cloud and

earth, it is called Lightning strike. Each lightning stroke is

actually a combination of strokes. The leader stroke is the

discharge originating from the clouds meeting the pilot stroke

originating from the earth and travelling towards the cloud.

Once the leader stroke and pilot stroke meet a return stroke is

formed which rises from earth to cloud completing a circuit.

The entire process occurs so quickly in less than one-half of a

15


Table 2 : Internal Findings and Blast Effect

second the entire flash is perceived as one single stroke. [13-14]SAFETY PRECAUTIONS :

1. If you are anticipating thunderstorm and the hair on

your body stands or skin tingles, it indicates strong

electric field. Seek shelter immediately.

2. The varied landscapes of Tigray region offer vast

open fields and high mountains. These open fields

with high projecting objects should be avoided.

3. If you are caught in open fields crouch down like a

baseball catcher so that the smallest possible target is

presented and do not lay flat on the ground. The only

thing touching the ground should be the balls of your

feet.

4. Cover both ears with hands tightly. This will

minimize hearing loss from loud thunder clap.

5. The agricultural lands in most part of Tigray are

nurtured by wells found adjacent to the land which

are used to store water for farming. It is advisable to

get out of water and move away from water bodies.

6. Seek shelter in a closed building. Stay away from

metal conductors, doors, windows and plumbing.

7. In an open field do not seek shelter under isolated

trees or buildings. Majority of lightning strikes occur

on isolated tall trees.

8. If you are caught in a vehicle, roll the window glass

and avoid contact with metal conductors

9. Avoid using mobile phones, radio, computer and

transistors.

10. Follow 30-30 rule. When the time gap between

visualization and hearing a thunder is less than or

equal to 30 sec, immediately seek shelter.

CONCLUSION :

The observations made in the present study are only the tip of

an iceberg. Lightning deaths are much more prevalent and their

incidence is increasing every year. More research has to be

undertaken to properly address and understand the problem

and prepare for major disasters due to lightning. The family

members, health care professionals and police personnel

should be educated regarding the precautions to be undertaken

while dealing with a case of lightning deaths. The safety

precautions discussed above should be taught to the people of

remote areas who are most vulnerable.

LIMITAIONS OF STUDY :

During our study period of two years, 23 deaths occurred due

to lightning were autopsied. This number cannot be used for

calculating true prevalence rate of deaths due to lightning in

Tigray region for various reasons such as, not all deaths due to

lightning are being reported to police and not all reported cases

are being autopsied. The reason for this is most of the Tigray

region has remote rural areas which don't have access to proper

and timely transport, the financial burden the family has to bare

while transporting the body for examination and back to

cremation ground back in the remote rural areas and lack of

knowledge that such type of deaths need to be reported to

police for postmortem examination.

Funding: Nil

Conflicts of Interest: None

REFERENCES :

1. Christian HJ, Blakeslee RJ, Boccippio DJ, Boeck WL,

Buechler DE, Driscoll KT, et al. Global frequency and

distribution of lightning as observed from space by the

Optical Transient Detector. J Geophys Res. 2003;108.

2. Mary AK, Gomes C. Lightning Accidents In Uganda. In:

2012 International Conference on Lightning Protection

(ICLP), Vienna, Austria. 2012. p. 1–6.

3. Guntheti BK, Singh UP. Profile and Analysis of Lightning

Victims Brought to MGH , Khammam ; Telangana State. J

Indian Acad Forensic Med. 2015;37(3):258–62.

4. Korah MK, Guria J, Mahto T, Bhengra A. Profile and

Analysis of Lightning Victims Brought To RIMS ,. IOSR J

Dent Med Sci. 2016;15(11):26–9.

5. Gebre-selassie A, Bekele T. A Review of Ethiopian

Agriculture : Roles , Policy and Small-scale Farming

Systems. 1999.

6. Korecha D, Barnston AG. Predictability of June –

September Rainfall in Ethiopia. Mon Weather Rev.

2006;135:628–50.

7. Seleshi Y, Zanke U. Recent changes in rainfall and rainy

days in ethiopia. Int J Climatol. 2004;24:973–83.

8. Anne A, Lewis ME. Understanding the principles of

lightning injuries. J Emerg Nurs. 1997;(December

1997):535–41.

9. Ritenour AE, Morton MJ, Mcmanus JG, Barillo DJ,

Cancio LC. Lightning injury : A review. Burns.

2008;34:585–94.

10. Cooray V, Cooray C, Andrews CJ. Lightning caused

injuries in humans. J Electrostat. 2007;65:386–94.

11. Saukko P, Knight B. Knights Forensic Pathology. 3rd ed.

London: Hodder Arnold; 2004. p333.

12. Vij K. Text book of forensic medicine and toxicology.

Principles and practice. 5th ed. India: Elsevier; 2011. p179 .

13. Zimmermann C, Cooper MA, Holle RL. L ightning Safety

Guidelines. Ann Emerg Med. 2002;(June):0–5.

14. Col L, Nagesh I V, Col L, Bhatia P, Mohan CS, Lamba

BNS. A bolt from the blue : Lightning injuries. Med J

armed forces india. 2015;71:134–37

16


Informed Consent in Medical Treatment – KAP Study1. Nidhi Sachdeva, Assistant Professor*

2. Vivek Srivastava, Associate Professor*

3. Ashok Najan, Assistant Professor*

*Netaji Subhash Chander Bose Medical College, Jabalpur.



Dr. Nidhi Sachdeva,


Department of Forensic Medicine

Netaji Subhash Chander Bose Medical College, Jabalpur.

Contact : +91 95890-04138

Email : [email protected]

KEYWORDS : Informed Consent, Awareness, Medico-legal.

Article History:Received: 15 March 2018Received in revised form: 25April 2018Accepted on: 25 April 2018Available online: 1 July 2018

INTRODUCTION :

The element of consent is one of the critical issues in the area of

medical treatment today. It is well known that the patient must

give valid consent to medical treatment; and it is his

prerogative to refuse treatment even if the said treatment will

save his or her life. No doubt this raises many ethical debates

and falls at the heart of medical law today. The earliest

expression of this fundamental principle, based on autonomy, [1] is found in the Nuremberg Code of 1947 .The code makes it

mandatory to obtain voluntary and informed consent of human

subjects. Similarly, the Declaration of Helsinki adopted by the

World Medical Association in 1964 emphasizes the

importance of obtaining freely given informed consent for

medical research by adequately informing the subjects of the

aims, methods, anticipated benefits, potential hazards, and [2] discomforts that the study may entail . The circle of legal

development in the area (i.e., consent) appears to be almost

complete when the apex court in India recently ruled that, it is

not just the 'consent' or 'informed consent' (as it is known

worldwide) but it shall also be 'prior informed consent'

generally barring some specific cases of emergency. This

places a medical professional in a tremendous dilemma.

Hence, it is time to revisit the area of 'consent and medical

treatment' to understand the sensitive and underpinning

elements. Informed consent is an integral part of patient-

centered medical care. It occurs in almost every patient

encounter. Documenting your discussion with the patient is

important. In general, it is always useful to note that "patient

understands plan" at the end of a patient note.

Consent can be either expressed or implied. Expressed

consent may be written or verbal. Implied consent is indicated

by the demeanor and behavior of the patient and is adequate for


17

ABSTRACT:

Introduction: The circle of legal development in the area (i.e., consent) appears to be almost complete when the apex court in India

recently ruled that, it is not just the 'consent' or 'informed consent' (as it is known worldwide) but it shall also be 'prior informed

consent' generally barring some specific cases of emergency. Doctors are increasingly being criticized for imposing treatment

without adequate consent.

Objective: The: present study was conducted to know the level of awareness, knowledge and actual practice pattern of the informed

consent among all age groups of practicing doctors (Both clinical and Non-clinical branches).

Material and Method: The questionnaire was designed which comprised of around 19 questions, to test the knowledge of how,

when and in what form the consent has to be taken, attitude of the physician, when they are taking the consent and to know the actual

practice pattern which is being practiced.

Result: In the present study it was found that doctors of age more than 35 years, only 73.3 % knew about the difference between

consent and informed consent. In Doctors of less than 35 years of age, 92.9 % knew the difference.In the present study it was found

none of the senior doctors have faced any litigation as compared to the junior doctors. This shows that the risk of practioners facing

litigation is increasing day by day.

Conclusion: There is a continuous need of up gradation of Medico legal knowledge in the form of CMEs, workshops, Medico-legal

lectures in other platforms like specialized conferences etc.

knowledge about informed consent while giving treatment to

their patients. The questionnaire used has been included.

Chi Square test applied, P value is significant if p<0.05 and

highly significant if p<0.01.

RESULTS : Questions and Answers are tabulated below :

Question No. 1

How do you obtain consent

before any treatment procedure?

verbal or written

Cor

rect

Inco

rrec

t

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

11

15

15

11

19

7

78.6

100.0

93.8

84.6

90.5

87.5

3

0

1

2

2

1

21.4

0.0

6.3

15.4

9.5

12.5

14

15

16

13

21

8

0.058

0.42

0.81

routine general examinations but special examinations such as

vaginal, rectal etc, require express consent to be taken. For

more complicated diagnostic and therapeutic procedures like

endoscopy or for surgical procedures, written consent is

essential.

Doctors are increasingly being criticized for imposing

treatment without adequate consent. Capacity remains the

cornerstone of the Medico-legal doctrine of informed consent.

Although capacity to consent is ultimately a legal construct,

doctors of all specialties must assess their patient's capacity to

consent on a variety of issues. Although guidelines are

available, there is no gold standard for the assessment of

capacity. Doctors in general are expected to know the standard

for capacity, but may at times apply them incorrectly.

As far as possible, consent must be obtained after explaining

the nature and consequences of the treatment procedure being

contemplated in the presence of disinterested third party such

as nurse or receptionist. This is termed as informed consent.

Failure to take informed consent can expose a doctor to legal

action if anything goes wrong during a particular procedure.

Informed consent help patients make informed decisions about [11,12]their proposed treatments . The concept of informed

[13,14]consents is rooted in moral, cultural, and legal principles .

Informed consents are often perceived as necessary for legal [15]protection against malpractice claims . Present Study has

been conducted to know about level of theoretical knowledge

of doctors with the actual implementation in their routine

practice and to compare actual and correct use of informed

consent among medical and surgical fields.


The present KAP study is a cross sectional & hospital based

study performed on 29 randomly selected Medical

practitioners (faculty members both young and old, males and

females, clinical and non-clinical, of the different specialties),

via a questionnaire after taking prior permission from dean and

medical superintendent. Doctors were very supportive,

encouraging and enthusiastic while answering the

Questionnaire. Coding was done to interpret answers

statistically. 1- for yes, 2- for No. After preparing master

chart, results were interpreted using SPSS IBM 20 software.

Identity of the doctors were not disclosed. Post analysis a

seminar was conducted about informed consent.

The questionnaire comprised of 19 questions, to test the

knowledge of how, when and in what form the consent has to

be taken, attitude of the physician, when they are taking the

consent and to know the actual practice pattern which is being

practiced. 11 questions (1-11) were included to test the

Knowledge, 3 questions (12-14) to test the attitude and 5

questions (15-19) to know about how they practice their


18

Question No. 2Whether consent is taken

in proper printed format or on plain paper

orPatient own hand writing

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

6

13

10

9

14

5

42.9

86.7

62.5

69.2

66.7

62.5

8

2

6

4

7

3

57.1

13.3

37.3

30.8

33.3

37.5

14

15

16

13

21

8

0.013*

0.71

0.82

Cor

rect

Inco

rrec

t

Question No. 3Before taking consent,

what information isgiven to the patient?

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

14

10

15

9

18

6

100.0

66.7

93.8

69.2

85.7

75.0

0

5

1

4

3

2

0.0

33.3

6.3

30.8

14.3

25.0

14

15

16

13

21

8

0.017*

0.082

0.49

Cor

rect

Inco

rrec

t

Question No. 7Have you attend any

CME/Workshop?

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

4

10

8

7

9

6

28.6

66.7

50.0

53.8

42.9

75.0

10

5

8

6

12

2

71.4

33.3

50.0

46.2

57.1

25.0

14

15

16

13

21

8

0.041*

0.83

0.12

Question No. 8Do you know what is therole of ethical committeein a medical College &

amp: Hospital?

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

3

7

6

4

6

4

21.4

46.7

37.5

30.8

28.6

50.0

11

8

10

9

15

4

78.6

53.3

62.5

69.2

71.4

50.0

14

15

16

13

21

8

0.15

0.71

0.27

Question No.9-A

Who will give consent for treatment (Medical

and Surgical): If the Patient below18 Years.

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

13

9

13

9

15

7

92.9

60.0

81.3

69.2

71.4

87.5

1

6

3

4

6

1

7.1

40.0

18.8

30.8

28.6

12.5

14

15

16

13

21

8

0.038*

0.45

0.36

Cor

rect

Inco

rrec

t

Question No. 6Do you know that: any written consent taken

from a patient in a properformat and manner cansave you from litigation?

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

11

14

15

10

19

6

79

93

94

77

90

75

3

1

1

3

2

2

21

7

6

23

10

25

14

15

16

13

21

8

0.25

0.19

0.28

Question No. 5Do you know the

difference between consent and informed

consent?

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

13

11

14

10

17

7

92.9

73.3

87.5

76.9

81.0

87.5

1

4

2

3

4

1

7.1

26.7

12.5

23.1

19.0

12.5

14

15

16

13

21

8

0.16

0.45

0.67

Question No. 4In which languages do

you explain andtake consent form the

patient?

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

14

12

15

11

18

8

100.0

80.0

93.8

84.6

85.7

100.0

0

3

1

2

3

0

0.0

20.0

6.3

15.4

14.3

0.0

14

15

16

13

21

8

0.077

0.42

0.26

Cor

rect

Inco

rrec

t


19

Question No.12

Do you explain youself,about treatment procedure/surgical procedure when

patient is underyour care before obtaining

consent?

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

13

13

14

12

18

8

92.9

86.7

87.5

92.3

85.7

100.0

1

2

2

1

3

0

7.1

13.3

12.5

7.7

14.3

8

14

15

16

13

21

8

0.58

0.62

0.25

Cor

rect

Inco

rrec

t

Question No.11

Is consent thought electronic media valid?

(a) Email (b) Whatts app (c) Video conferencing

(d) SMS

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

6

1

7

1

4

2

42.9

6.7

43.8

7.7

19.0

25.0

8

14

9

12

17

6

57.1

93.3

56.3

92.3

81.0

75.0

14

15

16

13

21

8

0.022*

0.031*

0.072

Cor

rect

Inco

rrec

t

Question No.9-B


and Surgical): If Patient above 18 Years.

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

13

9

15

8

16

7

92.9

60.0

93.8

61.5

76.2

87.5

1

6

1

5

5

1

7.1

40.0

6.3

38.5

23.8

12.5

14

15

16

13

21

8

0.038*

0.033*

0.51

Cor

rect

Inco

rrec

t

Question No.9-C


and Surgical): If Patientbetween

12-18 Years.

Pre

sen

ts

No

An

s.

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

12

9

12

9

14

7

85.7

60.0

75.0

69.2

66.7

87.5

2

6

4

4

7

1

14.3

40.0

25.0

30.8

33.3

12.5

14

15

16

13

21

8

0.12

0.73

0.26

Question No.10

In emergency situationdo you think that

consent is necessary?

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

2

3

3

2

5

0

14.3

20.0

18.8

15.4

23.8

0.0

12

12

13

11

16

8

85.7

80.0

81.3

84.6

76.2

100.0

14

15

16

13

21

8

0.68

0.81

0.13

Cor

rect

Inco

rrec

t


20

Will you take consent from all indoor patient or

selective patient?

Age [years]

Sex

SpecialtyClinical

Non Clinical

<35

>35

F

M

8

5

7

6

9

4

Cor

rect

Question No.13

Total P Value

% %

57.1

33.3

43.8

46.2

42.9

50.0

6

10

9

7

12

4

42.9

66.7

56.3

53.8

57.1

50.0

14

15

16

13

21

8

0.19

0.89

0.72

Inco

rrec

t

Question No.15

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

6

12

10

7

11

6

42.9

80.0

62.5

53.8

52.4

75.0

8

3

6

6

10

2

57

20

38

46

48

25

14

15

16

13

21

8

0.039*

0.63

0.26

How do you take consentin

(a) Proper Format (b) Plane Paper

(c) Approved Printed Format

Cor

rect

Inco

rrec

t

Do you take informed consent(a) Before any surgical procedure?

(b) In case of poor prognosis(c) For staying in a hospital with

available facilities(d) All indoor patients.

(e) All of the above.

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

12

7

11

7

9

7

85.7

46.7

68.8

53.8

42.9

87.5

2

8

5

6

12

1

14.3

53.3

31.3

46.2

57.1

12.5

14

15

16

13

21

8

0.027*

0.41

0.031*

Cor

rect

Inco

rrec

t

Question No.14


21

Cor

rect

Inco

rrec

t

Question No.16

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

10

13

13

10

18

5

71.4

86.7

81.3

76.9

85.7

62.5

4

2

3

3

3

3

28.6

13.3

18.8

23.1

14.3

37.5

14

15

16

13

21

8

0.31

0.72

0.17

Do you think format for all treatment is same

or different Question No.19-B

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

8

10

10

8

17

3

57.1

66.7

62.5

61.5

81.5

37.5

6

5

6

5

4

5

42.9

33.3

37.3

38.5

19.0

62.5

14

15

16

13

21

8

0.59

0.96

0.023*

While examining the Accused of rape, informed

consent should betaken or not?

Question No.18

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

1

0

1

0

1

0

7.1

0.0

6.3

0.0

4.8

0.0

13

15

15

13

20

8

92.9

100.0

93.8

100.0

95.2

100.0

14

15

16

13

21

8

0.29

0.54

0.53

Have you faced any litigation Because of nottaking proper informed

consent?

Question No.19-A

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

11

13

14

10

18

6

78.6

86.7

87.5

76.9

85.7

75.0

3

2

2

3

3

2

21.4

13.3

12.5

23.1

14.3

25.0

14

15

16

13

21

8

0.56

0.45

0.49

While examining the victim of rape, informed

consent should betaken or not?


22

Question No.19-E

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

4

4

4

4

5

3

28.6

26.7

25.0

30.8

23.8

37.5

10

11

12

9

16

5

71.4

73.3

75.0

69.2

76.2

62.5

14

15

16

13

21

8

0.91

0.72

0.46

For the post mortem examination

of MLC case, who has died in the hospital,

consent is needed or not?

Question No.19-C

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

1

6

4

4

4

4

7.1

40.0

25.0

30.8

19.0

50.0

13

9

12

9

17

4

92.9

60.0

75.0

69.2

81.0

50.0

14

15

16

13

21

8

0.038*

0.73

0.91

While examining the drunken person brought by

police, informed consent should be taken or not?

Question No.19-D

Yes No

Total P Value

Age [years]

Sex

SpecialtyClinical

Non Clinical

% %

<35

>35

F

M

1

7

5

4

5

4

7.1

46.7

31.3

30.8

23.8

50.0

13

8

11

9

16

4

92.9

53.3

68.8

69.2

76.2

50.0

14

15

16

13

21

8

0.018*

0.97

0.17

While examining an insaneperson, informed consent should be taken or not?

DISCUSSION :

In the present KAP study, it was found that when questionnaire

was given to access the knowledge level of various medical

practitioners (both clinical and non-clinical), of different

specialties, maximum number of correct answers about the

way consent is taken prior to treatment was given by doctors

age more than 35 years of age on one hand. On the other hand,

it was found that proper information about the treatment

procedure was provided by the practitioners, who are less than

35 years of age. This shows that in the present scenario doctors

of age less than 35 years, take consent by giving detailed

information to the patient in their local language.

As per judgement passed in Samira case, it was said that

doctors should take prior informed consent of the patient,

before giving treatment or undergoing any procedure,

otherwise the consent will not be valid.

In the present study it was found that doctors of age more than

35 years, only 73.3 % knew about the difference between

consent and informed consent. In Doctors of more than 35

years of age, 92.9 % knew the difference. Female doctors were

found to be more aware about the difference than the male

doctors. There was no significant difference found between the

clinicians and Non-clinicians.

This shows that there is a needs to be constant training and

education sessions for the up gradation of medico legal

knowledge among doctors of all specialties, which can save

them from any unwanted litigation.

There are lot of CME and workshops, which are conducted by

various Medico legal consultants as well as by doctors with

Medico legal knowledge especially by forensic medicine

experts, who are also law graduates. Only very few doctors less

than 35 years of age knew about these workshops and around rd2/3 of those more than 35 years of age were aware about these

workshops. This difference was found to be statistically

significant.

Knowledge about the age of giving valid consent was found to

be more among doctors of age less than 35 years as compared

to the doctors of age more than 35 years. The difference was

found to be statistically significant.

As per various Supreme Court judgement and MCI guidelines,

it is clear that consent is not necessary in Emergency situations.

It is important to save the life of the patient first. But as per

present study only 14.3 % of the doctors of the age less than 35

yrs and 20 % of the age more than 35 yrs gave correct answer,

which is really very low. This shows very poor knowledge

among doctors about correct use of consent. None of the Non-

clinicians gave correct answer and only 23.8 % of the doctors

in clinical field gave correct answers.

Consent through Electronic media viz Teleconferencing,

SMS, what's app etc. is not valid as per present Supreme Court

judgement till date. No valid literature regarding the same is

available.

The treating physician should explain to their patient

themselves, about the treatment procedure as patient is under

his duty of care. If patient is not able to understand anything,

patient has the right to get his doubts clear from the treating

physician. The treating physician should tell about all the

possible complication that can occur due to the procedure or

due to the disease per se, otherwise if any untoward

complication arise, then the treating physician is held

negligent for the same. In the present study, only 92.9 % of the

doctors of age less than 35 years explain the procedure and

related complications to the patient themselves and only 86.7

% of the doctors of age more than 35 years does the same. It

should be 100 % and nothing less is acceptable.

Very few percentage of the female practitioners explain the

procedure themselves to their patient as compared to the males.

When the clinicians were compared with the non- clinicians

the ratio was (85.7 % vs. 100 %).

Taking informed consent in a proper format and in the proper

manner is more important for the treating physician. While

non-clinical doctors generally take consent before doing any

survey for Research purposes. This shows lack of awareness,

knowledge or the underutilization of the knowledge, which the

doctors gain in their under graduation level by studying the

subjects regarding medical law.

In our country, where the number of litigation cases are

increasing day by day, doctors are growing towards practicing

defensive medicine compared to preventive medicine. Doctors

are always tense at the back of their mind. It is very important

for them to save their neck and practice with proper

precautions to avoid unnecessary mental and financial

harassment. Therefore proper informed consent, in the

language the patient understands should always be taken,

before starting treatment procedure of all the indoor patients.

Ideally informed consent should be taken before any treatment

procedure. If the prognosis is poor and the hospital has limited

facilities, this should be properly explained to the patient and

proper informed consent in the proper format should be taken.

In the present study, it was found that only 46 % of the doctors

above 35 years of age and 85.7 % of the doctors less than 35

years practice this. This difference was found to be statistically

significant (p value = 0.027)

Very few doctors in the clinical field actually practice this, on

the contrary 87.5 % of the clinicians are aware about the same.

So it is clear that knowledge and the actual practice of the


23

clinicians are different. This is unethical and therefore more

and more doctors are landing themselves in the litigation.

Format to take consent for different treatment procedure,

should be different. It should cover all aspects of the treatment

and complications related to a particular procedure. Then only

it can be held valid. 71.4 % of the doctors of age less than 35

years of age and 86.7 % of the doctors more than 35 years of

age are aware of this concept.

In the present study only 1 clinician less than 35 years of age,

had to face litigation for not taking proper informed consent.

None of the doctor more than 35 years of age faced any such

litigation.

Every medical practitioner in their undergraduate curriculum

are taught about the concept of informed consent, which is

covered under Medical Law and Ethics, with various relevant

to them, in actual practice. But in the present study, on the

whole only 70 – 80 % doctors are aware about how to proceed

in situations like examination of rape victim, examination of

rape accused, examination of drunken people, examination of

insane person and death of Medico Legal case in a hospital.

As per section 164 A of CrPc, doctor does not need to take

consent while examining a person accused of rape, but the

consent is mandatory while examining a victim of rape.

An Insane person cannot give a legal consent. The valid

consent can only be given by the immediate guardian of the

insane person.

Under section 53 of CrPc, consent is not needed before

examining a drunken person brought by the police.

Consent is not necessary from the next of kin of deceased

person involved in a MLC case. Consent is mandatory before

pathological autopsy and not before Medico legal autopsy.

CONCLUSION :

The present study was conducted to know the level of

awareness, knowledge and actual practice pattern of the

informed consent among all age groups of practicing doctors

(both clinical and Non-clinical branches)

It was found that none of the senior doctors have faced any

litigation as compared to the junior doctors. This shows that the

risk of practioners facing litigation is increasing day by day.

The following points are concluded from the present study.

1. There is lack of application of the theoretical

knowledge and correlation in various situations

among practioners.

2. The consent are not being taken in a proper format,

because of the lack of knowledge and sheer

carelessness of the practitioners. So in this changing

era, one need to be extra careful about all these legal

things, because these things can result in both mental

as well as financial harassment.

3. As the medical profession has come under the

umbrella of Consumer Protection act, more and more

dissatisfied patients file complaints to retrieve their

money. The patients are more educated and aware of

their rights than before, so the practioners needs to be

more careful and legally sound. The doctor- patient

relationship has undergone a sea change, and the

patients are more of a customer/client to the doctor.

Now a days the ethical committee plays a very important role

in an institutional setup. There is a continuous need of up

gradation of Medico legal knowledge in the form of CMEs,

workshops. Medico-legal lectures in other platforms like

specialized conferences etc.

REFERENCES :

1. Shaha KK, Patra AP, Das S. The importance of informed

consent in medicine. Sch J App Med Sci. 2013; 1(5):455-

63.

2. Samira Kohli versus Dr Prabha Manchanda (2008) 2

SCC1:2008 ACJ 747: AIR 2008 SCI 385: JT 2008(1)

SC399 (2008)1 Scale 442

3. Shukla V, Tripathi R. Chikitsa Sthana. Ch. 13, Verse

no.176- 177, Part-II.2007. Charaka Samhita; p. 314.

4. Valiathan MS. Bioethics and Ayurveda. Indian J Med

Ethics. 2008; 5:29–30.

5. Nandimath OV. Consent and medical treatment: The legal

paradigm in India. Indian J Urol. 2009; 25:343–7.

6. Kumar NK. Bioethics activities in India. East Mediterr

Health J. 2006;12:56–65.

7. Kumar N, Ravindran GD, Bhan A, Srivastava JS, Nair

VM. The India experience. J Acad Ethics. 2009;

6:295–303.

KNOWLEDGE

Q.1 How do you obtain before any treatment procedure?

(a) Verbal Consent (b) Written Consent

Q.2 Whether consent is taken in proper printed format or on

plain paper?

(a) Printed Format (b) Plain Paper

(c) Patient own hand written Consent

Q.3 Before taking consent, what information is given to the

patient?

(a) All relevant information about ailment and treatment

option.

(b) Significant risk Involved in procedure.

(c) All available alternative treatment option.

(d) All of the above.

Q.4 In which languages do you explain and take consent form


24

the patient?

Q.5 Do you know the difference between consent and

informed consent.

(a) Yes (b) No

Q.6 Do you know that: any written consent taken from a

patient in a proper format and manner can save you from

litigation.

(a) Yes (b) No

Q.7 Have you attend any CME / Workshop?

Q.8 Do you know what is the role of ethical communities in a

medical College & Hospital?

Q.9 Who will give consent for treatment (Medical and

Surgical): If the Patient age is:

(a) Below 18 Years. (b) Above 18 Years.

(c) Between 12-18 Years.

Q.10 In emergency situation do you think that consent is

necessary?

(a) Yes (b) No

Q.11 Is consent thought electronic media valid?

(a) Email (b) What's app

(c) Video conferencing (d) SMS

ATTITUDE

Q.12 Do you explain yourself to the patient about treatment

procedure / surgical procedure when patient is under your

duty of case before obtaining consent?

(a) Yes (b) No

Q.13 Will you take consent from all indoor patient or selective

patient?

Q.14 Do you take informed consent-

(a) Before any surgical procedure.

(b) In case of poor prognosis.

(c) For starting in a hospital with available facilities

(d) All indoor patients.

(e) All of the above.

PRACTICE

Q.15 How do you take consent in

(a) Proper Format (b) Plain Paper

(c) Approved Printed Format

Q.16 Do you think format for all treatment is same or different?

Q.17 Have you come across any circumstance: When you have

taken consent:

(a) During the procedure. (b) After the procedure.

Q.18 Have you faced any litigation Because of not taking proper

informed consent?

Q.19 In the under mentioned medical legal conditions informed

consent should be taken or not:

(a) Examination of victim of Rape.

(b) Examination of accused of Rape.

(c) Examination of a drunken person brought by police.

(d) Examination of an insane.

(e) Death in a hospital of an MLC case followed by –

Body to be sent for post mortem examination.




Dr. Ashok Najan

Assistant professor,

Department of Forensic Medicine, NSCB Medical

College Jabalpur

Contact : 97522-12017


KEYWORDS : Medico Legal Case, Casualty, Profile


INTRODUCTION :

A medico-legal case is “a case of injury or illness where the

attending doctor, after eliciting history and examining the

patient, thinks that some investigation by law enforcement

agencies is essential to establish and fix responsibility for the [1]case in accordance with the law of the land” . Emergency

department plays a vital role in functioning of any hospital.

Ours is a tertiary care hospital providing medical care to vast

population in Mahakaushal region of Madhya Pradesh. A large

number of cases of these are medico legal cases which mandate

c o m p u l s o r y d o c u m e n t a t i o n a f t e r e m e r g e n c y

treatment.Medico legal cases constitute substantial proportion

of workload in tertiary care hospitals. Study of profile of

medico legal cases is helpful to know the burden of medico

legal cases on different specialty departments of the hospital, to

identify load of preventable medical emergencies and also to

know the crime in particular area.

MATERIAL AND METHODS :

After getting approval from IEC, present retrospective study

was conducted on 912 medico-legal cases attended on OPD

basis and admitted in the month of September 2017 in the

emergency department of NSCB Medical College and

Hospital Jabalpur. Documentation of age, gender, manner,

number of departments referred or from which opinion is

sought, type of cases was confirmed from the hospital and also

police records. The data was collected and analyzed. The

objectives of the study was to know cause, manner and

profiling of medico legal cases.

OBSERVATIONS:

Out of 912 cases, 301 (33%) were in the age group of 21-30

years followed by 31-40 years (21.49%) (Table 1).

In respect to gender distribution, 694 (76.09%) were male as

compared to 215 (23.15%) female and male to female ratio was

3.22:1 in this study (Table 2).

Manner of blunt injuries other than road traffic accidents, in

maximum cases i.e.153 (57.73%) is homicidal, followed by

accidental i.e 110 cases (42.96%) which include fall from .

height, cow goring, dog bite, human bite cases. (Table 3)

Manner of sharp injuries in maximum cases is homicidal 18

(69.23%) cases (Table 4)

Maximum cases reported were of road traffic accidents 323

25

1. Vivek Srivastava, Associate Professor, Department of Forensic Medicine, NSCB Medical College Jabalpur

2. Ashok Najan, Assistant professor, Department of Forensic Medicine, NSCB Medical College Jabalpur

3. Pradeep Kumar Markam, Casualty Medical Officer, Emergency Department, NSCB Medical College Jabalpur

4. Shivoham Shukla, Casualty Medical Officer, Emergency Department, NSCB Medical College Jabalpur

ABSTRACT :

Introduction: Medico legal cases constitute substantial proportion of workload in tertiary care hospitals. Methods and material:

The study was conducted retrospectively during the month of September 2017 to know cause, manner and to make profiling of

medico legal cases. Results: Maximum cases i.e.301 (33.00%) were reported in the age group of 21-30 years. Male to female ratio

was 3.22:1. Manner of blunt injuries other than road traffic accidents, is homicidal i.e. 153 (57.73%) cases. Manner of sharp injuries

in maximum cases is homicidal 18 (69.23%) cases. Maximum medico legal cases were referred to Surgery department i.e. 492

(53.94%). Discussion: Sharp injuries were found in 27 (02.96%) cases in which predominant manner of death was homicidal i.e.18

cases (69.23%). Most common medico legal cases were RTA followed by fall from height, snake bite. This finding is consistent

with findings of other studies. Conclusion: Most common injury involved in these cases is blunt injury. In cases of sharp injuries

commonly manner of production is homicidal in nature. Surgery, orthopedics departments most commonly involved in medico

legal cases. Opinion of single department is most commonly sought by CMO’s.

Profile of Medico Legal Cases at Netaji Subhash Chandra Bose Medical College Jabalpur, Madhya Pradesh


26

Table 3 : Manner of Blunt Injuries (other than Road Traffic Accidents)

Homicidal

Accidental

Suicidal

153 (57.73%)

110 (42.96%)

02 (00.75%)

Table 1 : Age Wise Distribution of Medical Legal Cases

Age (yrs)

Number

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90

51(05.59%)

149(16.13%)

301(33.00%)

196(21.49%)

109(11.95%)

60(06.05%)

37(04.05%)

07(0.76%)

02(0.21%)

Table 2 : Gender Wise Distribution of Cases

Sex

Number

Males Females

110 (42.96%) 02 (23.57%)

Table 4 : Manner of Sharp Injuries

Homicidal

Accidental

Suicidal

18 (69.23%)

7 (26.92%)

1 (03.84%)

Type of Case

Road Traffic Accident

Fall From Height

Snake Bite

Poisoning

Brought Dead

Burns

Dog Bite

Alcohol Poisoning

Scorpion Bite

Cow Goring

Hanging

Human Bite

Unconscious

Drowning

Electric Shock

Fire Cracker

Fox Bite

Hot Oil Burns

Injection Cellulitis

Table 5 : Type of Medical Legal Cases

No. of Cases

323 (35.41%)

100 (10.96%)

72 (07.89%)

56 (06.14%)

32 (03.50%)

26 (02.85%)

21 (02.30%)

21 (02.30%)

07 (00.76%)

06 (00.65%)

05 (00.54%)

03 (00.33%)

3 (00.33%)

2 (00.22%)

2 (00.22%)

01 (00.10%)

01 (00.10%)

01 (00.10%)

01 (00.10%)

Departments Referred

Surgery

Orthopedics

Medicine

ENT

Ophthalmology

Pediatrics

CMO

Obstetrics & Gynecology

Dentistry

Table 6 : Opinion Sought per MLC from other Specialty Department

No. of Cases

492(53.94%)

257(28.17%)

189(20.72%)

68(07.45%)

19(02.10%)

08(00.87%)

07 (00.76%)

02 (00.20%)

01 (00.10%)

(35.41%) followed by fall from height 100 (10.96%) snake

bite72 (07.89%) poisoning 56 (06.14%) (Table 5).

Maximum medico legal cases were referred to Surgery

department i.e.492 (53.94%) followed by orthopedics

257(28.17%) cases, Medicine 189 (20.72%) cases, ENT

department 68 (07.45%) cases (Table 6).

In 736 (80.70%) cases CMO sought opinion from one

department and in 146 (16.00%) cases they sought opinion

from more than one department. (Table 7)

DISCUSSION:

In our study most common age group involved in Medico-legal

cases was 21-30 years as this age group is socially and

occupationally involved in outdoor activities. This outdoor

activity and active life style make this age group more

vulnerable to such hazards. This finding is similar to findings [2]of the studies done by Garg V and Verma S K , Salgado MS

[3] [4]and Colombage SM , Sahdev P and Lacqua MJ , and Singh B [5]and Dogra .

Male to female ratio was 3.22:1 which is not consistent with [2]finding of the study done by Garg V and Verma S. K .

Most common medico legal cases were RTA followed by fall

from height, snake bite.This finding is consistent with findings [2,6,7]of other studies . This could be due to the fact that Jabalpur

is a divisional headquarters and daily a large population is

moving towards and away from Jabalpur with heavy traffic.

Most of the surrounding districts of Jabalpur are agriculturally

highly active which expose the population to insecticidal

poisons and snake bites. Besides cases of burns, dog bite, and

alcohol poisonings are also common.

In our study blunt injuries were observed n 595 (65.24%) case

Similar finding differs from study done by Arif M, Rasool SH, [7]Ali SMH who observed that almost two third of the victims

suffered from blunt injuries (64.77%). Blunt injuries other than

road traffic accident were observed in 272 (29.82%) cases.

Manner of blunt injuries other than road traffic accidents, in

maximum cases i.e. 110 (42.96%) is accidental (Table 3),

which include fall from height, cow goring, dog bite, human

bite etc.

Sharp injuries were found in 27 (02.96%) cases in which

predominant manner of death was homicidal i.e.18 cases

(69.23%)(Table 4). Our findings differ from those of study [7] done by Arif M, Rasool SH, Ali SMH who observed sharp

weapon injuries in 8.8% cases.

Single department opinions were most commonly sought but

more than one department opinions were also sought.

Maximum opinions were sought from Surgery followed by

Orthopedics and Medicine department which is consistent [2]with workload of these departments in other studies .

Cases of sexual assault are dealt with at other civil hospitals in

Jabalpur and not at our medical college.

CONCLUSION:

Most commonly males in young age group are involved in

medico legal cases. Most common injury involved in these

cases is blunt injury. Excluding road traffic accidents most

commonly blunt injuries are homicidal in nature. In cases of

sharp injuries manner of production is commonly homicidal in

nature.

Cases of road traffic accidents are most common cause of

medico legal cases.

Most commonly medico legal cases were handled by Surgery

and Orthopedics departments Opinion of single department is

most commonly sought by CMO's.

Conflict of interest: None

Source of funding: Self

REFERENCES :

1. Dogra TD, Rudra A. Lyon's Medical Jurisprudence &

Toxicology. 11th Ed. Delhi Law House. 2005:367.

2. Garg V, Verma S.K. Profile of Medico-legal Cases at

Adesh Institute of Medical Sciences and Research,

Bathinda, Punjab J Indian Acad Forensic Med, 2010.

32(2); 150-52.

3. Salgado MSL, Colombage SM. Analysis of fatalities

in road accidents. Forensic Sci Int. 1998; 36: 91-96.

4. Sahdev P, Lacqua MJ, Singh B, Dogra TD. Road

Traffic fatalities in Delhi: causes, injury patterns and

incidence of preventable deaths. Accidental Ann

Prev. 1994; 26: 377-84.

5. Friedman Z, Kungel C, Hiss J, Marganit B, Stein M,

Shapira S. The Abbreviated injury scale – a valuable

tool for forensic documentation of trauma. Am J

Forensic Med Pathol. 1996;17(3):233-8

6. Malhotra S., Gupta R.S. A study of the workload of

the casualty department of a large city hospital.

Health and Population - Perspectives & Issues.

1992.15(l&2); 68-76.

7. Mahajan A, Dhillon S, Sekhon H. Profile of Medico

Legal Cases in Shimla (June 2008- December 2008).

Medico-Legal Update, 2011. 11 (2); 64- 66.

8. Arif M, Rasool SH, Ali SMH. Profile of medicolegal

cases; accident & emergency department of services

h o s p i t a l , L a h o r e . P r o f e s s i o n a l M e d J .

2017;24(3):366-369.

27

Number of Departments

One

More than one

Table 7 : Opinion Sought Departments

No. of Cases

736 (80.70%)

146 (16.00%)



Dr Sonu Gupta

Lecturer,

Dashmesh Institute and Research Dental Sciences, Faridkot.

Contact : +91 92176-66699


KEYWORDS : Hospital, Healthcare, Medical College, Public Sector, Bio-Medical Waste training


INTRODUCTION:

Growing health care industry has been seeing parallel growth

of generated bio-medical waste which requires scientific

approach for its management. Many studies have been done on

Bio-Medical Waste (BMW) management in the past assessing

and describing knowledge, attitude and practices at various

Health Care Organisations (HCO). Hospitals have been

working hard to maintain standards for biomedical waste [1]management as notified by Government of India . Studies

have reported that potential infectious waste to be segregated [2]as BMW is approximately 340 gm to 2 kg per bed . Typically

inpatient general wards at medical colleges with 30 beds are

likely to generate 9-15 kg of bio-medical waste, which when

divided into 3 shifts shall translate into 3-5 kg of BMW to be

segregated in each shift. This again gets divided among doctors

and nurses on duty at a particular time. Successful

implementation of Bio-Medical Waste (Management and [ 3 - 4 ]Handling) Rules (B M W M H) requires s incere

implementation efforts in terms of training, administrative

focus and uniformity across organizations. While BMWMH

defines the colour coding and end point requirements from the

HCO's; it becomes imperative for the organizations to define

their systems, processes, responsibility assignments and

monitoring systems. BMWMH have left it for the

organization to educate and endow adequate training to their

employees and staff generating and handling Bio-Medical

Waste (BMW). BMWMH training is a part of nursing study [5]curriculum , additionally nursing students are required to

attend their clinical postings on regular basis. Post

employment in-service training must include two components;

one to inform about BMWMH rules with respective

organization policies and second to provide conceptual clarity.

While earlier studies were focused on knowledge, attitude and

practices at various organizations, current study focuses to

identify reasons for possible lapses in BMWMH.

OBJECTIVES:

This study was conducted to assess the differences in

conceptual clarity on BMWMH among diploma and graduate

nurse and identify areas requiring management focus.


Gaps in Nursing Training on Biomedical Waste Management and Handling:

Situational analysis at a Tertiary Care Public Hospital1. Ravinder Nath Bansal, Deputy Medical Superintendent, GGS Medical College Hospital, Faridkot.

2. Sonu Gupta, Lecturer, Dashmesh Institute of Research and Dental Sciences, Faridkot.

28

ABSTRACT:

Introduction: Growing health care industry has been seeing parallel growth of generated Bio-Medical Waste (BMW) which

requires scientific approach for its management. Hospitals have been working hard to maintain levels of standards for Bio-Medical

Waste (Management and Handling) Rules (BMWMH) as notified by Government of India. BMWMH have left it for the

organization to define their systems, processes, responsibility assignments and monitoring systems and to educate and endow

adequate training to their employees and staff generating and handling BMW. While earlier studies were focused on knowledge,

attitude and practices at various organizations, current study focuses to identify reasons for possible lapses in BMWMH.

Objective: The objectives of this study were to assess the differences in conceptual clarity on BMWMH among diploma and

graduate nurse and identify areas requiring management focus. Method: Study was conducted at a tertiary care public sector

Medical College. Validated questionnaire was used where by questionnaire was specifically framed to assess the clarity on basic

concepts behind the BMWMH.

Result: Graduate nurses were found to have higher conceptual clarity compare to diploma holder nurses. Training levels were

found to be below national averages in tertiary care hospitals. Study goes on to identify, suggest methods and actionables for tertiary

care institutions to improve compliance to BMWMH rules which can also be replicated for other healthcare organizations.

BMWHM rules and 74% nurses assessed their confidence

levels to be more than 50% (Table 3).

On comparing the self assessed confidence levels significant

(p=0.00) differences were found between Diploma and

Graduate nurses with graduate nurses responding as being

more confident. Following this respondents filled the

questionnaire and the last question asked the respondents to

specify if, they felt that they required further training on

BMWMH (Table 4).

Paired t-test was run to identify if, there were significant

differences in confidence levels before the start of test and felt

training needs after the test. It was found that there was

significant differences with p=0.000.

MATERIALS AND METHODS:

For the purpose of study GGS Medical College, Faridkot,

Punjab (a tertiary care public sector) was selected by choice

being easily accessible to the researchers. This institute was

established more than 35 years ago and currently has an

average OPD of more than 1800 patients per day with more

than 36000 admissions per year supported by 700 plus beds

and being manned by 1000 plus personnel including more than

280 nurses. Government Medical College was chosen

expecting higher awareness levels being teaching institution.

Following NULL hypothesis was formed H 1: that is there is 0

no significant difference in knowledge and awareness levels

between diploma holder and graduate nurses.

STUDY INSTRUMENT:

Based on the previous studies, available guidelines and

applicable rules, a structured questionnaire was formed.

Questionnaire was got validated out and pilot study was

conducted. Consent was obtained from the college.

Questionnaire consisted of two parts namely: respondent's

demographic profile and awareness on BMWMH rules.

Questionnaire was specifically framed to assess the clarity on

basic concepts behind the BMWMH.

SAMPLE SIZE AND SAMPLING:

All the nurses at the college were contacted and a cross

sectional study was performed. Pre-defined questionnaire was

distributed to all the nurses. They were met in small groups,

consent was obtained and study objectives were explained

while ensuring confidentiality of responses.

STATISTICAL ANALYSIS:

After the survey responses were fed in Microsoft Excel

software. Further assessment was done applying mean,

median, t-test using statistical package (SPSS, Ver.20).

RESULT :

Feedback was received from 240 nurses with females being

91% (n=291). Graduate nurses were 69% and the rest were

diploma (GNM) holders. It was found that almost all the

participants were in regular job and had been in the profession

for more than 1 year. No formal training was received by 16%

of them even though they had completed nursing studies

including diploma and graduation course and had been in job

for more than 1 year. Only 45% of the nurses had received

training session within last one year (Table 1).

Nurses trained by nursing incharges were 30% and by

administrators 37% (Table 2).

Before starting filling specific questions, respondents were

asked for self assessment (the first question of the

questionnaire) of their confidence on knowledge about the


29

Trainer

Administrator

BMW Coordinator

Faculty/Doctor/HOD

Infection Control Nurse

No Response

Nurse of that Area

Grand Total

Table 2 : Training Session Delivery Trends

N

90

18

18

30

42

42

240

%age

37.5

7.5

7.5

12.5

17.5

17.5

Table 3 : Pre Test Confidence Levels

Confidence

100%

75% to 100%

50% to 75%

< 50%

No Response

Grand Total

GNM

33

81

48

3

165

B.Sc

3

60

9

3

75

N

36

141

57

3

3

240

%

15.00

58.75

23.75

1.25

1.25

Table 1: Time When Last Trained/Orientation Session Delivered

Training in BMW

Never

< 1 year

> 1 year ago

No response

Total

n

39

108

75

18

240

%age

16.25

45.00

31.25

7.50

nurses fared better.

Subsequent section pertained to BMW handling and

segregation in clinical areas: tasks which nurses are expected

to be performing on day to day basis. Significant differences

were found for items pertaining to awareness on rules and

policy applicable between diploma and graduate nurses.

Graduate nurses had overall higher scores. Tests performed

were adjusted for all pair wise comparisons within individual

variable.

DISCUSSION: With 61% of the nurses having not received

any training/reorientation session in the last 1 year, Medical

College needs to focus more on implementation of BMWMH.

In a similar study at another Government Medical College of

the same state, 50.2% staff had received training in the last one

Table 6 : Variation in knowledge on handling and treatment of BMW by CBMWTF

Incineration

Autoclaving

Shredding

Chemical

Disinfection

Burial

Mutilation

What is done to waste is yellow bags by outsourced agency?

Incinerated

AutoclavedCrushed and Autoclaved

Disinfected with Hypochlorite and then buried

What is done to waste is Blue bags by outsourced agency?

Incineration

Autoclaved

Chemical Disinfection

Deep Burial

Shredding

Mutilation

What is done to sharps by outsourced agency?

Incineration

Autoclaved

Chemical Disinfection

Deep burial

Shredding

Results are based on two-sided tests assuming equal variances with significance level .05. Group with the higher correct scores has been '*' marked.

Correct Response

DiplomaNursen=165

GraduateNursen=75

PValue

p<0.05*

NurseGNM

NurseB.Sc.

What are modes of disinfection used by outsourced contractors?

Mutilation

A

B

C

D

48

63

33

72

57

24

45

27

24

36

27

3

.000

.747

.043

.531

.828

.003 *

*

*

72

0

15

72

63

3

0

12

.000

.010

.000

.000

*

*

*

*

30

21

60

33

18

0

9

15

27

9

12

6

.202

.175

.957

.104

.302

.013 *

*

*

30

3

54

33

27

9

21

6

30

12

15

0

.106

.066

.275

.464

.494

.002

Respondents were asked as to why BMW management,

segregation and proper disposal was required, with expected

answer as to prevent cross infection through reuse of items

(Table 5).

and significant differences were found between the response

by diploma and graduate nurses with p=0.003.

Independent t-test was applied to test the differences in

perception on mentioned items being bio-medical waste or not

between graduate and diploma holder nurses. Significant

differences were found in response for following items:

syringe wrappers and consumables (p=0.003), vegetarian food

(p=0.000), non-veg food waste (p=0.028), paper (p=0.000),

removed plasters (p=0.014) and amputated body parts

(p=0.01). No significant difference was found for item 'expired

medicines and tablets' (p=0.175) with graduate nurses with

higher correct responses.

Generated BMW is picked up from the hospital by Common

Bio-Medical Waste Treatment Facilities (CBMWTF).

Segregation of BMW is linked to treatment options being

exercised by the CBMWTF. Questions were asked to

respondents to assess their awareness on treatment being given

by CBMWTF. Significant differences in responses were

observed for between diploma and graduate nurses (Table 6).

Tests were adjusted for all pair wise comparisons with in

individual variable using Bonferroni correction and graduate


30

Table 5 : Cross Infection Through Reuse of Items

Yes

No Response

GNM

120

45

B.Sc

39

36

Total

159

81

Table 4 : Post Test Self Assessment of Need for Further

Felt Training Need

Strongly Agreed

Partly Agreed

Not Agreed/Not Required

No Response

Grand Total

GNM

60

48

12

45

165

BSC

42

24

6

3

75

G. Total

102

72

18

48

240

%

42.50

30.00

7.50

20.00

[6]year while the national average among tertiary care hospitals [1]has been reported at 66.7% . As shown in Table 2 structured

training programs were found to be lacking with some of the

nurses being trained by nurse trainers, some by faculty and rest

trained by administrators. There seemed to be no uniformity in

training/trainers pattern. It is possible that different

instructors/trainers have different teaching content: leading to

difference in opinions/perceptions among nurses. Training

programs had no fixed timing and schedule. On discussion

with the hospital head it was found that there was no defined

BMW coordinator, train the trainer program and thus no

uniformity in trainings. Felt training need were found to be

significantly more than the pretest confidence levels.

Questionnaire was designed specifically to assess the

conceptual clarity. Post test nurses realized that there is lot

more for them to know and be aware of. This possible gap is

likely to be due to deficient training programs which possibly

cover only portion of BMWMH and training being provided

on need to know basis only instead of comprehensive training.

Lack of clarity on overall picture limits the staff's decision

making ability which can result in lapses.Significant difference

was found in confidence levels of diploma and graduate nurses

with graduate nurses having higher confidence levels. This

difference can be attributed either to higher education status,

better curriculum of graduate course or better faculty of higher

education institutes. Pre test nurses assessed their awareness

levels at higher levels which could be based on their

assumption on knowledge of limited tasks which they have

been performing on day to day basis and post test they felt that

more information and training was required. Such difference

was found to be statistically highly significant (p=0.000) using

paired T-test. Gaps identified require to be bridged by

comprehensive training programs. Studies have shown

significant increase in awareness in the hospital setup after [7]training .

With respect to tasks being performed by CBMWTF graduate

nurses fared better and there were significant difference in the

knowledge levels. With little training programs at the current

work place (which shall be same for diploma and graduate

nurses), such difference can be attributed to their nursing

education curriculum. Items with significant differences

highlight and specify the portion of training program which

need to be covered better. Nursing curriculum has been found [5]to include teaching on BMWMH . Gaps in the training and

education programs as identified in the studies includes

training on management by CMBTF, colour coding for

segregation for uncommon items, logic behind color coding.

While it has been discussed above that there were significant

differences in diploma and graduate nurses. Yet it needs to be

noted that even if one of staff members has a different thought

then errors in the form of non-compliances are bound to

happen. The question that arises is how can there be variation

in practice within the same organization? This variation needs

to be dealt with by the HCO's to bring down their errors which

can result into non-compliances. Further structured induction

program is one solution should be mandatory in HCO's to

bring down variation rates within the organization.

CONCLUSION: Organizations need to define their standard

operating procedures for BMWMH. While the required

outcomes in terms of color coding have been defined under

BMWMH for ensuring uniformity in terms of colour coding of

bags and collection bins, what needs to be addressed is the

uniformity in implementation and forming Standard Operating

Procedures (SOP's). Organizations need to define their

training teams, train their trainers and empowering trainers

with sufficient material for information and educating staff

members on regular basis and through induction program.

Difference in SOP's and implementation plans among various

organizations may lead to confusion to employees switching

their jobs and students moving to another institution,

especially when subsequently joined organizations do not

conduct induction sessions. Medical college may be taking the

implementation of BMWMH heedlessly by being inadequate

in forming SOP's, structured training, implementation and

review programs. Scenario is likely to be same in other similar

institutions. Organizations not having structured training

teams and programs are likely to have non-compliances which

can be measured either by organizational audit or by assessing

the staff awareness levels. Training program should not be

limited to awareness on ward level functions but must be

comprehensive covering all aspects to improve nurse's

decision making skills. Success lies in imparting training while

medicos and paramedics are still students. Conceptual clarity

can help staff and students understand with reasoning thus

providing better knowledge, ability to correlate the rules and

act with organization policies and enabling them to take

informed decision in all situations.

Acknowledgement: We express our gratitude and thanks

towards all who have directly or indirectly helped us to

complete this study and to the participating respondents.

Limitations of the Study: 1. Individual bias of the

respondents. 2. Study being conducted at a single institution.

Conflict of interest: There is no conflict of interest.

REFERENCES:

1. INCLEN Program Evaluation Network (IPEN)

study group. Bio-medical waste management:

situational analysis & predictors of performances in

25 districts across 20 Indian States. Indian J Med Res


31

2 0 1 4 ; 1 3 9 ( 1 ) : 1 4 1 - 5 3 . A v a i l a b l e a t :

h t tp : / /www.ncbi .n lm.nih .gov/pmc/ar t ic les

/PMC3994730/#!po=83.3333.

2. Pandey A, Ahuja S, Madan M, Asthana AK. Bio-

Medical Waste Management in a Tertiary Care

Hospital: An Overview. Journal of Clinical and

Diagnostic Research 2016;10(11):DC01-3.

DOI:10.7860/JCDR/2016/22595.8822

3. Government of India. Ministry of Environment and

Forests Gazette Notification No.460, dated 27th July

1998, New Delhi , pp.10-20. Available at :

http://envfor.nic.in/legis /hsm/ biomed.html.

4. Government of India ministry of Environment,

Forest and Climate change, Notification dated 28th

March, 2016, New Delhi, pp.1-37. Published in the

Gazette of India, Extraordinary, Part II, Section 3,

Sub-section (i).

5. Chauhan AS, Chauhan SR, Pati S, Pati S. Teaching of

Biomedical Waste in India: A Mapping Exercise. Ntl

J Community Med 2016;7(5):386-90.

6. Verma V, Sharma ML, Oberoi S, Singh A.

Biomedical waste management at tertiary level

hospital–Rajindra Hospital [Government Medical

College], Patiala-A situational analysis. Int J Med

R e s R e v 2 0 1 6 ; 4 ( 1 1 ) : 2 0 5 4 - 8 .

doi:10.17511/ijmrr.2016.i11.26.

7. Sarotra P et al. Health care professional training in

biomedical waste management at a tertiary care

hospital in India. J Biomed Res 2016;30(2):168-70

8. World Health Organization (WHO). Wastes from

healthcare activities. Fact sheet No. 253, Geneva.

2009.


32




Dr. Prashantha Bhagavath,

Forensic Advisor,

International Committee of the Red Cross, New Delhi

Contact : +91 94486-24014


KEYWORDS : Suicide, Women, Reproductive age group, South India

Article History:Received: 2 April 2016Received in revised form: 30 April 2016Accepted on: 16 May 2016Available online: 1 July 2018

INTRODUCTION :

Suicide not only affects the single individual who takes his life,

but also his/her immediate circle community at large. It may be

anticipated that everyone during the “intolerable moments” in

his or her life will succumb to the idea to put an end to it all. In

fact suicidal thoughts, threats and attempted suicide are a [1]common human phenomena . Given the size of the

population, almost 30% of all cases of fatal deliberate self-

harm worldwide are seen in China and India. The number of

incidents of fatal deliberate self-harm in India is comparable to

those put together in the four European countries with the

highest number of fatal deliberate self-harm incidents (Russia,

[2]Germany, France and Ukraine) . More than one hundred

thousand people (1,25,017) in India lost their lives by

committing suicide during the year 2008 with an overall [3]suicide rate of being 10.8 per 100,000 population . Karnataka

state in South India had a suicide rate of 21.2/100000 which is [3]nearly double the national average for the year 2008 . These

statistics reveal that suicide is a major problem faced not just

by the developed world but even the developing countries.The

causes and methods of suicides vary greatly between males [4]and females . Though in absolute numbers more men commit

suicide than women, there are various complexities associated

with female suicides. Self-inflicted injuries accounts for 6-7%

A Study of Completed Suicide Among Women in the Reproductive Age Group From

Coastal Karnataka1. Haneil Larson D'Souza, Associate Professor*

2. Prashantha Bhagavath, Forensic Advisor, International Committee of the Red Cross, New Delhi

3. Francis NP Monteiro, Professor, Department of Forensic Medicine, A J Institute of Medical Sciences and Research Centre,

Mangalore

4. Tanuj Kanchan, Associate Professor, Department of Forensic Medicine, All India Institute of Medical Sciences, Jodhpur

5. Suresh Kumar Shetty, Professor and Head*

6. Jagadish Rao P.P, Associate Professor*

7. Pavanchand Shetty H, Associate Professor*

*Department of Forensic Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education

(M.A.H.E), Manipal

ABSTRACT :

Introduction: Though in absolute numbers more men commit suicide than women, there are various complexities associated with

female suicides. The studies on suicides among women based on whether or not they are in the reproductive age group may lead to

greater understanding of specific factors attributable to this particular sub-population of women.

Materials and Methods: Women in the reproductive age group who died as a result of fatal deliberate self-harm were autopsied at

the Department of Forensic Medicine, Kasturba Medical College, Manipal during January 2010 and September 2011.

Results: 44 women suicides were included. Thirty-one of the victims (70%) were aged above 19 years (adults) and 13 (30%) were

adolescents. In 11 cases (25%) the motive was either not mentioned or could not be ascertained. Out of the remaining 33 victims,

the most common reason for committing suicide was health related issues (n=16). Among the suicide methods, poisoning was the

most common, seen in 28 of the victims (64%). In 41 cases (93%) the place of occurrence of the incident was indoors. Thirty of the

victims (68%) were hospitalised after the suicide attempt.

Conclusion:It is recommended that psychiatric assessment should be considered for women with chronic and vague symptoms of

ill health not responding to treatment, as a possible manifestation of the underlying psychiatric disease, which then turns into the

primary motive for suicide for women in the reproductive age group.

33

of all the deaths worldwide in females in the age group between [5-6]fifteen and forty-four years . It has been observed that

economic and social influences and factors have led most

Indian males to commit suicide. The situation is different

among women. Emotional and personal causes have been the

main contributors to incidents of fatal deliberate self-harm in [3]Indian women . Women specific factors include societal

influences; marital status and stressors associated with it,

failed relationships, socio-economic inequality are just a few [7] of the factors that influence suicidal behaviour in women .The

proportion of female victims by 2008 in India was

comparatively more under the heads 'Dowry Dispute' (98.1%),

'Illegitimate Pregnancy' (91.6%), 'Physical Abuse (Rape,

Incest etc.)' (72.8%), 'Barrenness/Impotence (Not having

children)' (65.5%), 'Divorce' (62.2%),'Cancellation/Non-

settlement of marriage' (53.5%) and 'Suspected/Illicit

Relations' (50.8%). The present research was undertaken to

study the factors affecting completed suicides among the

women in the reproductive age group from a coastal region of

South India.


The material for the study comprised of cases involving

women in the reproductive age group (from onset of

menarche till menopause) who died as a result of fatal

deliberate self-harm and whose autopsies were performed at

the mortuary of the Department of Forensic Medicine,

Kasturba Medical College, Manipal during January 2010 and

September 2011. The confirmation of the reproductive age

group was based on correlation of age and histological features

of the uterus in the reproductive age group. Women outside the

reproductive age group, and cases wherein the manner of death

was in doubt were excluded from the study. Data regarding age

of the victim, date of suicidal attempt, method adopted to

commit suicide, place of occurrence, whether hospitalized or

not, the date of death and survival period were collected from

the information furnished by the Karnataka State Police and

the hospital records of Kasturba Hospital, Manipal.

RESULTS :

During the study period, a total of 44 women who were in the

reproductive age group as confirmed from histological

examination of the uterus were included in the study. Thirty-

one of the victims (70%) were adults over the age group of 19

years and 13 of the victims (30%) were adolescents (Table

No.1).

The youngest victim was 11 years old and the oldest victim was

48 years. The motive behind the suicides are shown in Table

No. 2.

In 11 cases (25%) the motive was either not mentioned or could

not be ascertained. Out of the remaining 33 victims, the most

common reason for committing suicide was health related

issues as reported in 16 victims (36%). In two victims the

health related issue was specific to uterine pain. In one case, it

was stated that the victim could not cope with the health

problems of her husband. The next most common motive for

committing suicide was relationship related issues among

eight victims (18%). For relationship related issues, three

victims cited reasons of loneliness due to the loss of/ being

away from a loved one. Three victims were involved in failed

romantic relationships; while one victim cited family discord

and the other marital discord as the motives behind the suicide.

Six victims (14%) committed suicide due to either

frustration/depression. The underlying reason for the

frustration/depression was not mentioned/ could not be

ascertained. For two victims (5%), the suicide was a result of

academic failure and one victim (2%) committed suicide as a

result of being unemployed and unable to find work.

Among the methods of fatal deliberate self-harm adopted by

the victims, poisoning was the most common, seen in 28 of the

victims (64%) as shown in Table 3.

The next most common method adopted was hanging in10

victims (23%). Four of the victims (9%) died due to self-

immolation. One victim (2%) resorted to being run over by a

train while in another (2%) the method was fall from height.

In 41 cases (93%) the place of occurrence of the incident was

34

Table No. 2 : Motive for Suicide

Motive Number (n=44)

Motive unascertainable

Heath related issues

Relationship related issues

Depression/Frustration

Academic

Unemployment

11 (25%)

16 (36%)

8 (18%)

6 (14%)

2 (5%)

1 (2%)

Table No. 1: Age Distribution of the Study Group

11-19 years 20-48 years Total (n=44)

13 (30%) 31 (70%) 44 (100%)

Table No. 3 : Methods Adopted by the Victim

Poison consumption

Hanging

Self-immolation

Run over by a train

Fall from height

Method adopted Number (Total n = 44)

28 (64%)

10 (23%)

4 (9%)

1 (2%)

1 (2%)


indoors while in three cases (7%) it was outdoors. Thirty of the

victims (68%) were hospitalized while the other 14 (42%)

were not. Of the hospitalized patients, 25 of the admitted cases

(83%) were after consumption of poison, hanging accounted

for three (10%) and the self-immolation for two cases (7%).

Information regarding time interval between suicide attempt

and death i.e. the survival period could only be ascertained for

admitted cases. Among the cases admitted after poison

consumption the minimum period of survival was a couple of

hours and the maximum period of survival was 17 days. In the

three hospitalized hanging cases, one victim survived for a

couple of hours and another survived for five days. Among the

two cases admitted for burn injuries following self-

immolation, the period of survival was five days and eight

days, respectively.

DISCUSSION :

The main gender difference seen in suicidal behavior

worldwide, is that the rate of completed suicides in women are [9]lower than men, the exception being China .The same is true

in India as well. However the reported sex ratio of 4:5.8 in [10,11]India is low when compared internationally . The reasons

[10,12]for this seem to be diverse . The higher suicide rate in the

male gender has been stated, as being due to the more rigorous

subjection of men variations and stressors of daily living and [13,14]life when compared to females . Suicide is best studied and

researched as a multi-factorial event, with biological,

relationship, psychological, social and cultural factors, to [10,15,16]name just a few .

According to an earlier analysis of the National Crime Records

Bureau, fatal deliberate self-harm is among the top ten causes

of death in India. Fatal deliberate self-harm is also among the

top three causes of death in India between the ages of sixteen [17]and thirty-five . It can therefore be deduced from the present

study that people in the early stages of their lives are more

predisposed to getting affected by the turmoil of life. They

then unfortunately opt for self-harm over trivial issues.

It is known that the mortality risk for fatal deliberate self-harm

associated with a psychiatric illness such as depression is many [18]times the risk faced by the general population . The WHO

suicide statistics suggest that mental disorders (depression and

substance abuse) are associated with more than ninety percent

of all cases of suicide. Also psychological autopsy approach to

death investigation has revealed that psychiatric disorders are

present in about ninety percent of people who are victims of

fatal deliberate self-harm. These people also contribute

between forty-seven to seventy-four percent of the population [19]at risk of suicide . So also a study in Wolverhampton

ascertained a positive psychiatric history in 64.5% cases of [20]suicide . Our findings are in contrast to the findings observed

by the above-mentioned workers wherein the health related

issues dominated followed by relationship related issues,

frustration/depression, academic failure and unemployment.

This lower incidence of depression, a well-documented and

researched risk factor for destructive self-harm worldwide has

been previously documented in poisoning self-destructive [21 ]mortalities in the region . In India, studies using

psychological autopsies have reported that suicide is related to

interpersonal conflicts, marital discord, alcoholism, financial [22]problems and unemployment . A study undertaken in

Singapore also ascertained that illness (51%) was the [23]predominant factor associated with suicide . However the

study included both physical and mental illness as a single

entity.With regards to the suicide with unemployment as the

motive, suicide rates are high in people without gainful

employment.The reasons for this relationship are however [12]complex . As previously mentioned, high rates of suicide are

associated with mental illness. Mental illness can thus be seen [24]as a common factor of both unemployment and suicide .

Among the methods of fatal deliberate self-harm adopted by

the victims, poisoning was the most common, followed by

hanging, self-immolation etc. This is in agreement with the

study done by Banerjee et al which stated that poisoning with

insecticides was the most common mode of suicide among [25]Indian women . This also in accordance of the fact that as a

generalization, men may be said to have a tendency to choose

more violent means of self-destruction (such as shooting).

Women on the other hand may be seen to prefer less violent [26]methods to end their lives (such as poisoning) . It has been

observed that in the less developed and agricultural hinterland

of many developing countries, intake of pesticides is the

method of choice for self-destruction. This may be due to the

perceived advantages of easy availability, enhanced toxicity [27]and poor storage . As many as thirty percent of global self-

[27]destruction deaths might involve intake of pesticides . In

concurrence of our findings, females of Geneva, Brazil and

Israel adopted common methods like poisoning and fall from [28-30]height for committing suicide . It has been observed in the

Southern Part of India and in countries like Pakistan, Japan,

Austria and England that the commonest method used by [31-35]females for committing suicide was by hanging . Chao et al,

in their study on changing trends of suicide by poisons in

Singapore, points out that until the early sixties, corrosive

acids and alkali, inorganic chemicals, heavy metals and plant [36]alkaloids were the mainstay of poisons principally used . The

seventies and eighties witnessed a swing towards

pharmaceutical products. The early nineties saw a peak of

alcohol, insecticides such as malathion, paraquat and [36]household items such as detergents, and antiseptics .

According to the study conducted by Bhatia et al and Agarwal

35


et.al, the common methods used in suicide include drowning, [37-38]hanging, poisoning and burning . Methods of self-

destruction and self-harm can be said to echo the availability of

these methods. Pattern of self-destruction in the vicinity

depends upon a multitude of factors and their interplay. These

include obtainability and access of the method, the socio-

economic status and also not to forget the prevailing socio-

religious influences. Knowing the pattern of suicide in an area

not only helps in early management of such cases but also [39]allows taking early preventive measures . Forty one out of

forty four females preferred to commit suicide inside the four

walls of the house. This high incidence at home can be

attributed to the preference of the victims for a familiar home

environment. This is in agreement with a study reported from [33]Southern India .

It is necessary for the death investigators to be knowledgeable

of the many scenarios, stressor and risk factors, methods,

methodology as well as deterrents that may be encountered in

investigating such incidents. We recommend psychiatric

assessment for women with chronic and vague symptoms of ill

health not responding to treatment, as a possible manifestation

of underlying psychiatric disease. Left untreated or

misdiagnosed, many women may be committing suicide for

manageable psychiatric conditions.

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Forensic Medicine & Toxicology 2001; 18(1); 8-11.

37



An Alternative Method for Extraction and Cleaning of Bones From Buried Cadavers 1. Monika Gupta, Professor, Anatomy*

2. Parmod Goyal, Professor & Head, Forensic Medicine*

3. Navita Aggarwal, Professor & Head, Anatomy*

*Adesh Institute of Medical Sciences & Research (AIMSR), Bathinda (Punjab)



Dr. Parmod Goyal,

Professor & Head, Forensic Medicine

Adesh Institute of Medical Sciences & Research, Bathinda

(Punjab)

Contact No. : 98760-05211

E-mail : [email protected]

KEYWORDS : Extraction, Cleaning, Bones, Burial, Buried bodies

Article History:Received: 7 March 2018Received in revised form : 8 June 2018Accepted on: 8 June 2018Available online: 1 July 2018

INTRODUCTION :

The human bones are an integral tool in the study of anatomy.

Bones are necessary not only for teaching anatomy but also

provide three dimensional instructions in osteology as well as

understanding the sites of soft tissue insertion and the course of

neurovascular structures in a region. Knowledge of bones also

required for planning of various surgeries and assessing the [1-2]efficacy of orthopaedic devices .

In the absence of original human bones, artificial bones made

of plaster of paris or glass fibre or plastic replica are used in

many health care institutions, which do not provide the actual

picture especially of bone ridges/elevations/tubercles etc but at [1-2]the same time too much costly . The source of original

human bones is human bodies only. With the efforts of many

Non Governmental Organisations (NGO’s) and inclusion of

voluntary body donation clause in the Anatomy acts,

successful Body donations programmes are running in many

medical institutions of the country. As a result many medical [3]institutions are receiving even excess of cadavers . But it has

been seen that even in such medical instituitions, sufficient

number of dry bones are not available for studying, for First

Year MBBS students, orthopedics faculty, post graduate

students , ENT surgeons and oral and maxillofacial surgeons.

If a first year mbbs student has dry bones in his hostel room, it

help in better understanding of anatomical structures

especially of limbs and head and neck.

The insufficient number of dry bones is due to absence of any

guidelines for extraction of bones from cadavers. Bones

require soft tissue removal, bleaching and colouring before

being used for teaching purpose. Various methods mentioned

in literature for bone cleaning are boiling, maceration, use of [4-11]enzymes, insect and burial excavation etc . We have used the

burial excavation method. In our institute authors had [2]conducted a previous study and found use of hydrogen

peroxide as a useful tool for cleaning of bones. But over a

period of time, authors felt that although cleaning of bones

with hydrogen peroxide is a good method but many times

especially in long bones and skull, small tag of soft tissue

remain intact and over times some part of bones become

brittle.So we experimented with an alternative method of bone

cleaning. Although present method is lengthy, more time

consuming and required comparatively more hard work but the

ultimate recovered bones were more clean, completely devoid

of soft tissues, more appealing to the eyes and nice to touch.

38

ABSTRACT :

Introduction : Bones are required for studying the human anatomy, osteology etc. Artificial available bones are costly and do not

bear expressions.Various methods of extraction and cleaning are in use. In the present study method adopted at our institute is

shared.

Methodology : Dissected bodies were buried in the burial ground attached to anatomy department. Remains were extracted after

one year. cleaned with water and brush followed by immersion in H O . followed by rinsing in water, drying in shade followed by 2 2

varnishing and colouring.

Results: Obtained bones were free from flesh and smell. Varnishing and colouring gave more better picture.

Conclusion: Method is lengthy and tedious and required lot of hard work but resultant bones were in good condition.

MATERIALS AND METHODS:

The present study was conducted on embalmed as well as

freshly dissected cadavers in Department of Anatomy, AIMSR

Bathinda. Ours is a unique department in the sense that as per

our knowledge, it is the only Anatomy department in Punjab

where unembalmed donated bodies are dissected (5 in a year)

for the enhancement in the learning of anatomy especially for [12]first professional MBBS students . For present study

dissected human bodies were buried in the burial ground

attached to the anatomy department for a period of one year at

the depth of 2 feet. After one year, soil was dug and bones were

retrieved from burial ground. Bones recovered were cleaned

with water and detergent (Step 1). Then bones were manually

cleaned off any remnant soft tissue and soil with scotch brite

and toothbrush (Step 2). Next bones were dipped in hydrogen

peroxide solution overnight (Step 3), followed by immersion

in normal water (Step 4). Then bones were dried in shade ( Step

5). After that coating of wood primer (Step 6) followed by

coating of wood paint ( Step 7) was done. At the end bone were

coloured with acrylic colours (Step 8). The results were

compared with technique employed earlier in the same

institute where only above mentioned Step 3 and Step 4 were

used.

FLOW CHART:

39

1 2

3 4

5 6

7

8

9 10


Dissected Donated bodies (embalmed/Unembalmed) buried

Remains extracted after one year

Bones were kept in the solution (Water mixed with the detergent)

for 3-4 days

Bones were manually cleaned off any remnant soft tissue and

soil with scotch brite and toothbrush. (Fig. 1,2,3)

Dipped in hydrogen peroxide solution

overnight. (Fig. 4,5)

Next day bones were kept in water for 24 hrs (Fig 6)

Bones were dried in shade (Fig 7)

Application of primer and wood paint (varnishing) followed by

colouring (Fig 8,9,10)

RESULT :

The bones obtained after this procedure were clean, intact and

their quality was better compared with the bones extracted

with previous technique. Application of wood primer resulted

in consumption of less amount of wood paint so the cost

involved in cleaning got reduced.

LIMITATIONS :

Since the wood primer was of white colour, Resultant bones

seem to be of white colour. Next time we shall try to procure

transparent wood primer.

CONCLUSION :

Although the procedure may appear to be labour requiring but

it is comfortable, cost effective, ecofriendly and suitable

method for obtaining the human bone specimens from the

cadavers. Bones obtained looked good, strong and suitable for

teaching purpose.

ACKNOWLEDGEMENT :

l The Families and the deceased for donating the bodies for

noble contributions toward the mankind.

l Dera Saccha Sauda Sirsa organization and Taraksheel

Society, Punjab for motivating peoples regarding

voluntary body donations.

l Management and Staff of Adesh University for their

continuous support, guidance and encouragement.

REFERENCES:

1. Modi B S, Puri N, Patnaik VVG. Evaluation of

Techniques for Cleaning Embalmed Cadaver Bones. Int J

Anat Res 2014; 2(4):810-13.

2. Aggarwal N, Gupta M, Goyal P K, Kaur J. An Alternative

Approach to Bone Cleaning Methods for Anatomical

Purposes. Int J Anat Res 2016; 4(2):2216-21.

3. Goyal P K, Monika G. Study of the profile of cadavers

donated to the Anatomy Department of a Private Medical

College of Punjab for Medical Research vis a vis Body

Donation Programme. A First Hand Experience of Five

Years, Journal of Research in Medical Education &

Ethics. 2011;1(3):176-9.

4. Cleaning methods - SEABIRD OSTEOLOGY.

Available from: http://www.shearwater.nl/index.php?

file= kop131. php. (last accessed on 20 April 2018).

5. Mair S, Swift B. Detergent An Alternative Approach to

Traditional Bone Cleaning Methods for Forensic Practice.

Am J Forensic Med Pathol. 2004; 25(4):276- 84.

6. Simonsen KP, Rasmussen AR, Mathisen P, Petersen H,

Borup F. A Fast Preparation of Skeletal Materials Using

Enzyme Maceration. J Forensic Sci 2011; 56(2):480-4.

7. Motz VA ,Garner , Schultz B. Defleshing of Embalmed

Human Cadaveric Bone in situ. Available from http:/

/www.lifescitrc.org/resource.cfm? submissionID =2230

(last accessed on 20 April 2018).

8. Sullivan LM, Romney CP. Cleaning and Preserving

Animal Skulls. The University of Arizona-A Cooperative

E x t e n s i o n . A v a i l a b l e f r o m h t t p : / /

extension.arizona.edu/sites/extension.arizona.edu/

files/pubs/az1144.pdf (last accessed on 20 April 2018).

9. Fenton TW, Birkby WH, Cornelison J. A fast and safe

non-bleaching method for skeletal preparation. J Forensic

Sci.2003;48:274-6.

10. Mishra S Rj, Singh R, Shukla R, Passey J, Singh S,

Sushobhana. Burial, Excavation and Chemical Cleaning -

An Economical Approach for Extraction of Human Bones

from Embalmed Dissected Cadavers in India.

International Journal of Anatomy, Radiology and Surgery

2016;5(3): 14-18

11. Okada DM, De Sousa AM, Huertas RA, Suzuki FA.

Surgical simulator for temporal bone dissection training.

Braz J Otorhino laryngol. 2010;76:575–78. ( Plastic

replica)

12. Goyal PK, Gupta M, Kaur J.Autopsy as a tool for learning

gross anatomy during 1st year MBBS. Int J Appl Basic

Med Res. 2016;6(3): 230–32.

40



For Ethical Doctors: Does selection process for Medical students require a change?1. Mrinal Kanti Jha, Associate Professor*

2. Jagadish Biswas, Assistant Professor Department of Forensic Medicine and Toxicology, North Bengal Medical College,

Sushruta Nagar, Darjeeling. West Bengal.

3. Tilak Bose, Administrative Officer, IIM Rohtak

4. Shyam Sekhar Choudhury, Demonstrator*

*Department of Forensic Medicine and Toxicology, KPC Medical College. Jadavpur, Kolkata 700032



Dr. Jagadish Biswas,

Assistant Professor

Department of Forensic Medicine and Toxicology, North

Bengal Medical College, Sushruta Nagar, Darjeeling.

KEYWORDS : Ethical Doctor, Restructure of selection process for Medical students, Reducing unethical practice by doctors.

Article History:Received: 26 May 2018Received in revised form: 18 June 2018Accepted on: 18 June 2018Available online: 1 July 2018

INTRODUCTION:

There has been a rise in unethical practices by doctors. These

have been brought to light by the print and electronic media,

and have given rise to an atmosphere of scepticism in society.

Doctors are probably no longer considered noble professionals

or healers who would always do the patient good. Rather, they

are service providers, and the patients the service users. This

change may have come about partly because of the corrupt and

unethical practices of a few doctors, resulting in a loss of trust [1]in the doctor–patient relationship .

Some of disturbing recent news include: June 10, 2017-Doctor

injured in nursing home attack after patient's death, Aug

13,2015-2 junior doctors beaten up at SSKM Hospital, Jan

11,2016-A PG trainee at R G Kar admitted in ICU after he was

assaulted by a mob, Jun 22,2016- Junior doctor assaulted at

SSKM Hospital, Mar 24, 2017- Doctors attacked at RG Kar

Medical College, Feb 15, 2017-Mob vandalism at CMRI [2]Hospital . The attacks on doctors are more due to lack of

doctor-patient relationship or understanding of medical ethics

than anything else.

It is expected that the principles of ethics would either come

from within or that budding doctors would imbibe morality

from parents at home.Among the earliest influences on child

behaviour are the attitudes and behaviours of the parents.

Therefore, parental behaviours have a strong influence on

children. Studies have shown that parental and environmental

influences have a significant role in promoting pro-social [3]behaviours among children . Parental role has a significant

influence on moral values of children.

Ethics is moral conduct of right and wrong in a civil society,

which comes from within. It is a branch of Philosophy.

Medical Ethics guides doctors in dealing with their patients,

for the best possible outcome. Unlike Law which is enforced

on an individual after commission of crime, ethics prevents

individual from committing wrong. As per Definition:

Medical ethics deals with moral principles which should

guide the members of medical profession, in dealing with [4]each other, with patients and with the state . India can boast

41

ABSTRACT:

Introduction: There is an increase in unethical practice by doctors, which is widely, publicized both by electronic and print media.

This is due to lack of understanding of Medical ethics or moral values involved in doctor-patient relationship. One of the methods to

reduce unethical practice can be selection of medical students based on core ethical knowledge as was done in ancient India.

Objective: To evaluate core ethical knowledge among medical students, before ethics is taught to them in class by teachers and find

out means to recruit medical students who are sound in ethics for future ethical doctors.

Material and Method: An anonymised, questionnaire-based, cross-sectional survey of students.

Result: 51.80% of students in the study had core ethical knowledge.

Conclusion: If all selected students have core ethical values and knowledge, unethical practice by doctors will automatically

diminish. Ancient India had stringent selection process for pupils who were admitted as medical students,they were honest,

humble, temperate, generous. This is practiced in medical schools across US and Europe. This is high time we should change the

process of selection to prevent unethical practices and revert to selection of students as was done in ancient India.

Table 1 : Topics Covered and Marks Obtained.

Charaka

Ancient Indian Ethics followed 2500 years age

Contribution of Hippocratic in medicine

Medical ethics is followed for benefit of: Patient/Doctor

International Committee of Red Cross

WHO

First Noble Prize was given to founder of ICRC

Aim of Doctor

Function of MCI

Should a doctor learn self defense to protect himself from patient

1

2

3

4

5

6

7

8

9

10

Topics Covered

70

60

95

69

65

70

63

72

68

25

Number of students with correct answer

57.3%

49.1%

90.4%

56.55%

53.2%

57.3%

51.63%

59.1%

55.73%

20.4%

PercentageSr.No.

of its own code of ethics proposed by Charaka roughly 4700

years ago” ethics prevented physicians to eat meat, drink

alcoholic beverages and commit adultery. Physicians should

not harm their patients and be solely devoted to patient care, [5]even if this puts their lives in danger . In Western world,

medical ethics had its foundation as Hippocratic Oath. The thexamination of moral issues in medicine largely began in 4

century BC by the great Greek physician Hippocrates [6](sometime between 460-377 BC the accepted life period) .

th thHistorically, India is a country of ethics. In 5 and 4 Century

BC, teaching of Buddha consisting of Sila or ethics of life.

Ethics was practiced not only by doctors but also common

man. Sila or ethics practiced by common men had Five [7]Precepts : To abstain from killing of any living being, To

abstain from stealing, To abstain from sexual misconduct, To

abstain from wrong speech, To abstain from all intoxicants.

OBJECTIVE: To evaluate core ethical knowledge among

students, before the subject of Medical Ethics was taught to

them by teachers. If ethical awareness is found less, a method

be suggested to curb unethical practice.

MATERIAL AND METHOD: After taking approval from

Institutional Ethics Committee and consent from participants

present cross sectional study was conducted on 122 students of rdMBBS (3 Semester) at Department of Forensic Medicine and

st stToxicology from 1 August 2015 to 31 July 2016. Students

were properly briefed about the study and its objectives and

informed not to disclose personal identity. 10 Pre-designed and

pre-tested questionnaire were asked. Correct answer was given

1 mark and wrong answer was given '0' mark. Data collected

and analysed.

RESULTS : Mean age of students was 20 years. Majority

(71%) of the students were from English medium school and

rest from non-English medium schools. Topics covered and

marks obtained by students are as per Table No. 1.

Total average score obtained: 51.80%. Highest score obtained

was: 10/10. Lowest score obtained was 04/10. Distribution of

Study Population according to Father's Education is depicted

in Table No. 2.

DISCUSSION : Total average score obtained: 51.80%. Out

of every 2 doctors 1 does not have core ethical background.

This is an alarming situation, unless the students learn ethics in

class, chances of them becoming ethical doctor is remote.

Study questionnaire were on objective medical knowledge and

medical ethics and not based on psychological assessment.

Our study indicate that medical students have difficulty in

understanding ethics in class. A study done in 2013 in South

India, indicated there are major deficiencies in the

unders tanding of medical e thics among medical [8]undergraduates . A cross-sectional study in West Bengal,

42

Under Graduate

Graduate

Post Graduate

MBBS/MD, MD, BDS, MDS

Total

12%

38%

19%

1%

100%

Table No. 2 : Distribution of Study Population According to

Father's Education

India, revealed that though medical students agreed that an

awareness of ethics was important, their knowledge was

deficient and there was no increase in their scores [9]corresponding to additional years of medical education .

Another study found that when medical students recorded the

ethical issues encountered by them, the most common issues

were related to ethics in medical education, professionalism,

confidentiality, the doctor–patient relationship, informed [10]consent and the doctor–peer relationship . Students may be


either unaware of the code of conduct or the principles of

ethics, or unable to translate the knowledge into actual

practice.Education of father was taken into account, since vast

part of, ethics and morality is taught at home. Education of

father may serve as a pointer to condition at home. In USA and

Europe students have to pass MCAT a multiple-choice

examination where Physical science, biology, critical thinking, [11]and verbal skills are all tested in a 5-hour computerized test .

This is followed by interview which finds ethical knowledge,

self less service provided by the students in addition if the

student is honest, humble, temperate, generous, and hard-

working. In ancient India Sushruta Samhita describes in detail

the internal character and external built of a pupil who are to be

admitted as a medical student. This admission process was

very stringent. A medical student was expected to be honest, [12]humble, temperate, generous, and hard-working . He was not

supposed to be enamored with women or engage in gambling

or hunting. His memory and academic performance were also [13]given importance .

CONCLUSION:

This study is an eye opener. Almost 50% of students of Medical

College so not have core ethical knowledge. Other studies also

points out that it is difficult to obtain knowledge on ethics from

Medical College. Time has come to change the process of

selection of Medical Students to have ethical doctors in our

Country. It can be done in the way as was done in past by

ancient Indian Doctors, which is followed by many Countries

of west except our country.

Stringent selection criteria can be adopted coupled with

interview, projects and work done for the service of ill and

unwell person in addition to multiple-choice examination

where Physics, Biology, Chemistry, Critical Thinking and

Verbal Skills can tested in a computerized test. If the selection

of Medical Students can be stream lined, only can we expect

ethical doctor population.

REFERENCES:

1. Chattopadhyay S. Corruption in healthcare and medicine:

why should physicians and bioethicists care and what

should they do? Indian J Med Ethics. 2013 Jul-

Sep;10(3):153-9.

2. The Times of India, Kolkata, Saturday, June 10, 2017,

page 39, column 1

3. Knafo A, Plomin R. Prosocial behavior from early to

middle childhood: genetic and environmental influences

on s tabi l i ty and change. Dev Psychol . 2006

Sep;42(5):771-86.

4. VV Pillay .Textbook of Forensic Medicine and thToxicology, 18 edition, Hyderabad Paras Medical

Publisher. 2017 page 30

5. English V et el. Medical ethics today. The BMA hand ndbook of ethics and law. 2 edition, page 25

6. Nandy A. Principals of Forensic Medicine including rdToxicology, 3 edition reprint, New Central Book

Agency(P) Ltd, Kolkata 700009, 2010 page 24rd7. Lay U K. Manual of Vipassana Meditation. 3 edition

reprint, Vipassana Research Institute, Dhamma Giri.

Igatpuri422403, 2010 Page 40.

8. Arun Babu T, Venkatesh C, Sharmila V. Are tomorrow's

doctors aware of the code of medical ethics? Indian J Med

Ethics. 2013 Jul-Sep;10(3):192-4.

9. Chatterjee B, Sarkar J. Awareness of medical ethics

among undergraduates in a West Bengal Medical College.

Indian J Med Ethics. 2012 Apr-Jun;9(2):93-100.

10. Fard NN, Asghari F, Mirzazadeh A. Ethical issues

confronted by medical students during clinical rotations.

Med Educ. 2010 Jul;44(7):723-30.

11. h t t p : / / s t u d y. c o m / r e q u i r m e n t s t o b e c o m e a

doctor.html.downloaded on 10 Oct. 17

12. Nuraliev YN. Doctor's ethics in ancient east written

classics and in the works of middle age medical scientists.

In: Abdi WH, Asimov MS, Bag AK, Khairullayev MM,

Mikulinsky SR, Mukherjee SK, et al., editors. Interaction

between Indian and Central Asian Science and

Technology in Medieval Times. Medicine, Technology,

Arts and Crafts, Architecture and Music. Vol. II. New

Delhi: Indian National Science Academy; 1990. pp. 11–8.

13. Lochan K. Varanasi: Chaukhambha Sanskrit Bhawan;

2003. Medical education. Medicines of Early India: With

Appendix on a Rare Ancient Text. Ch. 4; pp. 90–103.

43

PROFORMA

Sex: Age: Religion :

Name of School/ Location :

Medical of Instruction in School : English/ Hindi/ Bengali

Education and Occupation of Father :

Q 1. India has its own Code of Medical Ethics, composed by

Charaka: Yes/ No

Q2. In Ancient India, Ethics was strictly followed , who

contributed : Buddha/Patanjali/ Both

Q3. What is Contribution of Hippocratic in Medicine : Ethics/

Oath

Q4. Medical Ethics is followed for benefit of : Patent/Doctor

Q5. International Red Cross says-treat enemy soldiers also:

Yes/No

Q6. Where is HQ of WHO : Geneva / New York

Q7. First Noble Prize was given to founder of : WHO/

International Red Cross

Q8. Aim of a Doctor : Cure / Prevention / Teach

Q9. Function of MCI : Recognize Medical College/ Set Medical

syllabus/ Both

Q10. Should a doctor learn Karate (self defense) to protect himself

form patients: Yes/ No


Multiple Linear Regression to Determine Stature Using Hand and Feet Dimensions Among Central Indian Population.

1. Anudeep Singh, Senior Lecturer, Department of Anatomy, Faculty of Medicine, Saujana Putra Campus, MAHSA

University, Jenjarum, Selangor, Malaysia. 42610



Dr. Anudeep Singh

Senior Lecturer,

Department of Anatomy, Faculty of Medicine, Saujana

Putra Campus, MAHSA University, Jenjarum, Selangor,

Malaysia. 42610

Contact No. : +60163546930

E-mail : [email protected]

KEYWORDS : Hand and foot measurements, Stature estimation, Forensic anthropometry, Forensic anthropology, Central India.


INTRODUCTION :

Anthropometric data collected from different races, age and

sex groups is greatly useful for designing products for

ergonomics, biomedical engineering, surgery and especially in [1-3]forensic medicine . Anthropologists have always been

interested in computing stature using measurements of

different parts of the body, as stature is one of the most [4-8]important factors in profiling the individuals . These data are

extremely useful in countries where techniques like DNA or

dental markers, which can be used for identification, are

expensive or not easily available.

The human remains, as the result of wars, airplane crashes,

traffic accidents, criminal mutilation and dismemberment and

other mass disasters, are present in different forms. The

primary challenge for any medico-legal investigator in

identifying unknown human remains is the development of a

biological profile via the estimation of race, sex, age and [9-10]stature . Using population specific standards is the most

[11]accurate and generally accepted method .

The estimation of stature from various skeletal parameters has [12- 18]been performed in different studies . Studies have also been

done where stature as well as gender is estimated from [19-29]dimensions of hands and feet .

There is currently a dearth of gender based studies done among

the population from central India. Thus, the purpose of the

present study was to analyse the relationship between the

measurements of the hand and foot dimensions and the stature

and to devise linear and multiple regression equations for each

gender. There are differences among populations due to

variations of race and ethnicity thus region based study of

subjects is necessary to have population specific forensic [30-33]standards .


After taking approval from research review committee of the

university and informed consent from participants the study

was conducted in Bhopal, India which is a region in central part

of India. All the measurements were taken in centimeters in a

reasonably well lit room by author himself to avoid inter-

observer error in methodology. 140 healthy subjects (70

female and 70 male) between the age group of 20 to 25 years

were chosen randomly. Sliding calliper was used for hand/feet

measurements and Stadiometer was used to measure vertical

height for stature estimation. The subjects were made to stand

on the level platform barefoot and erect against the stadiometer

bar with head in the Frankfurt plane for stature. Length and

width of hand and foot were measured separately of the left and


44

ABSTRACT :

Introduction : The identification of body parts is essential of biological profiling. Present study aims to use hand and feet

measurements to estimate stature based on sex.

Material and Methods : The study included 140 adults with 70 male and 70 female from central India. The age group was between

18 to 25 years. Length and breadth of both hands and feet were taken into account.. A descriptive analysis was done and regression

equations were derived to estimate the stature for each gender.

Results : The correlation coefficient was significantly positive between measurements and stature in both sexes. The stature

prediction accuracy ranged from ±3.49 - ±4.25 in males and ±0.86 – ±1.37 in females.

right sides of each individual.

• Hand length [HL]: It is the projected distance between

the midpoint of a line joining the styloid process of radius

and ulna bones of forearm and the tip of third finger.

(Figure 1)

• Hand breadth [HB]: It is the distance between the most

prominent point on the lateral aspect of head of second

metacarpal and the most prominent point on the medial

aspect of the head of fifth metacarpal. (Figure 1)

• Foot length (FL): The distance from the most prominent

part of the heel to the most distal part of the longest toe.

• Foot breadth (FB): It is the distance between the most

prominent point on the medial aspect of head of first

metatarsal and the most prominent point on the lateral

aspect of head of fifth metatarsal. (Figure 2)

STATISTICAL ANALYSIS:

Right hand length (RHL), right hand width (RHW), right foot

length (RFL), right foot width (RFW), left hand length (LHL),

left hand width (LHW), left foot length (LFL), left foot width

(LFW) were measured. The data was subjected to statistical

analysis using statistical package for social sciences (SPSS-

20). The independent t-test was used to test for differences

between the mean measurements. The strength of correlation

between hand and foot dimensions were calculated using

Pearson's correlation coefficients (r). Linear and multiple

regression equations for stature estimation were developed [30]using the hand and foot dimensions .


45

(Figure 2)

(Figure 1)

MALE FEMALE

Min Max Mean Std. D. Min Max Mean Std. D. P Value

AGE 18 22 19.06 1.089 18 25 18.86 1.21 0.000*

Height 158 185 171.41 5.617 145 166 157.3 5.51 0.000*

RHL 18 22 19.49 1.236 16 20 17.96 0.824 0.000*

RHW 9 12 10.04 0.939 8 10 8.61 0.519 0.000*

RFL 25 28 26.10 0.950 21 25 23.44 1.08 0.000*

RFW 10 11 10.33 0.473 8 10 9.16 0.67 0.000*

LHL 18 22 19.53 1.176 16 20 17.93 0.78 0.000*

LHW 8 12 9.96 0.842 7 9 8.59 0.52 0.000*

LFL 10 11 10.34 0.478 21 25 23.53 1.08 0.000*

LFW 25 28 26.29 1.009 8 10 9.17 0.68 0.000*

Table 1 : Descriptive Statistics of Stature, Hand and Foot Dimensions (cm) for both sexes.

RESULTS :

Table I shows the descriptive statistics for hand and foot

dimensions for both sexes. All the measurements were found

to be significantly larger for males as compared from females.

Sex specific Pearson's correlation of coefficients showed

statistically significant correlation of hand and foot

dimensions with stature (P- value <0.01) (Table 2). The

highest correlation in males was observed for the right hand

length and least with left foot length while among females the

highest correlation was with left foot length and least with right

hand width.

The linear regression equations were calculated for the stature

estimation for both the sexes for each individual measured

variable as shown in Table 3 for males and Table 4 for

females. The Standard Error of Estimate (SEE) was also


46

Table 3 : Linear Regression Equations for the Estimation of Stature (in cm) from Hand and Foot Dimensions in Males.

Males

Linear Regression Equation SEE R� P Value

S =102.52 + 3.53 × RHL 3.55 0.60 <0.001

S =145.55 + 2.57 × RHW 5.10 0.17 <0.001

S =124.03 + 1.81 × RFL 5.38 0.08 <0.001

S =94.18 + 7.47 × RFW 4.39 0.38 <0.001

S =100.89 + 3.61 × LHL 3.70 0.56 <0.001

S =143.45 + 2.80 × LHW 5.13 0.16 <0.001

S =133.74 + 1.43 × LFL 5.46 0.05 <0.001

S =95.96 + 7.29 × LFW 4.43 0.37 <0.001

Table 4 Linear Regression Equations for the Estimation of Stature (in cm) From Hand and Foot Dimensions in Females.

Females

Linear Regression Equation SEE R� P Value

S = 49.30 + 6.01 × RHL 2.42 0.809 <0.001

S = 84.48 + 8.45 × RHW 3.35 0.629 <0.001

S = 43.73 + 4.84 × RFL 1.66 0.909 <0.001

S = 88.86 + 7.47 × RFW 2.26 0.831 <0.001

S = 43.99 + 6.32 × LHL 2.39 0.810 <0.001

S = 84.62 + 8.46 × LHW 3.28 0.644 <0.001

S = 41.77 + 4.91 × LFL 1.38 0.936 <0.001

S = 89.42 + 7.40 × LFW 2.25 0.833 <0.001

Variables Value of ‘r’

Male Female

RHL 0.778** 0.900**

RHW 0.431** 0.796**

RFL 0.307** 0.954**

RFW 0.630** 0.913**

LHL 0.756** 0.902**

LHW 0.421** 0.806**

LFL 0.257*** 0.968**

LFW 0.621** 0.914**

Table 2 : Pearson’s Correlation Between Stature and Hand and Foot Dimensions.

calculated. It predicts the deviation of the estimated stature

from the actual stature (lower values indicate more reliable

stature estimates). The SEE was between ±3.55 (right hand

length) and ±5.46 (left foot length) for the males and was

between ±2.42 (right hand length) and ±3.35 (right hand

width) for the females. The regression coefficients were found

to be statistically significant for all of the derived equations.

Multiple regression equations (Table 5 and 6) were derived to

assess whether using multiple variables would increase the

accuracy of predicting stature. This showed a reduce SEE,

±3.37 for males and ±0.86 for females. The regression

formulae were developed for all hand and foot, in case

individual hand or foot of either side are found to be

dismembered.


47

The SEE values using multiple regressions for each hand and

foot dimension showed improved values in both the sexes.

DISCUSSION :

The limb dimension is valuable in forensics especially for

estimation of stature. Many previous studies have established a

positive relation between hand and foot dimensions and stature [40]estimation .

[29, 39]Each person has a unique shape and size of hand and foot

as they show ethnic and regional variations due to congenital

and climatic conditions. Physical activities, nutritional

conditions and the foot wear worn also affect the shape and size [31]. This study was done with 140 subjects between the age

group of 18 and 25 years. The results of our study showed that

stature and all measured dimensions of hand and feet are

significantly greater in males as compared to females. This is in [33, 35, 36, 41]agreement with the results shown in previous studies .

This is attributed to late skeletal maturity in boys as compared

to girls which gives them more time to grow. In addition to this,

climate, geography and nutritional stature also play a role in [42]stature growth . Studies have shown that general shape and

size of foot remains permanent throughout life once reaching

age of 16 years in males and 14 years in females, however foot

breadth may be affected due to the spread of the toes due to [30, 41, shoe wearing habits, physical activity and nutritional status

43, 44].

While evaluating for the correlation, all the measurements of

hand and feet of both sides were found to be significantly

correlated with stature in both sexes. The correlation

coefficient between stature and hand dimensions were higher

for hand length on both the sides for both males (0.778 right

hand length and 0.756 left hand length) and females (0.900

right hand length and 0.902 left hand length) as compared to

hand breadth. The correlation of coefficient for stature and foot

dimensions were greater for foot width in males (0.630 right

foot width and 0.621 left foot width) as compared to breadth

while foot length in females (0.954 right foot length and 0.968

left foot length). This result is in agreement with Kanchan et al

who also found higher correlation was exhibited by foot

breadth. However, the results of present study are not in [42]concordance with findings among rajbanshi population

where the foot length was found to have higher positive

correlation with stature in both sexes. These variations could

be attributed to biological and environmental factors affecting

the studied populations.

The standard error of estimation was found to be least for right

hand length (± 3.55) and left hand length (± 3.0) in males as

while it was lowest for the right foot length (± 1.66) and left

foot length (± 1.38) in females.

The standard error of estimation is lesser when using the

multiple regression equations as compared with linear

regression as is shown is previous studies. It is also less in

females when compared to males for all the variables. Thus the

accuracy of with multiple regressions is higher in females as

compared to males which is similar to the findings in previous [43- 44]studies .

CONCLUSION :

Estimation of stature is essential for determining dismembered

bodies especially in natural disasters or an accident like plane

crash leading to severed body parts. Expensive procedures like

DNA analysis are not always possible due to economic

reasons. In present study multiple regression equations have

been derived from limb measurements. These equations can be

used to determine the sex and stature. One of the limitations of

the study is the age group. In future studies a wider age group

Table 5 : Multiple Regression Equations for the Estimation of Stature (in cm) From Hand and Foot Dimensions in Males.

REGRESSION EQUATION SEE R� P VALUE

1 87.17+3.78*RHL+1.07*RHW 3.37 0.63 <0.001

2 78.51+0.912*RFL+6.67*RFW 4.25 0.42 <0.001

3 90.91+3.70*LHL+0.86*LHW 3.49 0.61 <0.001

4 75.35+0.88*LFL+7.02*LFW 4.20 0.43 <0.001

Table 6 : Multiple Regression Equations for the Estimation of Stature (in cm) From Hand and Foot Dimensions in Females

REGRESSION EQUATION SEE R� P VALUE

1 47.76+1.93*RHL+8.65*RHW 1.25 0.947 <0.001

2 31.34+5.49*RFL+0.3*RFW 1.05 0.963 <0.001

3 46.93+2.54*LHL+7.48*LHW 1.37 0.937 <0.001

4 32.33+5.44*LFL+0.37*LFW 0.86 0.970 <0.001


48

can be studied.

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50



Dr Seema Rani Pathak,

Professor and Head,

Department of Chemistry, Biochemistry and Forensic

Sciences, Amity School of Applied Science (ASAS), Amity

University, Gurugram, Haryana- 122413, India.

Contact : +919871803613


KEYWORDS : Homogenous Strokes, Three-Dimensional Analysis, Ball Point Pens, Gel Pens.

Article History:Received: 13 April 2018Received in revised form: 25 April 2018Accepted on: 25 April 2018Available online: 1 July 2018

INTRODUCTION :

Forensic Document examination is one of the oldest branch of

Forensic sciences and till now being used for investigation of

the documents. One of the most challenging part in Forensic

Questioned Document is the determination of sequence of

strokes or in other words sequence of two intersecting lines [1]placed on a writing surface . Sequence of strokes means, the

sequence in which words or alphabets are placed or written on

writing surface. The need for investigation of sequence of

strokes arises when it is alleged that a statement is written after

a signature was done on the document, the two handwritings

touch at the same point or this examination can be performed to

learn which of the two writings that touch was last written. The

examination of sequence determination is very important job

to fix the accountability of the document.There are many cases

in which the signatory claims that the document he signed may

be disputed as the paragraph or sentence written just above his

signature was not present when he signed it. The most common

examples are blank paper signatures, addition in security

documents like cheques, etc. The dispute could be settled if we

could determine the sequence of writings when they are

intersecting (whether the paragraph was written first or the

signature). The importance of sequence of strokes Forensic

Questioned Documents was first mentioned by Albert S

Osborn in his book “Questioned Documents”. He stated that

“in various situations it is not possible to tell the correct

chronological order of two crossed lines and under these

situations a strong evidence should be made. This evidence

should be supported by observations from instruments. These

observations should be clear enough that a layman is able to

conclude the correct sequence of crossed lines”. Albert S

Osborn also said that the time interval between two writing is

also an influential factor. Examining the sequence of stroke is

not easy because there are several factors which affect the

analysis process like, writing instrument, types of ink, the

number of intersections, the color intensity of the lines [2]intersecting each other, the color of the ink and much more .


Determination of the Sequence of Strokes Made from the Same Color and Type of the Ink

1. Manisha Mann, Research Scholar*

2. Sudhir Kumar Shukla, Professor and Head, Amity Institute of Forensic Sciences (AIFS), Amity University, Noida.

3. Seema Rani Pathak, Professor and Head*

* Department of Chemistry, Biochemistry and Forensic Sciences, Amity School of Applied Science (ASAS), Amity

University, Gurugram, Haryana- 122413, India.

ABSTRACT :

Investigation of the sequence of strokes is an integral part in Forensic Questioned Document Examination. With the modernization,

forgers are also using modern methods for forging the documents and hence making the examination process more tedious. The

present study focuses on investigating the sequence of two intersected lines made from same type and color of the ink using

Confocal microscope and Docucenter Nirvis. Oil-based and liquid based inks in the color black was used for making the sample.

All the intersections made were homogenous in nature.The samples were first analysed under Docucenter Nirvis and then finally

examined under Confocal microscope for more accuracy. It was found that the Confocal microscope covered all the area in which

the Docucenter Nirvis lacked in the analysis and gave more confident result. The three dimensional feature of Confocal microscope

aided the study and the authors was able to find the correct sequence of the lines placed on the writing surface.

Many studies are done and still going on sequence of

intersecting lines. The study on sequence of strokes is done by

examining one factor at a time. For Instance, Cheng et al. used

laser scanning electron microscope for determining the

sequence of the strokes. They examined the samples in three

ways- first by using the microscope, second by using a sticky

lifter technique and finally by measuring the color error at the [3]point of intersection . Saini et al. studied the physical

characteristic of the ink as phenomena for examining the

sequence of intersecting lines using Digital microscope and

Stereomicroscope, and they concluded the result by

discovering the features like “skipping of ink, relative sheen,

gaps of ink lines at the point of intersection and specular [4]reflection .” Vaid et al. used VSC 2000 HR for examining the

sequence of strokes by studying the reflectance spectra of the [5]ink .

Examination of sequence of strokes made from same type and

color of ink is very difficult. The dispersal of homogenous ink

particles from one line into another makes the analysis even [6]more tedious . Luminescence and gloss of the ink also affect

[7]the analysis process . Blobbing cause excess of penetration of

the ink on the paper and that affects the interpretation part of

the analysis as it gives the wrong impression about the

sequence of the latter and former line as heavy ink line appears [2]on top position . These are some of the factors which produces

confusion in the minds of the Forensic Document Examiner.

In the present study, two instruments are used. One is

Docucenter Nirvis and second one is Nikon A1 Confocal

Microscope. Docucenter Nirvis is most commonly used in all

Forensic Science laboratories. The objective of the study is to

compare the outcomes of Docucenter Nirvis and Nikon A1

Confocal Microscope and to find out which instrument should

be used for more accurate and précised result. The study will

aid all the Forensic Document Examiner so that they could find

out the correct chronological sequence of the lines placed on

the paper despite of color and type of the ink used.


50 samples examined on A4 sheet of Trident Spectra

Photocopier Papers of 7x3 inches dimensions using Black Oil

based and liquid ink and Cello Pen Point/Gel Pen (Cello Butter

flow). Figure 1 represents one of the samples used for analysis.

On the sample, primarily 5000 was written, and then signature

was placed above 5000. Then one was added between 5 and the

first 0; it means the number 5 and 0 are below the stroke of the

signature, and one is above the stroke of the signature. This

type of sample preparation is the case of 'addition,' and it is

commonly done practice for making fraud documents.

All the samples were first examined under Docucenter Nirvis

and then under Nikon A1 Confocal Microscope Figure 2

explains the protocol which was applied for making samples.

Figure 2 : Graphical Representation illustrating the

Protocol of Producing Samples

RESULT AND DISCUSSION :

Analysis of sequence of homogenous intersected strokes

under Docucenter Nirvis : After examining each sample

under Docucenter Nirvis, the authors found that the

composition of ink played an essential role in concluding the

results. Table 1 represents the analysed result of the 50

samples under all the nine lights present in Docucenter Nirvis.

Table 1 : Observations of Docucenter Nirvis Depicting the

Positive Outcomes.


51

Homogeneous Intersected Lines(50 Samples)

Figure 1 : Model Sample

Type ofink

CelloPin Point

Ball Pen (Black)

CelloButter Flow

Gel Pen (Black)

White Light

Topside Light

Coaxial Light

IR Light

Side Left Light

Side Right Light

UV-A 365 Light

Bottom UV-A Light

LumiBP Light

4%

8%

0%

0%

100%

92%

0%

0%

100%

0%

8%

0%

0%

96%

84%

0%

0%

88%

1 was added after the signature

was placed on the paper

Area to be examined under

Docucenter Nirvis

Homogeneous strokes made by Cello pin point ball pen

(25 samples)

Homogeneous strokes made by Cello butter flow gel ball

pen (25 samples)

LumiBP filter light was found to be most reliable light for

qualitatively examining the fluorescence imparted by the ink.

The LumiBP filter 570 of excitation 530-570 nm and emission

was 570 nm, and LumiBP filter 590 of excitation 550-590 nm

and emission 590 nm was used. It was observed that Cello Pin

Point ball pen gave maximum fluorescence, which was

followed by Cello Butter flow gel pen ink. Side oblique left,

and right light also found to be efficient and reliable for

determining the sequence of homogeneous intersections. The

success of the oblique light depends on the depth of the groove

formed on the paper by the writing media due to the pressure

applied while writing. The depth of the groove is associated to

the amount of the pressure applied. The oblique light gets filled

into the grooves; the continuity of filling of light in the line will

be seen disturbed when the former line is intersected the latter

line.The observations of the samples under LumiBP filter, side

oblique right light and Bottom UV-A can be seen in Figure

3(a), 3(b) and 3©.

Figure 3 : Docucenter Nirvis Observation on Intersected

Homogeneous Strokes Under (a) LumiBP Filter Light, (b)

Side Right Light and (c) Bottom UV-A Light

Observations from Top side, Coaxial light, UV-A 365 light,

and Bottom UV-A light were found to be not so definite, in

other words, authors were not able to draw a positive inference.

As the intersected lines were made of same type and color, UV-

A 365 and Bottom UV-A light are generally used to determine

different types of ink used in making fraudulent documents.

Hence, UV-A 365 light and Bottom UV-A light can be used in

determining sequence of heterogeneous ink lines. Coaxial

light and top side also failed to impress the authors in analysis

process. White light and IR light were established to be

inefficient for analyzing the sequence of homogeneous

intersected lines.

Analysis of sequence of homogenous intersected strokes

under Nikon A1 Confocal Microscope : About 88 percent of

the samples gave confident result and the rest were belonged to

non-confident category. The result of the samples are presented

in Table 2.

Table 2- Observations of Nikon A1 Confocal Microscope

Depicting the Outcomes

The three-dimensional analysis aided the study and helped the

authors to form a positive judgement on the determination of

the sequence of the strokes made by homogenous inks. Two

types of images were taken using the Nikon A1 Confocal

Microscope; the first one is a three-dimensional image [Figure

–4, 5 (b), 2 (b)] and the second one was taken in different

channels like DAPI, FITC, and TD. The best outcomes were

seen in the TD channel [Figure- 4, 5 (a), 2 (a)].

Figure 4 : Confocal Microscope Observation on

Intersected Homogenous Strokes Made by Black Cello Pin

Point Ball Pen (a) Image Captured in TD Channel and (b) a

Three Dimensional Image of Intersection.


52

Ball Point Pen Ink

Fluorescing Under

LumiBP Filter

3 (a)

3 (b)

3 (c)

Type ofink

CelloPin Point

Ball Pen (Black)

CelloButter Flow

Gel Pen (Black)

Positive Outcome

Inconclusive

Negative Outcome

84%

12%

4%

92%

8%

----

4 (b)4 (a)

Three dimensional feature of the Nikon A1 Confocal

Microscope aided the authors to draw a definite conclusion

irrespective of color and type of ink used. The three-

dimensional image was handy, as the depth of the grooves

made by the writing media on the paper was observable and the

sequence of writing media strokes made on the paper could be

recognized.Pen pressure created by the writer also helped in

the analysis process. Higher the pen pressure, higher the ability

to find the sequences of overlapping pen strokes.

Figure 5 : Confocal Microscope Observation on

Intersected homogenous strokes made by black Cello

Butterflow gel pen (a) image captured in TD channel and

(b) a three dimensional image of intersection.

CONCLUSION :

Overall, the Nikon A1 Confocal microscope is a versatile

instrument for the analysis of the sequence of strokes. The

properties of the confocal microscope helped in the process of

the examination, especially the three-dimensional images

were extremely helpful for inspecting the sequence of the

strokes made by the homogeneous ink. The three-dimensional

analysis was valuable in determining the exact sequence of the

intersected strokes irrespective of the color and type of ink

used.After evaluating all the interpretations, it can be

established that the Docucenter Nirvis can be used for

determining the correct sequence of homogeneous intersected

lines, but up to a certain extent only. Out of all nine lights used

for analysis, LumiBP filter, Sidelight left, and right gave

positive results.LumiBP light is the best choice for analyzing

the intersected lines made from the ballpoint pen.The confocal

microscope is highly recommended for examining the

sequence of the strokes made by the black color ink. Its use is

not limited to low pen pressure. Further research is going on

sequence of strokes made by other types of inks like Pilot pen

ink and Fountain ink.

REFERENCES :

1. Brito L R, Martins A R, Braz A, Chaves A B, Braga J,

Pimentel M F. Critical review and trends in forensic

investigations of crossing ink lines. TrAC Trends in

Analytical Chemistry 2017;94:54-69.

2. Osborn A S.(1910) Sequence of writing as shown by

crossed strokes. In Questioned Document (pp. 375-

393). The Lawyer's Co-operative publishing Co.

3. Cheng K, Chao C, Jeng B, Lee S. A New Method of

Identifying Writing Sequence with the Laser

Scanning Confocal Microscope. Journal of Forensic

Sciences J. Forensic Sci. 1998;43(2)348-52.

4. Saini K, Kaur R, Sood N. Determining the sequence

of intersecting gel pen and laser printed strokes — A

comparative study. Science & Justice2009;49:286-

291.

5. Vaid B A, Rana R S, Dhawan C. Determination of

sequence of strokes through reflection spectra.

Problems of Forensic Sciences,2017;LXXXVII:

193-203.

6. C l a y b o u r n M , A n s e l l M . U s i n g R a m a n

Spectroscopy to solve crime: inks, questioned

documents and fraud. Science & Justice. 2000;

40(4):261-271.

7. Wilkinson T J, Perry D L, Martin M C, Mc Kinney W

R, Cantu A A. Use of Synchrotron Reflectance

Infrared Spectromicroscopy as a Rapid, Direct, Non-

destructive Method for the Study of Inks on Paper.

Applied Spectroscopy, 2002; 56(6):800-803.


53

5 (a) 5 (b)



Dr Pratik V Tarvadi,

Professor & Head,

Department of Forensic Medicine and Toxicology, Pacific

Institute of Medical Sciences, Ambua Road, Umarda, Udaipur

Contact : +91 98453-06634


KEYWORDS : Biomedical Waste, Knowledge, Management

Article History:Received: 10 May 2018Received in revised form: 10 May 2018Accepted on: 22 May 2018Available online: 1 July 2018

INTRODUCTION :

Biomedical waste or infectious waste or medical waste is

defined as solid waste generated during the diagnosis, testing,

treatment, research or production of biological products for

humans or animals. Biomedical waste includes syringes, live

vaccines, laboratory samples, body parts, bodily fluids and [1]waste, sharp needles, cultures and lancets . While biomedical

waste management means a technique, of dealing with

biomedical waste, from the point of generation to the disposal

of waste. As per the reports from developing countries

approximately 1-2 kgs per bed per day, whereas in developed

countries approximately 1-5 kgs of waste / bed / day is [2]generated. In India it is estimated to be 2.0 kgs /bed/day .

Biomedical Wastes in health care facilities are generated

commonly from wards, delivery rooms, operating theaters,

emergency, outpatient services, laboratories, pharmaceutical

and chemical stores. Hospital staff (doctors, nurses, health care

assistants, maintenance personnel, support personnel for waste

handling, transportation and laundry) working at these places,

patients and their visitors, and waste management facility

employees and scavengers are at high risk of exposure to

nosocomial infection resulting from biomedical wastes. The

management of the wastes plays a vital role in its management.

The management involves the following steps: generation,

segregation, collection, on-site transportation, on-site storage,

offsite transportation (optional), treatment and disposal of the

waste, with Segregation being the most important step in the [1-6]process of biomedical waste management .

Improper handling of biomedical waste increases the airborne

pathogenic micro-organisms, which would affect the hospital

environment and the community. Improper disposal of

Biomedical waste also carries a vital importance. If it is

disposed in open dumps, it increases the risk of injury from

sharps and the spread of infectious diseases to waste handlers


A Study On Waste Disposal Management In A Tertiary Care Hospital1. Pratik V Tarvadi, Professor & Head, Department of Forensic Medicine and Toxicology, Pacific Institute of Medical

Sciences, Ambua Road, Umarda, Udaipur

54

ABSTRACT:

Introduction: Hospital wastes pose a significant impact on health and environment. The quantity of the Hospital (Bio-Medical)

Waste generated varies depending on the hospital polices and practices and also the type of care that is provided. According to a

WHO report, globally, around 85% of the hospital wastes are actually non hazardous, 10% are infective (hence, hazardous), and

the remaining 5% are non-infectious but hazardous (chemical, pharmaceutical and radioactive).

Objectives: To collect information on the collection, treatment, handling, hauling, and disposal of medical wastes and determine

the type of hazardous medical wastes produced in hospital.

Material and Methods: Our study was done at a tertiary care hospital. Information regarding the biomedical waste was obtained

through observation and interview with the help of a validated questionnaire prepared for the respective medical and paramedical

staff of relevant departments.

Results: Our study revealed that the staff had knowledge of the biomedical waste handling but lacked the practical handling of the

waste. The predominant waste noticed in the hospital was human anatomical waste, solid waste, liquid waste and chemical waste.

We observed that the collection of waste from each department was twice a day (morning and evening) and was transported to the

government approved waste disposal locations.

Conclusion: Every hospital should have regular trainings regarding knowledge and practical application pertaining to handling of

Biomedical waste, which will inturn help in protecting themselves, patients and move towards a healthy society.

and scavengers; uncontrolled burning of wastes also increases [4-10]the risk of exposure to hazardous emissions .

Medical waste is responsible for serious health hazards and the

law requires hospitals to follow procedures that protect the

public from coming into contact with it, for which it has come

out with Bio-Medical Waste (Management and Handling) [6]Rules and Regulations, 1998 and amendments . Training of

employees regarding biomedical waste management has

become a necessity to combat the problems associated due to

biomedical waste generated at the health care facilities. It will

help the authorities to create strategy for improving the status [4,6]in future .

Aims and Objectives :

1. To collect information on the collection, treatment,

handling, hauling, and disposal of medical wastes

2. Determine the type of hazardous medical wastes

produced in hospital

3. Study the awareness amongst the hospital staff, about

biomedical waste management, so that policies for

improved status be formulated in future.


After taking Institutional Ethical clearance, the study was

conducted at a tertiary level centre Hospital at Dakshina

Kannada, Karnataka This is a full-fledged 800 bedded hospital

with adequate medical, paramedical staff and equipped with

modern facilities. The data was collected through observation

and interview with the help of a validated questionnaire

prepared for staff, doctors, nurses and employees of operation

theatres, laboratories, laundry and central sterilization

departments of the hospital. The primary data was collected by

observation and structured validated questionnaire and

secondary data was collected from literature.

RESULTS:

The data collected at the interview was Tabulated as:


55

S.No. Topic

W C LR HK A%

F N F F FN N N

Knowledge on hazardous nature of biomedical waste

Knowledge on transportation facilities for biomedical waste

Is the training given enough in case of biomedical waste management

Are you provided with adequate protective measures to protect yourself from biomedical waste

Are the biomedical wastes being disposed as per guidelines

Are your health records being maintained

Are the workers provided with immunization

Is the standard color coding method used for biomedical waste segregation

Knowledge on apparatus used for disposing the waste

1

2

3

4

5

6

7

8

9

1

0

1

0

0

1

0

1

0

1

1

1

1

1

1

1

1

1

1

0

0

1

0

1

0

1

0

1

1

1

1

1

1

1

1

1

1

1

0

1

1

1

0

1

0

1

1

1

1

1

1

1

1

1

1

1

0

0

0

1

0

1

1

1

1

1

1

1

1

1

1

1

4/4

100

50

25

50

25

100

00

100

25

Table 1: Interviewed Questions at Different Departments

*‘1' indicates positive answer or Yes *'0' indicates negative answer or NoW – Wards F – Finding in our studyC – Casualty / Emergency Medicine N – Normal standard resultL R – Labour room O T – Operation Theatre H K – House keeping A – Analysis done as percentage on each question in the interview, indicating the knowledge and status regarding biomedical waste.

Table No. 1 indicates the awareness of biomedical waste and

about its management among the hospital staff. It is very clear

from the table that though they have the knowledge about

biomedical waste but due to inadequate training given to them,

they do not have the practical application and knowledge of

waste management. From our findings, it was interpreted that

the institution is playing its part in waste management, but the

application is not there at the action level.

Table No. 2 enumerates the wastes produced in each

department.

In our study, we observed that the frequency of collection of

waste from each department was twice a day, Morning

between 8.00 am to 9.00 am and evening 4.00 pm to 5.00 pm,

and transported to storage place. From the storage place to

disposal center, the waste is collected on alternate days. The

general waste is shifted to Vamchur, while the hazardous waste

is shifted to Mulky, for its further treatment and disposal.

(Table 3)

S.No. Topic W C LR OT

1

2

3

4

5

6

7

8

9

1

0

1

0

1

1

1

1

1

Human anatomical waste

Animal waste

Microbiological Waste

Waste sharp

Discarded medicine & cytotoxic drugs

Solid waste

Liquid waste

Incineration ash

Chemical waste

1

0

1

1

0

1

1

1

1

1

0

1

1

1

1

1

0

1

1

0

0

0

0

1

1

1

1

Table 2 : Types of Biomedical Waste

DISCUSSION :[6]As per Biomedical Waste Management Rules, 1998 , “every

hospital generating biomedical waste needs to set up requisite

Biomedical waste treatment facilities on site or ensure

requisite treatment of waste at common treatment facility”.

Management of these waste is very important in all hospitals

and also important is the hospital staff having adequate

information regarding hospital waste and its management and

also be adequately trained for hospital waste management to

avoid nosocomial infections arising due to biomedical waste in

the hospital. In our study we observed that the hospital staff

though had the knowledge of the hazardous effects of the

biomedical waste but lacked the knowledge regarding its

transportation and were not adequately trained in biomedical

waste management.

In our study we observed that, adequate protective clothing

were though provided, but were not used, which can result in

infection to self while managing or transporting biomedical

wastes. As per Biomedical waste Management and handling [6]rules 1998 , Health care waste management workers should

be given proper protective clothing, provide immunization and

training to them. The hospital is doing its part, but inadequacy

from the workers in following the guidelines was noted.

In our study we observed that, sparing animal waste, all the

types of wastes are produced in our hospital, specifically the

departments we did our study on. These include general and

hazardous, which implies that it is very vital for the hospital

staff to be adequately trained and prepared in handling and

disposal of these wastes.

In our study we observed that the hospital was following the

Rules book in terms of maintaining color coded containers for

proper segregation of waste material, but apart from the data

about colour coding it was observed that the hospital staff did

not have adequate information regarding the disposal of

wastes.[10-11]As per handling of biomedical waste management , it is

mentioned that the color coded bags in the wards should be

emptied at-least once a day, preferably twice a day and the

wastes should be sent to the disposal at-least on alternate days.

It was observed in our study that the transportation of the waste

was done twice a day and at the time which did not interfere

with other activities like peak working hours and meal times.

Also the wastes were transported from the hospital storage

place to the disposal place for further treatment every alternate

day.

CONCLUSION AND RECOMMENDATIONS:

Biomedical waste management deals with biomedical waste,

from the point of generation to the disposal of waste. Our study


56

S.No.

Topic W C LR OT

1

2

3

Frequency of CollectionTime of Collection – Morning

Time of Collection – Evening

Table 3: Transportation Timings

Twice

8-9am

4-5pm

Twice

8-9am

4-5pm

Twice

8-9am

4-5pm

Twice

8-9am

4-5pm


57

dealt with the departments where the most infectious

biomedical waste is generated. Among all the wastes, only

animal wastes are not generated at our hospital.

In our study we observed that the studied departments

followed proper color coding segregation and collection

procedure. The frequency of waste collection was twice in a

day and the transport of waste from the department to the area

of disposal was on alternate days. Disposal of these wastes was

being done in accordance to the guidelines. As the hospital is

providing proper training to the staff, they are well aware about

the nosocomial infection due to improper biomedical waste

management. As no research or any statistical study is present

regarding any nosocomial infection resulting from Biomedical

wastage, we are of the opinion that a study is required to be

done to keep the hospital updated about the relation between

nosocomial infection and biomedical waste management.

Our team also had observed that the hospital is providing the

necessary basic protective measures but due to lack of training

the hospital staff is not well aware about the safety measures

they need to comply to. Hence it is of paramount importance

that all the hospital staff should be provided adequate training

regarding biomedical waste management. Also it is important

that hospital management should depute few paramedical

staff, properly trained in courses that provide training for

biomedical waste management who can work as supervisors in

biomedical waste management, to give a healthy hospital

atmosphere and prevent nosocomial infection to the hospital

staff, in particular workers of biomedical waste management

team.

The hospital authority should also look into re-design a

separate lift or stair case to transport the wastes other than

patient circulation area, so as to prevent the exposure of

biomedical waste to the already weakly immunized patients

present in the wards.

We observed in our study, that with certain limitations and

shortcomings also, the hospital is trying their level best to

effectively handle the Biomedical waste management and to

protect themselves and the patients from the hazardous nature

of the biomedical waste.

LIMITATION OF STUDY :

Ÿ The study is limited to only one hospital

Ÿ Short study period

FUNDING: None

ACKNOWLEDGEMENTS:

Ÿ My teacher and guide, Dr. Mahabalesh Shetty, M.D.,

Professor and Head, Department of Forensic Medicine, K S

Hegde Medical Academy, Mangalore for his constant

encouragement, constructive criticism, continuous

motivation and personal attention throughout this study.

Ÿ D r. Sampath Kumar , Dr. Sher ley , Nurs ing

Superintendent and all the participants, who spent their

valuable time for their kind help and assistance in

answering my questionnaire for the data collection.

REFERENCES :

1. Mathur P, Patan S, Shobhawat S. Need of Biomedical Waste

Management System in Hospitals - An Emerging issue - A

Review. Curr World Environ 2012;7(1):117-124

2. Grover P.D. Management of Hospital Wastes – An overview.

Proceedings of National workshop on Management of Hospital

Waste;1998:16-18.

3. S. Saini, S.S. Nagarajan, R.K. Sarma, Knowledge, Attitude and

Practices of Bio-Medical Waste Management Amongst Staff of a

Tertiary Level Hospital in India, Journal of the Academy of

Hospital. 2005; 17(2): 01-12

4. World Health Organization. Preparation of National Health-

Care Waste Management Plans in Sub-Saharan Countries.

Guidance Manual (Cited 20 February 2018). Available from:

http://www.who.int/water_sanitation_health/medicalwaste/en/

guidancemanual.pdf

5. World Bank. Health Care Waste Management in India. (Cited 25

February 2018). Available from:

http://siteresources.worldbank.org/INTRANETENVIRONM

ENT/1705736-1127758054592 / 20677728 / HCWMText.pdf

6. Ministry of Environment and Forests. Government of India.

( C i t e d 2 5 F e b r u a r y 2 0 1 8 ) . Av a i l a b l e f r o m :

http://envfor.nic.in/legis/hsm/biomed.html

7. World Health Organization. Management of solid health-care

waste at primary health-care centres. A Decision-Making guide.

(Cited 25 February 2018). Available from:

http://www.searo.who.int/entity/emergencies/documents/List_

of_Guidelines_for_Health_Emergency_solid-health-

care_waste.pdf?ua=1

8. World Health Organization. Health Care Waste Management.

Guidance for the development and implementation of a National

Action Plan (Cited 25 February 2018) Available from:

http://www.who.int/water_sanitation_health/medicalwaste/en/

napguidance.pdf

9. Mathur V, Dwivedi S, Hassan M, Misra R. Knowledge, attitude,

and practices about biomedical waste management among

healthcare personnel: A cross-sectional study. Indian J

Community Med. 2011;36(2):143–5

10. International Committee of the Red Cross. Medical Waste

Management. (Cited 1 March 2018). Available from:

https:/www,icrc.org/eng/assets/files/publications/icrc-002-

4032.pdf

11. World Health Organization. Safe Management of Bio-medical

Sharps Waste in India. A Report on Alternative Treatment and

Non-Burn Disposal Practices. (Cited 1 March 2018). Available

from:

h t t p s : / / w w w . h e a l t h c a r e - w a s t e . o r g /

fileadmin/user_upload/resources/Safe-management-bio-

medical-sharps-waste-India-2005.pdf



Dr Thanka J,

Professor,

Department of Pathology, Sri Ramachandra Medical

College & Research Institute, Porur, Chennai – 600116

Contact : 94440-47907


KEYWORDS : Gross Changes, Histopathology, Dating of Abrasions.


INTRODUCTION :

A wound or injury is defined as damage to any part of the body [1]due to application of mechanical force . Forensic experts are

frequently asked to comment on the age of injuries and the

interpretat ion may have significant medico-legal [2]consequences . Three basic lesions are recognized:

[3]Abrasions, Contusions and Lacerations . Age of wounds can

be determined by (i) Gross changes (ii) Histopathology [4](iii)Enzyme histo-chemistry and Immuno-histochemistry . In

Indian setting, generally, we adopt the “naked eye

examination” method to date an injury. It is difficult to

determine exactly the age of an injury on the basis of its [5]appearance by the naked eye . Hence this study of wound

dating of abrasions from macroscopic and microscopic level

was taken up in our set up, to look into the accuracy by

comparing with the age determined by colour changes and

microscopic examination with that of the known time of

infliction of injury.


58

Wound Dating By Gross And Histopathological Examination of Abrasions

- An Autopsy Based Study 1. Prashanthi Krishna Dharma Ramasamy Devaraj, Assistant Professor, Department of Forensic Medicine, Sri

Muthukumaran Medical College & Research Institute, Chikkarayapuram, Chennai – 600069

2. Thanka J, Professor, Department of Pathology, Sri Ramachandra Medical College & Research Institute, Porur, Chennai –

600116

3. Sampath Kumar, Professor and Head, Department of Forensic Medicine,Sri Ramachandra Medical College & Research

Institute, Porur, Chennai – 600116

4. Selva Arasi, Third Year Post Graduate Student, Department of Forensic Medicine,Sri Ramachandra Medical College &

Research Institute, Porur, Chennai – 600116

ABSTRACT :

Introduction: Abrasions are the commonly encountered blunt force injuries. Exact ageing of wound is inevitable in routine

forensic investigations. Each phase in wound healing such as inflammation, proliferation, and maturation helps us understand the

chain of events in wound healing. This study was done to determine the age of abrasions since the time of infliction till death by

histopathology and gross examination.

Materials and Methods: Postmortem study of wound dating by gross and histopathological examination of abrasions was

carried out in the Department of Forensic Medicine, in Sri Ramachandra Medical College. Cases subjected to medico legal

autopsy having well demarcated abrasions were taken up for the study. A total of 37 abrasions were studied by microscopy in

correlation with the gross changes at various time interval. Abrasions ranging from 0 hour to a maximum of 21 days were studied.

Cases with known time of infliction of injury were included in the study and cases in a state of decomposition were excluded from

the study.

Results: Microscopic changes corresponds to the gross changes in abrasions whereas, with various co-morbid conditions wounds

showed disparity by delaying healing process.

Conclusion: This study reveals us when subjective evaluation of gross findings are combined with the histopathological

examination, the reliability and precision of dating wounds increases in comparison with gross findings alone, especially before

giving opinions.


After clearance from Ethical committee, the present study was

carried out on cases with well demarcated abrasions and

known time of injury, which were subjected to medico legal

autopsy in the Department of Forensic Medicine of Sri

Ramachandra Medical College from May 2015 to Oct 2016.

Consent for tissue section was obtained. Abrasions were

grouped under 7 different time intervals : Injuries of 0-4 h,

4-12 h, 12-24 h, 24-72 h, 4-6 days, 7-14 days and more than 2

weeks old. The representative areas of injury were subjected to

histopathological examination along with control samples

from normal skin. After tissue processing, embedding,

sectioning, H&E staining and cover slipping, slides were

viewed under microscope.

RESULTS :

Gross Changes (Table No. 1 ) :

37 abrasions were studied. Red colour was observed in 19

abrasions, 17 of these injuries were 0-4 h old. Reddish scab was

noted in 5 injuries, of which 4 (80%) injuries were 12-24 h old.

Brownish scab was noted in 4 injuries of age between 24-72h.

The dark brown scab was noted in 2 injuries, out of which one

was 4-6 days old and the remaining 1 was 24-72 h old. The

black scab was noted in 2 injuries, out of which 1 was 7-14

days old and another was 4-6 days old. The fall of scab was

noted only after 6 days.

Microscopic changes (Table No. 2) :

17 abrasions showed haemorrhage/congestion of vessels, 11 of

them were 0-4 h old. Oedema was noted between 0-4h.

Margination of neutrophils was observed between 0-4h.

Prominent neutrophilic infiltration was observed in injuries

above 12 hrs old. It was noted earliest at 14h and progressive

increase was noted in the injuries of 24-72 h old. Mononuclear

cells infiltration was first noted at 14h. The earliest

regenerative change of epithelium was noted at 24hrs.

Fibroblasts were evident at 24 hrs in a male without any co

morbid conditions. The granulation tissue deposition was

noted in 6 injuries, which were more than 3 days old. Collagen

tissue was noted in injuries more than 1 week old.

Correlation of gross changes with microscopic changes

(Table 3-4) :

19 abrasions of red colour showed no appreciable

inflammatory response. 5 abrasions with reddish scab showed

early inflammatory changes. 4 among 5 abrasions with

brownish scab showed predominant neutrophilic infiltration.


59

Table No. 1 : Distribution of Abrasions by its Gross Changes

Gross Changes

Red Reddishscab

Brownishscab

Dark Brownscab

Blackscab

Scab fallenoff

partially

Scab fallenoff

completely

Total

0-4h

4-12h

12-24h

24-72h

4-6 days

7-14 days

>2 weeks

Total

17(45.9%)

2(5.41%)

0

0

0

0

0

19(100%)

0

0

4(80%)

1(20%)

0

0

0

5(100%)

0

0

1(20%)

4(80%)

0

0

0

5(100%)

0

0

0

1(50%)

1(50%)

0

0

2(100%)

0

0

0

0

1(33.3%)

2(66.6%)

0

3(100%)

0

0

0

0

0

0

1(50%)

2(100%)

0

0

0

0

1(33.3%)

2(66.6%)

0

3(100%)

0

0

0

0

1(50%)

1(50%)

0

2(100%)

Abrasion - Complete re - epithelization.Infuammatory granulation tissue in the upper dermis. H&Ex100

Abrasion - Skin with well formed scab. H&Ex100


60

Table No. 4 : Distribution of Abrasions by its Gross Changes

Microscopic changes Earliest appearance Routine appearance

Congestion/ hemorrhage 0 min 0-4 h

Oedema formation 0 min 0-4 h

Margination of polymorphs 1 hr 50 mts 0-4 h

Early infiltration of neutrophils - 4-12 h

Predominant neutrophilic infiltration 14 hrs 12-24 h

Mononuclear cell infiltration 14hrs 24-72 h

Fibroblast formation 24hrs 30 mts 71-78 h

Granulation tissue deposition 24hrs 30 mts 4-6 days

Collagen tissue deposition 10 days13hrs 24mts 7-14 days

Regression phase - >2 weeks

Table No. 2 : Distribution of Abrasions by its Microscopic Changes

Microscopic Scoring

0-4h

4-12h

12-24h

24-72h

4-6 days

7-14 days

>2 weeks

11

0

4

2

0

0

0

Age ofInjury

0 1 2 3 4 5 6 7 8 9

2

0

0

0

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

5

2

2

4

0

0

1

1

1

3

0

0

0

0

1

3

2

0

0

0

0

1

3

2

0

0

0

0

0

0

1

1

0

0

0

0

0

0

0

Score :

0- Haemorrhage and/or Congestion of vessels

1- Oedema formation

2- Margination of polymorph cells

3- Early infiltration of neutrophil cells

4- Predominant neutrophil infiltration with poorly

differentiated mononuclear cells.

5- Predominant mononuclear cell infiltration

6- Fibroblast formation

7- Granulation tissue with rich leucocyte infiltration and much

fibroblasts

8- Collagen tissue deposition

9- Cellular reaction subsides, fibroblast are more active with

increased collagen formation (regression phase)

Table No. 3 : Correlation of Gross Changes with microscopic Changes in Abrasions

Microscopic Scoring

Red

Reddish Scab

Brownish Scab

Dark Brown

Black Scab

Scab Fallen Off Partially

Scab Fallen Off Completely

11

3

1

1

0

0

0

GrossChanges

0 1 2 3 4 5 6 7 8 9

2

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

4

2

1

2

1

0

1

1

0

1

2

0

0

0

1

1

1

2

0

0

0

1

1

1

1

0

0

0

0

0

0

1

1

0

0

0

0

0

0

0

1 among 2 abrasions with dark brown scab showed

granulation tissue, macrophages and congestion . 2 abrasions

with black scab showed granulation tissue. One among 3

abrasions with scab fallen off partially showed collagen tissue

deposition . Scab was fallen off completely in one abrasion

which showed granulation tissue.

By comparing gross changes with microscopic changes, all the

injuries of 4-6 days duration showed grossly dark brown

except one which was black, whereas all their histological

pictures showed granulation tissue formation, which

confirmed the age of injury to be more than 4 days old. Scab

was fallen off completely in more than 2weeks old abrasions

and showed dense collagen tissue with decreased cellular

reaction.

DISCUSSION :

Maximum Number of cases observed were males and most of

the injuries were due to RTA. Maximum number of cases were

observed in the age group between 21-30 years. 17 out of 19

abrasions showing red colour were below 4 hrs of age. This

was in agreement with the study conducted by Sharma A et al : [6]he noted redness from 10 min up to 7 hours . It was observed

in another study that majority of cases on the first day were [4]dark red . Reddish scab was usually noted between 12-24 hrs.

Similar observation was made by Sharma A et al in their [6,8]study . An author also quotes that reddish scab forms by 8-24

[7] rdh .Brownish scab was noted on the 3 day. Dark brown scab

was noted after 63 hrs. Black scab was observed after 5 days. [6]Sharma A et al found hard brown scab 27 h onwards and an

author also quotes that by 4th and 5th day the scab looks dark [7]brown . However this was in disagreement with another

study, where they observed dark red scab instead of dark th [4]brownish scab on 5 day . The fall of scab was noted only after

6 days. Scab was fallen off completely in an abrasion of more

than 2weeks old. In a similar study by Sharma A et al found [6]that, the black scab started separating 7 days onwards and

thalso the author quotes that by 6 day it is blackish and it starts

falling off from the margins. A big scab takes a few more days [7]to fall off . However, this was in disagreement with the study,

where they observed dark brown scab instead of black scab on th [4]the 9 day .

Microscopy revealed loss of epithelial layer in all abrasions.

Loss of rete ridges was a prominent feature in all the pressure

abrasions. Haemorrhage/congestion of vessels and early

inflammatory changes were noted in abrasions of age less than

14 hours. Predominant neutrophilic infiltration was noted after

14hrs. Mononuclear cell infiltration was first noted at 14h. In a

similar study by Sharma A et al early mononuclear infiltration [6]was observed at 13h .The earliest regenerative change of

epithelium was noted at 24hrs.Granulation tissue was

predominantly noted after 5days.Collagen tissue formation

was noted in a wound more than 10 days old.

By comparing gross with microscopic changes, injuries of 4-6

days old with dark brown & black scabs showed granulation

tissue formation, which confirmed their age to be more than 4

days old.

Scab were fallen off completely and dense collagen tissue with

decreased cellular reaction were seen in abrasions of more than

2 weeks old. Deposition of granulation tissue was observed

routinely by 4-6days.

This observation is in agreement with the author - granulation [8]tissue formation is seen by 5-8 days and another author also

[1]quotes the similar finding . There may be significant delay of

fall of scab in septicaemia.

CONCLUSION :

The pattern of healing of abrasions by both gross and

microscopic appearance was uniform. For Indian population

with dark skin, gross changes by naked eye examination for

dating the injuries gives a rough estimate, thus subjecting the

samples for histo-pathological examination would be more

accurate, whereas gross changes are well appreciated in the fair

skinned people to some extent. Future studies should include

more number of cases comprising a) different age groups b)

each type of injury c) associated co-morbities d) different sites

to get a more detailed survey. In examination by

histopathology, the presence of artefacts in the form of sand,

mud particles, grease, paint & glass pieces etc. are to be kept in

mind.

Acknowledgement: Nil

Conflict of Interest : None

Limitations of Study : Samples studied were from

refrigerated bodies.

REFERENCES :

1. Knight B. The Pathology of wounds. In: Saukko P

(ed.)Knight's Forensic Pathology .3 rd ed London: Arnold

publishers; 2004. p. 136,166-69.

2. Pilling M.L, Vanezis P, Johnston A. Visual assessment of

the timing of bruising by forensic experts. J Forensic Leg

Med. 2010;17(3): 143-49.

3. Vij K. Mechanical Injuries. In: Vij K (ed.) Textbook of

Forensic Medicine and Toxicology. New Delhi: Reed

Elsevir India Private Limited; 2014. p. 203.

4. Aggrawal A. Mechanical Injuries. In: Aggrawal A (ed.)

Textbook of Forensic Medicine and Toxicology. New

Delhi: Avichal Publishing Company; 2014. p. 232.

5. Kumar L, Chaitanya B.V, Agarwal S.S, Bhastia B.K. Age


61


62

Related Changes in Mechanical and thermal Injuries-A

Pos t Mor tem Study. J Indian Acad Forens ic

Med.2011;33(2): 149-51.

6. Sharma A, Dikshit P.C, Aggrawal A, Mandal A.K. A Post

mortem study of histopathological findings to determine

the age of abrasion and laceration. Journal of Forensic

Medicine and Toxicology. 2010;27(1): 43-46.

7. Nandy A. Mechanical injuries. In: Nandy A

(ed.)Principles of Forensic Medicine and Toxicology.

New Delhi: New central book agency; 2000. p. 342,352.

8. Payne JJ, Busttil A, Smack W, (eds). Pathophysiology of

wound healing. In: Forensic Medicine, Clinical and

Pathological Aspects. London, England: Greenwich

Medical Media Ltd; 1977:83–87.

9. Reddy K.S.N. Medico-legal Aspects Of Wounds .

In:Murthy 0.P (ed.) The Essentials of Forensic Medicine

and Toxicology. Hyderabad: Om Sai Graphics; 2013.

10. Janssen W, Forster S. Forensic histopathology. Berlin:

Springer-Verlag:2011.

11. Vinay J, Harish S, Mangala GSR, Hugar BS. A Study on

P o s t m o r t e m Wo u n d D a t i n g b y G r o s s a n d

Histopathological Examination of Abrasions. The

American Journal of Forensic Medicine and Pathology.

2017;38(2):167–73.

12. Vinay J. Postmortem study of wound dating by gross and

histopathological examination of blunt injuries. Thesis,

2011;2014: 1-101.


Corresponding Author Dr. Lovleen

Assistant Professor

Department of Zoology, School of Bioengineering and

Biosciences, Lovely Professional University, Phagwara,

India

Contact : +91 94178-52950


KEYWORDS : Noon Tea, Reprotoxic Effects, Drosophila melanogaster


INTRODUCTION :

Noon tea (Kashmiri tea or Gulabi chai) is a special traditional

beverage, of Kashmir area, in India. Noon chai is composed of

Camella Sinensis, salt and a pinch of baking soda. Limited use

of noon tea possess many health benefits as it is powerful

antioxidant, inhibits formation of blood clots in intact blood

vessels, chances of heart attack and stroke wards off. The

Kashmiri tea (noon chai) is refreshing in the heat and resists the

cold in winters. The L-theanine, an amino acid component of

the tea helps to reduce the anxiety and stress, gaseous

distension, and intestinal spasms. Use of baking soda in noon

chai increases the alkalinity of the blood, which is useful in

muscle functionality. Major benefits of noon chai is, it

increases mental alertness, reduces headache and increase the [1]fluid levels in the body . Presence of oxalate in tea reduces the

[2]kidney stone formation by 8% in females and 14% in males .

But excessive use of noon chai is associated with induction of

gastric cancer in human beings and excess amount of sodium

bicarbonate can cause edema, alkalosis, heart failure,

hypertension, hypervolemic hypernatremia and also cause

urinary alkalinisation. It has been reported that 40% of gastric

cancer occur due to noon chai in Kashmir. It has been identified

that people suffering from anemia should avoid use of

Kashmiri tea as it contains polyphenolics which prevents

absorption of iron. It had been reported that regularly

consumption of noon chai enhance the level of ethylamine,

methyamine and pyrolidine in body, which are ultimately are

responsible for gastric cancer. Furthermore, noon tea cause

inflammation and generates free radicals of nitrogen and [1]oxygen which are carcinogenic .


As very limited data is available on reprotoxic consequences of

noon tea, therefore considering specific cognition, present

research work, had been executed, which deals with evaluation

of reprotoxic effects of noon tea on Drosophila melanogaster.

Reprotoxic consequences mean drastic effects of suspected

mutagen on reproductive potential of test organism.

About Test Model And Colonization under Laboratory

Conditions: For present research exploration Oregon strain of

Drosophila melanogaster was used. It is an excellent model

organism as it has simple food requirements, completes its life

cycle within 9-12 days, small diploid number 2n=8, high

fecundity and easy adaptability to laboratory conditions.


Reprotoxic Effects of Noon tea on Drosophila Melanogaster 1. Lovleen, Assistant Professor, Department of Zoology, School of Bioengineering and Biosciences, Lovely Professional

University, Phagwara, India

2. Altaf Hussain, MSc. Student, Department of Zoology, School of Bioengineering and Biosciences, Lovely Professional

University, Phagwara, India

3. Bhupendra Koul, Assistant Professor, Department of Botany, School of Bioengineering and Biosciences, Lovely

Professional University, Phagwara, India

ABSTRACT :

Present research work deals with reprotoxic effects evaluation of noon chai on, Drosophila melanogaster. To achieve, present

objectives, second instar larvae were exposed to 1% concentration of noon chai, thereafter exposed larvae were reared under

controlled condition of insectory, upto imago stage. Subsequently, adult flies were allowed to crossmate in two different sets,

including first set: treated males and normal female, second set: treated female and normal male, along with control stocks. It had

been observed that there was significant decline in fecundity of treated flies in comparison to untreated flies. Additionally, it had

been reported that reprotoxic effects were more pronounced in male flies than female flies. Finally, obtained data from different

experimental test was scrutinized by Z test, and procured data had been analysed statistically significant, in comparison to natural

population.

63

Further more, eggs are opaque which can be counted easily.

For experimental work, primary stock had been received from

Drosophila laboratory, Department of Biotechnology, Punjab

Agricultural University, Ludhiana. Drosophila melanogaster 0larvae had been maintained in BOD incubator at 25 ± 2 C with

its relative humidity 40% to 60% under dark conditions. The

culture media used to rear Drosophila was composed of yeast,

agar, sulphur free sugar, distilled water, methyl paraben and [3-5]propionic acid .

Selection of Suitable Exposure limit: Before executing any

reprotoxic evaluation it is fundamental requirement, to find out

a suitable exposure limits which should not be too high to kill

all the test organisms or too low to give wrong conclusion

about safe use of any chemical. Therefore for the present

research work 1% of noon chai was preferred as a suitable

exposure concentration to perform research work. For

preparation of noon tea, 0.5 gm of NaCl, 0.01 gm of NaHCO 3

and 1 gm green tea leaves was boiled in 100 ml of distilled

water for making a stock solution of noon tea.

Exposure to larvae and egg counting: Exposure was given to

second instar larvae for 20 hrs. by mixing noon tea in culture

medium, simultaneously control had been maintained with

experimental set. Second instar larvae had been treated for 24

hours under controlled condition of laboratory. Subsequently,

larvae had been reared upto adult stage, in normal culture

medium. Thereafter, imagos were allowed to crossmate in two

different sets including first set: treated male and normal

female, second set: treated female and normal male, along with

control. Each experiment was repeated thrice. Subsequently,

eggs obtained were counted under Bausch and Lomb,

dissection microscope, from each respective set. The data

obtained from each set, was scrutinized by Z-test (Figure1-5)

RESULT :

For the present research analysis, the reprotoxic impact of

noon tea on the Drosophila melanogaster had been evaluated.

Adult flies had been mated in two different experimental sets

along with control. It had been reported that fecundity had been

severely affected in treated samples than natural population.

Furthermore, it had been analysed that fecundity is more

predominantly affected if treatment was only male flies.

Results had been analysed significant when scrutinized

through Z-test (Table 1)

DISCUSSION :

Noon chai is a traditional pink coloured salted tea beverage

made in Kashmir. Limited research papers are available on

reprotoxic consequences of noon tea on living organism.

Considering particular cognition, present research work had

been executed. Many research explorations are available, in

scientific literature, which specify useful and harmful


64

Figure 2 : Drosophila

Melanogaster (Male)

Figure 1 : Drosophila

Melanogaster (Female)

Figure 3: Eggs Laid by Natural Population

Un

hat

ched

E

ggs

Figure 4: Eggs Laid by Treated Individuals

Un

hat

ched

E

ggs

Figure 5 : Rearing of Drosophila Larvae Under

Laboratory Conditions

Table 1. Statistical analysis of consequences of noon on reproduction of Drosophila melanogaster, in comparison to control stocks

Type

Control (egg count)

Treated male X normal female (egg count )

Treated female×normal male(egg Count)

Set-1 Set-2 Set-3 Mean Z value

2379

1811

2150

2272

1998

2100

2052

1410

1543

2235

1740

1931

10.39

6.06

consequences of tea on various test models, as in one study, it

had been concluded that tea-polyphenol are responsible for [6]cancer prevention whereas, another study concluded that

[7]that green tea decrease the life span of Drosophila . But

according to one exploration the high concentrations of green [8]tea water infusion showed toxic effect to Drosophila larvae .

Some other reports, related with effect of various bio-

chemicals and synthetic chemicals on reproduction and

development of fruit flies are available which includes: in one

exploration, it had been reported that royal jelly enhance the

fecundity of Drosophila melongaster and increase the time [ 8 ]duration required for development . According to

Mukhopadhyay, et al., 2006 cypermethrin, a synthetic

pyrethroid adversely affect the reproductive potential of [9]Drosophila . Furthermore, Lovleen, et al.,2017 reported,

negative effects of pesticides including , Bisрyribас Sodium,

Pinoxaden and Spinosad Pesticides on the reproductive of [4]Drosophila . Similarly, during present study, noon tea had

been reported to induce statistically significant reprotoxic

consequences on Drosophila melanogaster.

CONCLUSION :

It had been observed, after execution of research work which

dealt with reprotoxic consequences evaluation of noon tea,

using Drosophila melanogaster. It had been concluded that

noon tea induced statistically significant reprotoxicity in fruit

fly at 1% concentration. The specific tea induced more

pronounced effects on exposed flies than untreated flies.

Furthermore, effects become more pronounced in treated male

flies than untreated female flies.

Acknowledgement

Authors are very thankful to management of Lovely

Professional University, Phagwara, for providing all facilities

required to execute present research objectives.

REFERENCES :

1. Shafiq, S. Consumption pattern and knowledge

related to ill effects of salt tea (Noon Chai) among

rural dwellers in Kashmir. International Journal of

Advanced Research and Development 2017;2(6):

611-17.

2. Curhan GC, Willett WC, Speizer FE, Stampfer MJ.

Beverage use and risk for kidney stones in women.

Annals of Internal Medicine 1998;128 (7): 534–40.

3. Lovleen, Asma J. In vivo genotoxicity evaluation of

thiamethoxamus in Drosophila melanogaster.

International Journal of Chem. Tech. Research

2017;10(4):481-88.

4. Lovleen, Assmа K, Rani A, Devi L, Angurana R,

Amin DS. Rерrotoxiсity profiling of Bisрyribас

Sodium, Pinoxaden and Spinosad Pesticides on

DrosoрhilаnMеlаnogаstеr. Toxicology International

2017;24(3):233-39.

5. Lovleen, Angurana R, Amin DS. Clastrogenic

Instrict of Sodium Bispyribacand Pinoxaden

Herbicides on Drosophila melanogaster. Toxicology

International 2017; 24(2):178-84.

6. Sur S, Panda CK. Molecular aspects of cancer

chemopreventive and therapeutic efficacies of tea and

tea polyphenols. Nutrition 2017;43-44:8-15.

7. Lopez TE, Pham HM, Barbour J, Tran P, Nguyen BV,

Hogan SP et al. The impact of green tea polyphenols

on development and reproduction in Drosophila

melanogaster. Journal of Functional Foods 2016;20:

556–66.

8. Morgan SL, Seggio JA, Nascimento NF, Huh DD,

Hicks JA, Sharp KA et al. The phenotypic effects of

Royal jelly on the wild type D. melanogaster.

Plos,One 2016;11(8): e0159456.

9. Mukhopadhyay I, Siddique HR, Bajpai VK and

Saxena DK. Synthetic Pyrethroid Cypermethrin

Induced Cellular Damage in Reproductive Tissues of

Drosophila melanogaster: Hsp70 as a Marker of

Cellular Damage.Archives of Environmental

Contamination and Toxicology, 2006; 51(4): 673-

680.


65




Dr. Sukhdeep Singh Junior ResidentDepartment of Forensic Medicine, MMIMSR, Mullana, Ambala, Haryana, India.

Contact : +91- 7357500006


KEYWORDS : Skull Fractures, Head Injury, Intracranial Haemorrhages, Road Traffic Accidents


INTRODUCTION :

The majority of death are due to Road Traffic Accidents (RTA)

in India as well as worldwide. The factors responsible for RTA

are density of population, conditions of Roads, unawareness of

safety measures of driving and rash driving etc. More life years

are lost due to traffic accidents than cardiovascular diseases in [1]individuals older than four years of age . India accounts for

[2]about 10% of road accident fatalities worldwide . WHO

defined the accident as, “an unexpected, unplanned occurrence [3]that may involve injury” . Head injury has been defined as, “a

morbid state, resulting from gross or subtle structural changes

in the scalp, skull, and/or the contents of the skull, produced by [4]mechanical forces” .

The extent and degree of injury to the skull and its content is

not necessarily proportional to the quantum of force applied to

the head. According to Munro, any type of cranio-cerebral [5]injury is possible with any kind of blow on any sort of head .

Severe head injury, with or without peripheral trauma, is the

commonest cause of death and/ or disability up to the age of 45 [6]years in developed countries . The head being the most

vulnerable part of the body is involved frequently and leads to

morbidity and mortality in road traffic accidents.

MATERIAL AND METHODS :st thThe present study was carried out from 1 May 2016 to 30

April 2018 on 105 fatal RTA cases having head injury and

brought for autopsy to the mortuary of Department of Forensic

Medicine of MMIMSR Mullana. Decomposed bodies,

Accident cases with no definite history and without head

injuries were excluded. Patterns of skull fractures along with

age, sex, type of vehicles, anatomical sites involved is noted.

RESULTS :

Most of the victims were males (90.48%). Most of the victims

were in the 21-30 years age group (37.2%) followed by 31-40

years age group (18.1%). (Table 1-2)

66

ABSTRACT :

The majority of deaths are due to Road Traffic Accidents (RTA) in India as well as worldwide. Out of these Accident cases, Head

injury is responsible for maximum deaths as Head is the most vital part of the body. The present study was undertaken on 105

victims of RTA, died due to head injury to find out the patterns of head injuries and site distribution of different types of skull

fractures. The highest incidence was seen in age group of 21-30 years and males clearly outnumbered females. The motor-cyclists

were the commonest group of victims. Intracranial haemorrhages and skull fractures were seen in all the cases. Parieto- temporal

region was involved predominantly. A combination of subdural haemorrhage with subarachnoid haemorrhage was most commonly

observed. However Subdural haemorrhage was the commonest solitary haemorrhage noted.

Epidemiological Profile, Pattern of Skull Fractures and Intracranial Haemorrages in Fatal Road Traffic Accident Victims: An Autopsy Study

1. Munish Kumar, Junior Resident *

2. Sukhdeep Singh, Junior Resident *

3. Yatiraj Singi, Professor *

*Department of Forensic Medicine, MMIMSR, Mullana, Ambala, Haryana, India.

Age (Yrs.)

0-10

11-20

21-30

31-40

41-50

51-60

61-70

>70

Total

Male (%) TotalFemale (%)

2 (1.9)

8 (7.6)

38 (36.2)

16 (15.2)

9 (8.6)

12 (11.4)

9 (8.6)

1 (0.9)

95 (90.48)

0 (0)

0 (0)

1 (0.9)

3 (2.9)

2 (1.9)

2 (1.9)

2 (1.9)

0 (0)

10 (9.52)

2 (1.9)

8 (7.6)

39 (37.2)

19 (18.1)

11(10.5)

14 (13.3)

11(10.5)

1 (0.9)

105(100)

Table 1: Showing Distribution of Road Traffic Accident

Cases According to Age & Sex

observed in 64 (60.9%) followed by combination of extradural

(EDH), subdural (SDH) and subarachnoid haemorrhage

(SAH) in 24 (22.9%) cases. Solitary intra-cerebral (ICH) and

extradural haemorrhage was not observed. They were seen

only in combination with other haemorrhages. Subdural

haemorrhage was the commonest solitary haemorrhage

observed in 6 (5.7%) of the total intracranial haemorrhages.

(Table 4)

DISCUSSION :

Current trends in population growth, industrialization and

urbanization are putting heavy pressure on transport networks

particularly on the road systems in the developing world.

Because of this, deaths due to Road Traffic Accidents are [7]steadily increasing in the developing countries .

In the present study, males are largely involved in the accidents

with male to female ratio of 9:1. This is in concurrence with [8-14]other studies . This shows the male dominance in the

moving population especially on the roads and in vehicles.

In our study, 21-30 years was the most common and those

above 70 years was the least common age group involved in [8-13] accidents. This corresponds with other studies . The young

and middle aged groups largely consist of students and

working people in various jobs, who usually travel by either

own vehicles, buses or walk. This results in the involvement of

young adults more commonly in road traffic accidents.

The motor-cyclists were the commonest group of victims,

comprising 36.2% cases, followed by four wheelers occupants

comprising 19.1% cases. Similar trends were seen by Akhilesh [15]Pathak et al .

Parieto-Temporal bone were the most commonly fractured

bones of vault of skull. Ranjit MT et al found the similar

67

EDH ONLY

SDH ONLY

SAH ONLY

ICH ONLY

EDH+SDH

SDH+SAH

SAH+ICH

EDH+SDH+SAH

SDH+SAH+ICH

EDH+SDH+SAH+ICH

TOTAL

%

0

6

3

0

2

64

2

24

2

2

105

Intracranial Haemorrhage No. of Cases

0

5.7

2.9

0

1.9

60.9

1.9

22.9

1.9

1.9

100

Table 4 : Types of Intra Cranial Haemorrhages

Location

Frontal

Parietal

Temporal

Occipital

Frontal + Parietal

Frontal + Temporal

Parietal + Temporal

Temporal + Occipital

Parietal + Occipital

Frontal + Parietal + Occipital

Frontal + Temporal+ Occipital

Frontal + Parietal + Temporal

Frontal + Parietal + Temporal + Occipital

Total

(%)No.

16

15

6

17

18

2

19

1

3

1

1

5

1

105

15.2

14.3

5.7

16.3

17.2

1.9

18.1

0.9

2.9

0.9

0.9

4.8

0.9

100

Table 3: Distribution of Cases According to Anatomical

Location of Skull Fracture

Victims in the age group 1-10 years constituted 1.9% only.

Among the victims the lowest age was four years and highest

was 72 years. More than 70 years age group was minimally

affected.

Majority of death occurred in bike riders (36.2%) followed by

four wheeler occupants (19.1%). Heavy Vehicles like Truck

occupants constituted eight cases (7.6%). (Table 2)

Parieto-Temporal region was involved predominately in 19

(18.1%) cases, followed by fronto-parietal region in 18 cases

(17.2%). Occipital bone was the most commonly fractured

single bone of vault of skull, comprising of 17 (16.3%) of total

skull vault fractures.(Table 3)

Intracranial Haemorrhages were noted in 105 cases. A

combination of subdural haemorrhage (SDH) with

subarachnoid haemorrhage (SAH) was most commonly

Type of Vehicle

Unknown

Bicycle

Bike (Motorcycle)

Four Wheelers

Others( Heavy Vehicles)

Pedestrians

Total

No. of Cases

%

30

3

38

20

8

6

105

28.5

2.9

36.2

19.1

7.6

5.7

100

Table 2 : Showing Distribution of Road Traffic Accident

Cases According to Type of Vehicle


[16]findings .

Subdural haemorrhage was the commonest single

haemorrhage observed in 5.7% of the total intracranial [13,16,17]haemorrhages. The similar trends were seen by others .

CONCLUSION :

From the present study, following conclusions were derived

regarding road traffic accidents:

Ÿ Males are more commonly involved in accidents.

Ÿ Young adults between 21 - 30 years are more vulnerable to

accidents.

Ÿ Fatalities are more in two-wheeler riders than other

vehicles.

Ÿ Fatal head injuries are commonly associated with skull

fractures and Parieto- Temporal bone is most commonly

affected in RTA.

Ÿ Subdural haemorrhage was the commonest single

haemorrhage observed in RTA and a combination of

subdural haemorrhage with subarachnoid haemorrhage

was most commonly noted in RTA.

CONFLICT OF INTEREST : None Declared

REFERENCES :

1. Mohan D. Road traffic accidents and injuries in India:

Time for action, Nat. Medical Journal of India, 2004; 17:

63-6

2. Arvind Kumar, Sanjeev Lalwani, Deepak Agrawal, Ravi

Rautji, TD Dogra. Fatal road traffic accidents and their

relationship with head injuries: An epidemiological

survey of five year.Indian Journal of Neurotrauma, 2008 :

5(2).63-67

3. Hogarth J. Glossary of Health care terminology, WHO,

Copenhagen, 1978.

4. Chavli KH, Sharma BR, Harish D, Sharma A. Head

injury: The principal killer in road traffic accidents.

JIAFM, 2006:28(4).

5. Munro D. Cranio-cerebral injuries. Oxford University

Press, as quoted by Gordon I, Shapiro HA in ―Forensic

Medicine: A Guide to Principlesǁ, 3rd Ed, 1988, Page252.

6. Baethman A, Lehr D, Wirth A: prospective analysis of

patient management in severe head injury. Acta

Neurochirargica, 1998; 715; 107-10.

7. WHO. Road Traffic Accidents in developing countries.

Technical Report Series No. 703, World Health

Organisation, Geneva, 1984.

8. Patel NS. Traffic fatalities in Lusaka, Zambia. Med. Sci.

Law 1979; 19 (1): 61-5.

9. Chandra J, Dogra TD, Dikshit PC. Pattern of Cranio-

intracranial injuries in fatal vehicular accidents in Delhi

1966-76. Med. Sci. Law 1979; 19 (3): 186-94.

10. Akang EEU, Kuti MAO, Osunkoya AO. Pattern of fatal

head injuries in Ibadan - A 10 year review. Med. Sci. and

Law 2002; 42 (2): 160-6.

11. Gautam Biswas, Verma SK, Jag Jiv Sharma, Aggarwal

NK. Pattern of Road Traffic Accidents in North-East

Delhi. Journal of Forensic Medicine and Toxicology

2003; 20 (1): 27-32.

12. Nilambar Jha, Srinivasa DK, Gautam Roy, Jagdish S.

Epidemiological study of Road traffic accident cases: A

study from South India. Indian Journal of Community

Medicine 2004; 29 (1): 20-4.

13. Anand Menon, Nagesh KR. Pattern of fatal head injuries

due to vehicular accidents in Manipal. JIAFM 2005;

27(1): 19-22.

14. Swati Sonawane,Mahesh Jambure. Patterns of head

injuries in road traffic accidents-An autopsy study:

International Journal of Current Research 2015; 7 (12):

23733-37

15. Pathak Akhilesh, Vyas PC, Gupta BM. Autopsy finding

of pattern of skull fractures and intra-cranial hemorrhages

in cases of head trauma: A prospective study. Journal of

Indian Academy of Forensic Medicine, 2006:28(4), 187-

90.

16. Ranjit MT, Keoliya AN. Patterns of head injuries in fatal

road traffic accidents in a rural district of Maharashtra-

Autopsy based study. J Indian Acad Forensic Med. July-

September 2011: 33(3), 228-31.

17. Singh H, Dhattarwal SK. Pattern and distribution of

injuries in fatal road traffic accidents in Rohtak (Haryana);

Journal of Indian Academy of Forensic Medicine, 2004;

26(1):20-23.

68



Accessory Lobes of Liver - A Rare Malformation Noticed During Autopsy

1. Vijay Arora, Professor and Head, Dept. of Forensic Medicine, Dr. R.P. Govt. Medical College, Kangra at Tanda (H.P.)

2. Arun Gautam , MBBS Intern ( Admission batch 2013 ), Dr. R.P. Govt. Medical College, Kangra at Tanda (H.P.)-176001

Case Report


Dr. Vijay Arora, Professor and Head, Dept. of Forensic

Medicine, Dr. R.P. Govt. Medical College, Kangra at

Tanda (H.P.)

Contact : 94170-89939


KEYWORDS : Accessory Liver lobes (ALL), Torsion,Malformation

Article History:Received: 15 March 2018Received in revised form: 13 April 2018Accepted on: 15 April 2018Available online: 1 July 2018

INTRODUCTION :

The Malformations of liver include accessory lobes, agenesis

of the lobes, absence of segments ,deformed lobes, decrease in

lobe size, atrophy of the lobes and hypoplastic lobes Accessory

Lobe of Liver is congenital ectopic hepatic tissue mostly due to

embryonic heteroplasia though in rare instances an ALL may

occur after trauma or surgery. There are two types of ALL: An

accessory lobe joined to normal hepatic tissue and a lobe that is [1]completely separate . An ALL and especially completely

separate ALL is rarely seen clinically and is difficult to

diagnose before surgery; so it is easily missed or

misdiagnosed. An abdominal ALL and especially a right

abdominal ALL is reported relatively frequently.

ALL can be Classified in Two Ways :

Ÿ One classification is based upon the fact that whether the

accessory lobes are joined to Hepatic tissue or lying

completely separate. On this bases ALL can be classified as

Pedunculated or Sessile.

Ÿ The another classification is based upon volume and

weight:

Bulky ALL : Weight more than 31 gm, connected to Liver via

a stalk of tissue or wide base in sub phrenic or peri Hepatic

zone.

Small ALL : Weight category 11-30 gm,connected to Liver

via a wide base on the surface of Liver or around the right

posterior lobe.

A completely separate ALL with no connection to normal liver

tissue i.e. most often seen in thorax or pelvic cavity.

A Pin point atopic ALL with less than 10 gm weight and is most

often located at the margins of liver or even gall bladder wall.

CASE HISTORY :

An unmarried female body of moderate built, aged about 19

years with rural background was brought for medico legal

autopsy with alleged history of intake of some poisonous

substance .The body was examined externally and internally as

done in all other cases for post mortem examination and the

viscera and blood were preserved for chemical analysis.

There was no ante mortem injury appreciable over the

body.

A rare congenital anomaly was found in the Liver. Four

accessory lobes were present in addition to normal Right and

Left lobes. Left Lobe was also lying separate from the main

organ i.e. the Right lobe of Liver. In addition to these four

accessory lobes were present, two on the inferior surface and

two lying anteriorly which were joined/attached to normal

Hepatic tissue. (Figure 1-3)

DISCUSSION :

Patient with an ALL and no complications have no symptoms

or physical signs but may occasionally present with acute

stomach aches/recurring stomach aches. Other complaints can

be precordial pain, nausea and vomiting.

Clinical Manifestations of ALL Depend on Complications :

1. Torsion : Most patients visit the hospital complaining of

frequent, severe stomachache due to vascular obstruction,

ischaemia or even rupture or bleeding.

69

ABSTRACT :

''Accessory Liver lobes''is a rare condition and appear to be due to excessive development of Liver.The presence of an accessory

hepatic lobe is often diagnosed incidentally and some times revealed if it develops torsion especially in pedunculated forms.In most

cases,the accessory lobes are located below the liver.Riddle's lobe is the most known example of accessory lobe corresponding to th thhypertrophy of 5 and 6 segments.There are some reports of hepato cellular tumours that develop in these accessory lobes.

2. During the seventh and eighth week of embryonic

development : that is when mascular layer of abdominal wall

forms ,development of an ALL in embryo may obstruct

closing the umbilical ring which is why most ALLs are

associated with acromphalus (i.e.Umbilical hernia).

3. ALLs can also be associated with congenital biliary

atresia : Hundal noted that from 1925 to 2006 there were 18

cases of ALL diagnosed after Surgery or Biopsy.

Most reported cases of an ALL involve females ranging in age

from new born to 75 yearsof age however they might present in

any age group as an accidental finding.[1]Wang et al have reported three cases of accessory lobes of

Liver based upon CT scan and MRI and confirmed by Surgical

and Histilogical examination. Out of these three cases, one

case involved a pedunculatted ALL,another case involved a

true ectopic Liver and third case involved a sessile accessory

lobe of Liver. [2-3]Rao et al observed during routine autopsy ,that the Liver was

having some un usual morphology .There were two vertically

placed furrows present on the anterior surface of the right lobe.

The furrows were partially deep and measured 7cm and 4cm in

length.[2-3]Rao et al have also reported acase with unusual shape of

Liver .The left lobe of Liver was bifid having dumb bell typed

morphology.[5] Acording to Joshi et al the knowledge of morphological

variations on the Liver surface is important to imaging

specialists and surgeons, in order to avoid possible errors in

interpretations ,subsequent misdiagnosis and to assist in

planning appropriate surgical approaches.

Rapid advances in medical imaging provides more accurate

information for diagnosis of an ALL including its size ,shape,

classification, position and blood supply with the help of

equipment such as CT, MRI, PET scan and especially multi

slice spiral CT (MSCT)

An ALL in the thorax should be differentiatd from a tumour of

Pleura, Lungs, Chest wall or Diaphragm.

An ALL in the pelvic cavity should be differentiated from a

benign or malignant tumour of Pelvic organ.

An ALL of the surface of abdominal organs should be

differentiated from the pathological changes in Liver ,Gall

Bladder ,Pancreas, Spleen or Adrenal glands.

There is no need to treat patients with an ALL who have no

symptoms or complication but the patients with some serious

complications may be treated surgically and are reported to

have a satisfactory prognosis.

REFERENCES :

1. Wang C, Cheng L, Zhang Z. Accessory lobes of the

Liver: A cse report of three cases and review of

literature; Intractable and rare diseases Research,

2012, May 1 (2),86-91.

2. Rao PPJ, MurliManju BV, Lobo SW, Menezes RG.

An unusual morphology of Human Liver: a case

report with emphasis on its clinical implications;

Journal of morphological sciences,2011,28(4):303-

304

3. Rao PPJ, Murli ManjuBV, MEnezes RG. Dumb bell

shaped morphology of liver: An autopsy case

report;Clin Ter,2013,164 (1):29-30

4. GlenissonM,Salloum C. et al. Accessory Liver lobes:

a n a t o m i c a l d e s c r i p t i o n s a n d c l i n i c a l

impl ica t ions ; Journa l o f Viscera l su rgery

(2014),151(6):451-455.

5. Joshi SD, Joshi SS, Athavale SA. some interesting

observations on the surface features of Liver and their

clinical implications; Singapore Medical journal

2009;50:715-19

6. MacMohan HE. Congenital anomalies of the Liver.

American Journal of Pathology1929;5:499-508.

7. Aktan ZA, Savas R et al: Lobe and segment

anomalies of liver, Journal of Anatomical Society of

India2001;50:15-16

70

Fig. 1 Fig. 2

Fig. 3


Pericardial Rupture without Cardiac Injury or Herniation1. Vikram Palimar, Professor, Department of Forensic Medicine & Toxicology*,

2. Kaushal Kishore, Tutor cum Postgraduate Student, Department of Forensic Medicine & Toxicology*,

3. Sajan Babu, Tutor cum Postgraduate Student, Department of Forensic Medicine & Toxicology*,

4. Chandni Gupta, Associate Professor, Department of Anatomy*,

*Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.

A Case Report

KEYWORDS : Blunt Traumatic Pericardial Rupture, cardiac herniation.


INTRODUCTION:

Blunt traumatic pericardial rupture is rarely reported although

the incidence of chest trauma accounts for 10 -15 % of all the

traumatic cases and the mortality associated with it sums up to

25 %. The rare clinical presentation coupled with

misdiagnosis, complications and rapid deterioration of the

patient are the contributory factors for high incidence of

mortality.

Anatomically, pericardial sac is a pleuropericaridial fold,

develops in the fifth month of intrauterine life as a fold of [1]mesenchyme . The sac is composed of outer fibrous and the

inner doubled layered sac is serous pericardium. Anteriorly, it

is separated from the chest wall from the lungs and the pleura,

except at a small region corresponding of posterior sternum th thcorresponding to the 4 and 5 costal cartilage. Posteriorly lies

the principal bronchi, oesophagus, descending aorta, and

posterior aspects of both the lungs and pleura. Superiorly lies

the great vessels and inferiorly it is anchored to the [2]diaphragm's central tendon .

Pericardial injuries/ tears which often results from blunt chest

trauma may either present as tear varying in lengths from few

millimeters to the entire length of the sac. The most common

site being the left pleuropericardium parallel to the phrenic [3]nerve . Small lacerations may heal on its own by formation of

clot. But any tears beyond 8-12 cm may result in subluxation

/torsion of the heart and the deceased may die subsequently [4]due to cardiogenic shock .

CASE REPORT:

The deceased was a 46 years old adult male, with a history of

fall from height. He had sustained severe injuries over the back

of his chest and was not able to speak. He was brought dead.

On Autopsy : Left sided hemothorax was discovered with 800

ml of frank blood in the pleural cavity. Retrosternal contusion st thwas noted. Fracture of left 1 to 12 ribs were present along the

left side of the posterior chest wall along the left midscapular

line. Left lung showed lacerations and contusions. Pericardial

tear measuring 3 x 0.5 cm x pericardial cavity deep was seen

over the left pleuopericardial region. (Figure 1)


71

ABSTRACT:

Pericardial rupture following blunt chest trauma is rare and are usually observed intraoperatively or at autopsy. Such cases if

encountered in triage warrants emergency and prompt initiative as the complication like cardiac herniation are life threatening.

Cardiac herniation itself may lead to torsion of great vessels and subsequently decreased cardiac output. Mortality rate is high,

probably because of other associated polytrauma. Here by we are presenting a case of fall from height of a 46 years old male who

was declared brought dead on arrival at the hospital. Autopsy revealed left sided pericardial rupture without cardiac injury or

herniation. The clinical presentation, complications, issues related to diagnosis, and autopsy findings will be discussed in the case.


Dr Chandni Gupta

Associate Professor, Department of Anatomy,

Kasturba Medical College, Manipal,

Manipal Academy of Higher Education, Manipal, India.

Contact : 98867-38555


Figure 1 :

Showing the

Pericardial tear

100ml of frank blood was present in the pericardial sac. No

features of cardiac injury or any herniation was noted.

Cause of Death : was opined as death due to multiple injuries

to the chest as a result of blunt force trauma.

DISCUSSION:

It is often said that blunt traumatic pericardial rupture is an

incidental finding intra operatively, or at autopsy. Such patients

hardly have any time, and sometimes the patient are lost even

before they arrive at the hospital. Also the tense and stressful

environment of triage system also possess some difficulty in

diagnosing the condition. Multiple abrasions, contusions with

underlying ribs fracture can be associated findings. History

may be of Blunt trauma sustained as a result of road traffic

accident, Sudden deceleration, Fall from height with vector of [5]injury on the left side .

Clinical Features which may rise suspicion of cardiac [6]herniation includes displaced and heaving apex beat, a

splashing murmur "bruit de Moulin" as a result of the heart [7]moving in a haemopneumopericardium , hemodynamically

unstable despite intravenous fluid administration and inotropic

support, signs similar to that of cardiac tamponade, pulsus

paradoxus, raised jugular venous pressure (JVP), tachycardia

and dysrhythmia.

Investigation: Various imaging modalities are available.

Ÿ An ideal Triage usually have the facility of “FAST

(Focused Assessment with Sonography in Trauma)”.

The sensitivity of FAST in detecting pericardial fluid is as [8]high as 97 -100 % .

Ÿ CT (Computed Tomography) is useful in stable patients

especially detecting the complications such as Cardiac

herniation.

Ÿ MRI, Ultrasound, Chest X-ray, ECG can also provide

substantial information.

Treatment: Once diagnosis is established the treatment is [5]based on the severity of injury .

(1) Video-assisted thoracoscopy especially in stable

patient and where there is lack of diagnosis clarity.

(2) Small pericardial tears (on the left side) and without

herniation should be allowed to heal on its own.

(3) For moderate to large defect , Emergency

Thoracotomy is the treatment of choice with surgical

closure or mesh prosthesis.

CONCLUSION:

Blunt trauma with pericardial rupture are rarely encountered

and often associated with multiple injuries. Such patients

usually die before reaching the hospital, depending upon the

severity, however when encountered in triage requires

immediate and prompt measures. The clinical picture should

warrant the clinician about the possible diagnosis. Diagnosis

is often missed but with availability of imaging modalities like

FAST which is 97 – 100 % sensitive and other modalities it can

be diagnosed. Operative intervention is thoracotomy with

surgical closure.

REFERENCES:

(1) Larsen WJ. Human Embryology. 3. Philadelphia:

Churchill Livingstone; 2001.

(2) Gray H. Gray's Anatomy. 38. Philadelphia: Churchill

Livingstone; 1999.

(3) Thomas P, Saux P, Lonjon T, Viggiano M, Denis JP,

Giudicelli R et al. Diagnosis by video assisted

thoracoscopy of traumatic pericardial rupture with

delayed luxation of the heart: case report. The Journal of

Trauma Injury, Infection and Critical care. 1995;38: 967-

70.

(4) Carillo EH, Heniford BT, Dykes JR, McKenzie ED, Polk

HC, Richardson JD. Cardiac Herniation Producing

Tamponade: The Critical Role of Early Diagnosis. The

Journal of Trauma Injury, Infection and Critical care.

1997;43 (1): 19-23.

(5) Clark DE, Wiles CS 3rd, Lim MK, Dunham CM,

Rodriguez A. Traumatic rupture of the pericardium.

Surgery. 1983; 93:495-503.

(6) Sherre PB, Galloway R and Healy M. Blunt traumatic

pericardial rupture and cardiac herniation with a

penetrating twist: two case reports. Scandinavian Journal

of Trauma, Resuscitation and Emergency Medicine.

2009;17:64

(7) Wright MP, Nelson C, Johnson AM, Mcmillan IKR.

Herniation of the heart. Thorax. 1970;25: 656-66.

(8) Fulda G, Brathwaite CEM, Rodriquez A, Turney SZ,

Dunham CM, Cowley RA. Blunt traumatic rupture of the

heart and pericardium: a ten-year experience

[1979–1989]. J Trauma. 1991; 31:167–73.


72

A Case Report


Dr. Anil Garg,

Associate Professor,

BPS Government Medical College for Women, Khanpur

Kalan, Sonipat

Contact : 98724-02904

E-mail: [email protected]

KEYWORDS : Eagle Syndrome, Styloid Process, Autopsy

Article History:Received: 6 March 2018Received in revised form: 31 March 2018Accepted on: 1 April 2018Available online: 1 July 2018

INTRODUCTION:

Eagle syndrome is constellation of symptoms varrying form

recurrent neck pain on rotation, foreign body sensation in the

neck, hyper salivation, difficulty in swallowing, hypoacusis,

hyperacusis, earache, syncope and sudden death due to

elongation of the styloid process or ossification of stylohyoid [1]ligament . This syndrome was first described by Watt W.

[2]Eagle, an Otorhinolaryngologist in 1937 .

Every human is unique anatomically, even identical twins are

not alike. Stylos in greek means pillar which is a thin,

cylindrical, sharp osseous process, deriving from the posterior

lower surface of the petrosal bone just anterior to stylomastoid [3]foramen . On the same side, the apex of the styloid process is

connected with the lesser cornu of hyoid bone by stylohyoid

ligament. The ligament represents from embryological view

the continuation of the processes apex. The styloid process

originates from the Reichert cartilage of second branchial arch. [4]Styloid process length mostly ranges from 20 mm to 30 mm .

Stylomandibular ligament, Styloglossus, Stylohyoid, and [5]Stylopharyngeus muscles are attached at the styloid process .

In about 2 to 30% of general population an elongated styloid

[6]process occurs .

The elongated styloid process may present as one of cause of

sudden death due to pressure or constant irritation of jugular or

carotid arteries and carotid body. A case of Hispanic male with

external carotid pseudoaneurysm with pointed elongated

styloid process was reported in emergency with neck [7]oedema . Forensic experts may come across these type of

unnatural death reported to be syncope or heart attack which

may get missed if they are unaware of elongated styloid

process or ossified stylohyoid complex. Fractured elongated

styloid process may be present as important finding in [8]unnatural deaths like Hanging and Manual strangulation .

OBSERVATIONS :

In routine autopsies, on dissection in the neck region many a

times, styloid process is not visualized and not dissected out.

But in decomposed bodies as tissues are macerated and hence

it can be dissected out easily at the base of skull. We have also

encountered three cases at autopsy of decomposed body where

we found elongated styloid process and details are given in

Table No. 1.


73

ABSTRACT:

Eagle syndrome is constellation of symptoms varrying form recurrent neck pain on rotation, foreign body sensation in the neck,

hyper salivation, difficulty in swallowing, hypoacusis, hyperacusis, earache, syncope and sudden death due to elongation of the

styloid process or ossification of styloidhyoid ligament.

An awareness of this syndrome is important to all health professionals involved in the diagnosis and treatment of neck and head

pain. Forensic expert should also keep in mind regarding the Eagle syndrome as being one of the causes of sudden death and thus

explore styloid process. During routine autopsy dissections , 3 cases of elongated styloid processes were found. This article reviews

the clinical importance of the elongated styloid process. The anatomy of styloid process has immense embryological, clinical,

surgical importance.

Elongated Styloid Process (Eagle Syndrome) - A Rare Finding at Autopsy1. Yogesh Kumar Vashist, Assistant Professor, BPS Government Medical College for Women, Khanpur Kalan, Sonipat

2. Sakshi Sharma, Scientific Assistant, FSL, Madhuban

3. Bhagwat Rajput, Assistant Professor, Department of Psychiatry, WCMSR, Jhajjar.

4. Anil Garg, Associate Professor, BPS Government Medical College for Women, Khanpur Kalan, Sonipat

5. Rahul Chawla, Associate Professor, BPS Government Medical College for Women, Khanpur Kalan, Sonipat

6. Gaurav Sharma, Professor and Head, BPS Government Medical College for Women, Khanpur Kalan, Sonipat

DISCUSSION AND CONCLUSION :

Eagle syndrome may present as sudden death, fracture of

styloid process due to hanging and manual strangulation. Any

over pressure at the surrounding area of tonsilar fossa or

violent manipulations around the neck area by medical,

paramedical or manual therapists and rehabilitation personnel

may lead to fracture of styloid , with many clinical sequences

for the patient.

Conflict of Interest : None.

REFERENCE :

1. Chuang WC, Short JH, McKinney AM, et al. Reversible

left hemispheric ischemia secondary to carotid

compression in Eagle syndrome: surgical and CT

angiographic corre la t ion. Am J Neuroradiol .

2007;28:143–45.

2. Eagle WW. Elongated styloid process. Report of two

cases. Arch Otolaryngol 1937;25:584–87

3. Standing S. Skull and Mandible. In Gray's Anatomy. The thAnatomical basis of clinical practice 39 ed. Elsevier,

Edinburg; 2005:470.

4. Moffat DA, Ramsden RT, Shaw HJ. The styloid process

syndrome: aetiological factors and surgical management.

J Laryngol Otol 1977; 91: 279-94.

5. Balbuena L, Hayes D, Ramirez SG, Johnson R. Eagle's

syndrome (elongated styloid process). South Med J

1997;90: 331–34.

6. Kaufman SM, Elzay RP, Irish EF. Styloid process

variation. Radiologic and clinical study. Arch Otolaryngol

1970;91(5):460-63.

7. Dao A, Karnezis S, Lane JS, Fujitani RM, Saremi F. Eagle

syndrome presenting with external carotid artery

pseudoaneurysm. Emerg Radiol. 2011;18:263–65

8. Vougiouklakis T. Overview of the ossified styloid

ligament based in more than 1200 forensic autopsies.J clin

Forens Med 2006;13:268-70.


74

Case No. Sex Stage of Decomposition Length of Styloid Age of individual

Male

Male

Male

Adipocere

Adipocere

Mummified

left Side Right Side

4.8 cm

4.3 cm

5.1 cm

3.8 cm (Fig. 1)

4.8 cm (Fig. 2)

5.4 cm (Fig 3)

40-50 years

40-50 years

40-50 years

1

2

3

Figure 1

Figure 2

Figure 3

Table No 1 : Details of Cases

Role of Forensic Odontologists in Child Abuse Detection and Reporting : A Review1. Pooja Puri, Assistant Professor, Amity Institute of Forensic Sciences, Amity University, Noida, U.P.

2. SK Shukla, Professor and Head, Amity Institute of Forensic Sciences, Amity University, Noida, U.P.

3. I. Haque, Deputy Director, Directorate of Forensic Science Services ,Ministry of Home Affairs, Govt. of India ,CGO,

Complex, New Delhi, India

Review Paper


Dr. Pooja Puri,


Amity Institute of Forensic Sciences, Amity University,

Noida, U.P.

Contact : +91 98735-15547


KEYWORDS : Forensic, Child Abuse, Facial Injuries, Forensic Odontologist.


INTRODUCTION :

According to the convention on the rights of the child, Article 1

defines, “the child as every human being below the age of 18

years unless under the law applicable to the child, majority is [1]attained earlier” . In Indian legal system, the child has been

defined differently in various sections of the laws pertaining to

children. The Indian Immoral Traffic (Prevention) Act, 1956

defines a child as a person who has not completed the age of 16 [2] years . The sections 82 and 83 of Indian Penal Code state that

nothing is an offence done by child under 7 years and further

under 12 years, till he has attained sufficient maturity of

understanding the nature of act and the consequences of his [3conduct on that occasion . The World Health Organization

defines child abuse as: all forms of physical and/or emotional

ill-treatment, sexual abuse, neglect or negligent treatment or

commercial or other exploitation, resulting in actual or

potential harm to the child's health, survival, development or

dignity in the context of a relationship of responsibility, trust or [4]power .

Child Abuse is a globally prevalent phenomenon and this term

may have different connotations in different contexts. The

four major categories of abuse are traditionally [5]recognized :

1. Physical Abuse : Inflicting of physical injury upon a child.

This may include burning, hitting, punching, shaking, kicking,

beating or otherwise harming a child. The parent/ caretaker

may not have intended to hurt the child. It may however, be the

result of over discipline or physical punishment that is

inappropriate to child's age.

2. Sexual Abuse : Is an inappropriate sexual behavior with the

child by the person responsible for the care of the child. It

includes fondling a child's genitals, making the child fondle

adult genitals, intercourse, incest, rape, sodomy, exhibitionism

and sexual exploitation.

3. Emotional Abuse : Also known as verbal abuse or mental

abuse or psychological maltreatment. It includes acts or the

failures to act by parents or caretakers that have caused or

could cause, serious behavioral, cognitive, emotional or

mental trauma.

4. Neglect : Failure to provide for the child's basic needs.

Neglect can be physical (failure to provide adequate food,

clothing, medical care etc.), educational (failure to provide

schooling etc.) or emotional (lack of emotional support/love

etc.)

It is worth mentioning that these types of abuse are interrelated

and typically found in combination than alone. For instance, a

physically abused child is often emotionally abused and [6-7] sexually abused child may also be a neglected child .

Risk Factors For Child Abuse and Neglect: The child abuse

is a complex problem with no single attributable cause. Rather

it is the result of an interplay of multiple factors. Some of the

risk factors for child abuse and neglect are summarized in


75

ABSTRACT :

Child abuse or maltreatment includes physical, sexual or emotional abuse as well as child neglect. This maltreatment of infants and

children has been traced far back in history and tragically it is still globally prevalent in our so called, the Modern World. However

still in many countries including India, there has been no thorough understanding of magnitude and trend of the problem. This

article aims to develop a comprehensive understanding about the prevalence of this problem, literature review and role of forensic

odontologists in identification and evaluating such conditions.

child abuse on the oro-facial region may be a challenging task

for the medico-legal expert and by collaborating with

odonotologists they can better diagnose and detect such

injuries. The signs of abuse may vary from case to case. Most

of the victims will have injuries that are either unexplained,

inconsistent with the explanation given and of different

durations. There may be presence of burns/scalds, broken

bones, human bite marks etc. Some of the physical signs of

abuse/neglect in oro-facial region as summarized below :

In addition other features of child abuse may include

behavioral indicators such as withdrawn behavior, anger,

hostility, depression, anxiety, loss of self confidence and [16-17]flinching when approached or touched . The roles and

responsibilities of an Odontologist in such cases of child abuse

are quite crucial, especially when the victimized children

present symptoms of abuse in and around the areas of oral

cavity only. Once the Forensic Odontologist is sure about his

diagnosis of a case of child abuse, it becomes his legal

responsibility to report the matter to proper authorities.

Forensic odontologists and the pediatric dentists have a

mandated child abuse curriculum included in their formal

training courses. This helps them towards sharing the valuable

[8-11]Table 1 .

Table 1 : Risk Factors for Child Abuse

Some of the Alarming Statistics are:

l More than 200 million children are involved in child

labor, with more than 180 million working in [12]hazardous situations or conditions .

l An estimated 1.2 million children are subjected to

trafficking every year; 5.7 million are working as

forced and bonded labourers. 1.8 million Children are [13]involved in the act of prostitution and pornography .

l About 140 million girls and women worldwide are

suffering the consequences of Female Genital

Mutilation (FGM). In Africa, about 92 million girls in

the age group of 10 years and above are estimated to [14]have undergone FGM .

l Every year there are estimated 31000 homicide deaths

in children under 15 years of age and this number

underestimates the true extent of the problem, as a

significant proportion of deaths due to child

maltreatment are incorrectly attributed to falls, burns, [15]drowning and other causes .

l The deaths are only the tip of the problem. Millions of

children are victims of non-fatal abuse and neglect. In

a study, between one-quarter and one-half of children

report severe and frequent physical abuse, including

being beaten, kicked or tied up by parents. A

substantial amount of harsh punishment in the form of

hitting, punching, kicking or beating also occurs in [8]schools and other institutions .

Role of Forensic Odontologists : Recognizing the signs of


76

Ÿ Personality characteristics and psychological well beingŸ History of maltreatmentŸ Substance AbuseŸ Attitude and knowledgeŸ Marital ConflictŸ Domestic Violence

Ÿ HomelessnessŸ Poverty and

unemploymentŸ Social Isolation/Social

supportŸ Low Socio-economic

Status

Ÿ Stressful Life EventsŸ Violent Communities

Ÿ DisabilitiesŸ AgeŸ Developmental Delay or

mental retardatation

Parent/Caregiver Factors

Social Factors

EnvironmentalFactors Child

Factors

Oral/Facial

Region

Teeth

Intraoral

Lips

Jaw Bones

Nose

Orbital area

Skull /Scalp/

Hair

Ears

Signs of Abuse/Neglect

Fracture, Avulsion, Subluxation

Labial/ lingual frenum tears, burns, lacerations, contusions, abrasions on labial/buccal mucosa, palate, tongue, floor of mouth, poor oral hygeine, delayed dental treatment

Burns, lacerations, contusions,

abrasions

Burns, lacerations, contusions,

abrasions, bite marks.

Fractures of facial bones, maxilla or

condyles/ramus/symphysis of mandible

Nasal fractures, lacerations. contusions

Fractures of orbital bones, retinal

hemorrhages, ptosis, periorbital

bruising.

Fractures, subdural hematomas,

traumatic alopecia

Bruising of the auricle, damage to

tympanic membrane

Cheeks

information thus gathered and providing assistance to other

forensic examiners about oral and dental aspects of child abuse

and neglect. The Prevent Abuse and Neglect through Dental

Awareness (also known as PANDA) coalitions have trained [18]thousands of dentists and dental auxiliaries in United States .

CONCLUSION:

Child abuse is a vast multidisciplinary area involving experts

from different walks of life including general physicians,

pedodontists, forensic odontologists, psychologists,

councilors and other governmental and non-governmental

officials. Thus the formal formation of such task forces which

include all experts is a need of the hour to address the issue of

child abuse and neglect. All these teams should identify the

core problematic areas and work collectively utilizing mutual

resources towards eradication of such evils from the human

society thereby enhancing our abilities of love care and

protection for the children.

REFERENCES :

1. Flukinger A. International Law and the Right to Adequate

Food [Internet]. 2010 [cited 20 February 2018]. Available

from: http://treaty.org/reports/WUCL_Hunger&Law-

A_Flukinger.105.pdf.

2. The Indian Immoral Traffic (Prevention) Act, 1956.

3. Preventing child maltreatment: a guide to taking action

and generating evidence [Internet]. 2006 [cited 20

F e b r u a r y 2 0 1 8 ] . A v a i l a b l e f r o m :

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_eng.pdf.

4. Report of the Consultation on child abuse prevention.

[Internet]. [cited 20 February 2018]. Available from:

http://www.who.int/violence_injury_prevention/violenc

e/globalcampaign/en/chapter3.pdf.

5. Kenney JP, Spencer ED. Child Abuse and Neglect.

Manual of Forensic Odontology, Saratoga Springs, NY:

American Society of Forensic Odontology; 1997, p.

191–3.

6. Vale GL. Dentistry's Role in detecting and preventing

child abuse. In: Stimson PG, Mertz CA, editors. Forensic

Dentistry. First, Boca Raton, New York: CRC Press;

1997, p. 176–8.

7. Child Abuse and Neglect [Internet] .2002 [cited 2018,

Feb20].Available from:

www.who.int/violence_injury_prevention/violence/world_re

port/factsheets/en/childabusefacts.pdf

8. Goldman J, Marsha K.S, Wolcott D, Kennedy KY. A

Coordinated Response to Child Abuse and Neglect: The

Foundation for Practice, 2003 ; p.27 – 34

9. Leeb RT, Paulozzi L, Melanson C, Simon T, Arias I. Child

Maltreatment Surveillance: Uniform Definitions for

Public Health and Recommended Data Elements, Version

1.0. Atlanta (GA): Centers for Disease Control and

Prevention, National Center for Injury Prevention and

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A v a i l a b l e f r o m : h t t p : / / w w w . c d c . g o v /

v i o l e n c e p r e v e n t i o n / c h i l d m a l t r e a t m e n t /

riskprotectivefactors. html.

10. Emerging Practices in the Prevention of Child Abuse and

Neglect U.S. Department of Health and Human Services,

Administration for Children and Families, Administration

on Children, Youth and Families, Children's Bureau,

Office on Child Abuse and Neglect. 2003.[Online].[Cited

2 0 1 8 , F e b 2 0 ] ; a v a i l a b l e f r o m

URL:https://www.childwelfare.gov/preventing/program

s/whatworks/report/report.pdf

11. International Labour Organization: A Future without

Child Labour. Global Report, ILO, 2002.

12. International Labour Organization: New Global

Estimates on Child Labour. ILO, 2002.

13. Child trafficking [Internet]. UNICEF. 2011 [cited 20


https://www.unicef.org/protection/57929_58005.html.

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18. Oral and Dental Aspects of Child Abuse and Neglect

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Review Paper


Dr. Jaskaran Singh,


School of Bioengineering and Biosciences,

Lovely Professional University, Phagwara, Punjab

Contact : 99105-41247


KEYWORDS : Nanomaterials, Forensics, Identification

Article History:Received: 17 February 2018 Received in revised form: 14 April 2018Accepted on: 14 April 2018Available online: 1 July 2018

INTRODUCTION:

Nanotechnology deals with the manipulation of articles at the

Nano level. Nanoparticles, besides being strong and stable,

have a large surface area, and can exhibit quantum effects

ranging less than 10 Nanometres. This size range makes it

possible to control various physical and/or chemical

properties. Nanotechnology is practically applied in

Electronic Engineering, Physical, Material Sciences,

Biomedical Sciences and Forensic Sciences among many.

In the field of Forensic Sciences Nanoparticles have been used

as luminescent markers to detect gunshot residue,

development of latent fingerprints, enzymatic processing of

DNA, Forensic explosive detection, post blast explosive

residues analysis, Gold Particles to enhance PCR accuracy, the

atomic force microscope (AFM), to scan evidence surfaces,

Scanning Tunnelling Microscope (STM), that work on the

concept of quantum tunnelling. This Paper portrays reviews of

all and existing Nano techniques that aid Forensics in being

more accurate and quick in order to enable quick and reliable

delivery of justice.

APPLICATIONS OF NANOTECHNOLOGY IN

FORENSIC SCIENCES:

1. Authentication of sound recording- an evidentiary clue

(Figure 1-2) : The importance of tape integrity in civil criminal

hearing shows everlasting reliance that whether to disqualify

or qualify audio tape evidence. Since tape recordings can be

subjective to misinterpretation and falsification by editing [1]digitally through computer technology . These editing can be

done by various methods like:

Obscuration: a method used to distort a recorded signal in

order to render selected portions of information unintelligible

Deletion : Deletion of unwanted material by erasing, recorded,

stop/ pause.

Transformation : Alteration in a portion of recording to alter

its original content.


78

ABSTRACT :

The science, technology &engineering conferred at the nanoscale level of about 1 to 100 nanometres is called Nanotechnology.

The alluring potential of nanotechnology is rapidly becoming an integral aspect in medicine, healthcare and agriculture among

many. From aiding in DNA profiling, to its use in development of latent fingerprints, Nanotechnology has left no stone unturned in

changing the dynamics of modern science and technology. With recent inventions like the development and identification of latent

fingerprints by using nanoparticles via Atomic Force Microscope and Scanning Electron Microscope, Forensic Sciences aims to

identify, individualize and investigate evidence. Although an amazing tool in Modern Science, Nanoparticles can be detrimental to

the nature .This ensures that every piece of evidence, irrespective of size, can be scanned at the nanoscale levels. These then become

crucial pieces in crime scene reconstruction and ultimately crime solving. Several safety and regulatory questions remain to be

addressed regarding the usefulness of conventional in vitro and in vivo methods employed for assessing short-term and long-term

consequences of nanoparticles and nanomaterials in humans, marine and wild animals as well as acute and chronic levels of

exposure to environment. In this paper an attempt has been made to portray the advancements been made in the fraternity of

Forensic Sciences by utilizing the applications of Nanosciences & Nanotechnology. Also, it will give aid to legal justice system to

curb and solve crime in more efficient way.

Nanotechnology And Its Applications In Forensic Sciences- A Boon To Legal JusticeJaskaran Singh, Assistant Professor*, Neeta Raj Sharma, Professor & Dean*

Chelsea Marie Joseph**, Dattatraya Khisse**, Savreet Kaur**, Pratibha Rani**, Divya Sahu**

*School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab

** BSc. Forensic Science Student

Synthesis: Generalisation of artificial text by incorporating it

with either a background sound, or a conversation, to a taped

copy. In order to detect these editing nano particles of carbon

Ag and ZnO coated onto tapes which will help to detect these

aural anomalies on tape. Any editing onto these nano coated

tapes will alter the shape and size of nano particles, which will

be deciphered by AFM and wave form analysis.

Figure 1 : Different Type of Editing Shown by AFM

Figure 2 : Wave Form Analysis of Audiotapes.

Imbibing Nano Particles in writing and printing Ink

Analysis(Figure 3) : The most common ink types that contain

Nano particles (mainly those of Carbon and Silver) are gel inks [2] and ink jet inks . Carbon nano particles with different shapes

and sizes are imbibed in modern inks to give luminescence. On

other hand silver nano particles ink provide high surface area

on to object by adsorbing the interface surface and substrate.

Pigments, irrespective of size, cannot be easily characterised

by conventional methods to set up analytical profiles (for

instance, separation of various dye components via TLC or [3]HPLC) . To add “pigment characterization”, Carbon and

silver nanoparticles are included in the composition analysis of

the pigment (e.g., elemental profile) and for morphological [4]characterization (e.g., shape and size) .

Figure 3 : Luminous Carbon Nanoparticles for ink gel

analysis

This inculcation of nanoparticles in different types of inks will

give uniqueness to inks for identification purposes.

3. Nanoparticles as Security Tags (Figure 4-5) :

There are numerous ideas for making documents secure.

Passports, credit card and banknotes are just a few that are [5]always being upgraded in their security features.

there are generally 3 security features in a document of

importance: First, where counterfeit is detectable by the naked

eye; Second, where optical devices are used (like infrared

lighting etc); and Third, where the document has to be tested in

a laboratory. The use of nanoparticles to make documents more

secure by introducing them in their inks or paper is gaining

much popularity. For example, Q-dots can be made to

luminescence not only in the near infrared region (between 0.7

microns and 1 micron), but in the short-wave infrared region [6](between 1 micron and 2 microns) as well. Quantum dots (Q

Dots) are manipulated to give out a spectrum of colour in near,

as well as shortwave infrared regions. This makes screening of

documents more efficient and easy. Hence, a greater measure

of stealth can be assured since these semiconductor particles

are so small that their optical and electronic properties greatly [7]vary from their larger counterparts. However these

frequencies can also alter by changing dot size, shape, material

thus, giving various application in security tags.

For the same reason, now Q dots are routinely used in

currencies, passports, etc. for security purposes

Figure 4 : Luminous Q Dots in Passports


79

Abc abc abc abc abc abc abc abc abc

abc abc abc abc abc abc abc abccbacba

Distort


abc abc abc abc abc abc abc abccba

Delete abc


abc abc abc abc abc abc abc abcabc

Synthesis 123

123

123456789

Transformation of letter 23 from its Original Position

123456789 123456789

123456789 145678239 123456789

Fluroscent luminiouscarban nanoparticle

Ink gel

Luminescence (this luminescence is unique and found only in passports)

uv light

Figure 5 : Flowchart of Nanotechnology in Security Tags

4. Nanotechnology & Trace Evidences : Before the onset of

Nanotechnological applications in Forensic Sciences,

collection of critical trace evidence, found at the nan scale, was

not possible due to lack of proper instrumentation.

Nanoparticles have novel properties, which come in trace [8]evidence collection and analysis . Nanotechnology has made

a major impact on the analysis of micro surfaces through the

use of various probes that interact with the surface in question.

AFM has now become a crucial part of surface analysis of

various pieces of evidence like in collection and analysis of

latent foot print/ shoe print/ pugmark evidences.

How does AFM work? (Figure 6) :

Atomic Force Microscopy is a scanning probe microscopy that

possesses resolution of the order of Nanometres, a 1000 time

better than the optical diffraction limit. Desired information is

gathered by touching the surface against a magnetic probe.

Piezoelectric elements that facilitate tiny but accurate and

precise movements on (electronic) command enable very [9]precise scanning. .

Figure 6 : Block Diagram of the Working of AFM

Also, the AFM helps with deciphering complex written

evidence. The device measures the force exerted between a

microscopic tip and the atoms of the writing surface, which

enables the nanoscale viewing of the surface. This could help [10] with document evidence where overwriting has been done.

Using the AFM, one can determine how old a sample of blood

is. Blood gets stiffer with time (due to drying of Red Blood

Cells), hence the tip of the AFM will exert more force to pull

out from the surface of the sample. Hence, the age of blood

sample can be more or less determined based on the tip force.

In regards to fibre analysis, AFM can image and measure

properties on the surfaces or coatings of large fibres. For

innovative applications using advanced textiles with

nanofibers, nanoparticles or nanocomposites, visual

characterization requires measurements on the nanometre

scale.The Atomic Force Microscope (AFM) is ideally suited to

map the response of explosive materials with sub-micrometre

resolution. AFM has been used to study the surface

m o r p h o l o g y o f a m m o n i u m p e r c h l o r a t e ,

Cyclotrimethylenetrintramine (RDX), trinitrotoluene (TNT),

and Triaminotrinitrobenzene (TATB) systems.

5. Fingerprinting Analysis (Figure 7-8) : Fingerprint is as

impression formed on a surface upon being in contact with the

friction ridges present on the fingertips of a human being.

These are formed on suitable surfaces due to sweat secreted by

the eccrine glands present in the ridges of the epidermis. The

recovery of fingerprints from a crime scene is a very crucial [11]method in Forensic Science . Latent fingerprints are those

prints that are invisible to the naked eye and are required to be

“developed” (like in case of photographs from a negative) by

physical, and/or chemical means. The technique applied for

developing depends on various conditions present at the time

of collection. In most cases, latent fingerprints go undetected,

thereby hindering investigations.

Silver Physical Developer (Ag-PD) (Figure 7) : Silver

Physical Developer (Ag-PD) is a reagent used in standard

procedures used to develop latent fingerprints on wet and

porous surfaces, like paper and cardboard. Silver particles

present on the water insoluble components precipitates as a

black substance along the fingerprint ridges. This process is 2+ +based of the principle of Fe ions reducing Ag ions to metallic

Silver. This reaction is catalysed by fatty acids resent in the

fingermark deposits. Unfortunately, this procedure suffers a

considerable setback due the developing solution being highly

unstable. Owing to this, the chances of reproducibility are very [12] poor . In a recently developed procedure called Multi-Metal-

Deposition (MMD), Gold nanoparticles, stabilized by citrate

ions in an aqueous medium, followed by Ag-PD is used for [13]latent fingerprint collection. The Gold nanoparticles adhere

to the fingerprint residue and catalyse the precipitation of

Metallic Silver from the Ag-PD solution. The adherence

happens due to the interaction of the negatively charged Gold

colloid, and the positively charged fingerprint residue, at a low

pH.

Figure 7 : Working of Ag-PD and Au Nanoparticles


80

Figure 8 : Identification of Latent Fingerprints on Wet

Paper

Interaction of Au Nanoparticles and Amino Acids in

Fingerprints : There are some amino acids present in sweat,

and hence, in most fingerprint residues. These are targeted by

Gold nanoparticles linked with amino acid antibodies. To

develop the print, red fluorescent secondary antibodies are

sprinkled over the print, thereby making the fluorescent and

Gold antibodies stick.

Fingerprints were deposited onto an Aluminium foil, which

was then dipped in a solution containing Silicon Dioxide

(SiO ), and Gold nanoparticles coated with a Carboxyl group. 2

A special dye was also prepared in order to best view the

fingerprints. Development of the fingerprint became possible

due to the interaction between the Carboxyl group in the

solution, and certain Amine groups characteristic of fingerprint

residue. This procedure, however, is still under further

research and development.

With the development of the above-mentioned methods, it can

be concluded that certain chemical interactions between

nanoparticles and certain chemical groups present in

fingerprint residue can be promoted. These interactions, on

further development, can be used for more precision, increased

selectivity, and overall sensitivity to detail.

One of the best, and most effective methods of fingerprinting,

is the integration of Gold nanoparticles with Mass

Spectrometry Imaging. This technique enables the

visualization, as well as the molecular imaging of fingerprints.

Two contrasting colours, emitted from different surface

Plasmon resonance bands of the Gold nanoparticles, develop

the optical images of the latent fingerprints. The laser

ionisation property of the nanoparticles allows direct analysis

of the exogenous and endogenous embedded in the prints, and

allows their viewing without disturbing or destroying the

fingerprint pattern. This double imaging not only gives details

of an individual identity but also detects hazardous toxins, and

resolves overlapping fingerprints.

6. Enzymatic DNA Processing (Figure 9-10)

Gold nanoparticles are immobilised on double standard DNA

shows amenable to enzymatic cleavage by a range of various

restriction endonuclease enzymes. The efficiency of these

cleavages by the immobilization of gold nanoparticles can be

easily quantifiable using fluorescence spectroscopy.

Fluorescence spectroscopy is a type of electromagnetic

spectroscopy that analyses fluorescence from a sample. It

involves using a beam of light, usually ultraviolet light, that

excites the electrons in molecules of certain compounds and [14]causes them to emit light.

Figure 9 : Enzymatic DNA Processing with Gold

Nanoparticles

A novel bio-sensing methodology has been developed for

extremely sensitive and selective detection of histone

modifying enzymes, along with their inhibitors. This

methodology banks on the antibody-mediated organisation of

Gold Nanoparticles (AuNPs) decorated with substrate

peptides which undergo enzymatic modifications with the help

of histone modifying enzymes. This design enables the

enzyme activity to undergo a visual and homogenous assay

using antibodies, which offers a robust and convenient [15]platform for enzyme and inhibitor screening.

Figure 10 : Activity of Histone Proteins with Gold

Nanoparticles


81

7. Nanoparticles Used in Paint Material (Figure 11) :

Nanoparticles are used in many materials and Paint is one of

them.In general terms, Paint depicts a liquid that is used to cost [16]a solid surface in order to protect it, seal or colour it.

Nanoparticles are used in many materials, and paint is one of

them. Generally, paint is defined as a liquid used to coat the

upper surface of a solid substance to seal, protect, or impart

colour o it. Paints used in indoor as well as outdoor work have

added biocides, among other additives for protection against

chemical, physical, or biological deterioration. Of late, the

paint industry is not only focussing on upgrading their paint

formulation, but also consider the incorporation of

Nanoparticles (Nano-Silver, Nano-Copper, Nano-Zinc oxides,

photo catalytic active Nano-Titanium, Nano-Silica etc) as

additives for protection of material against spoilage. In the near

future, Nano materials should replace biodegradable additives [17]to aid in improvement of paint quality and properties.

Figure 12 : Use of Nanoparticle Coated Paint

8. Nanotechnology for Defence (Figure 12) : Protection

represents an important industry, both economically and

socially. The Nano products includes from simple plastic

gloves to sophisticated and confidential military armour.

Today's generation of body-armour systems can provide

protection at various levels. Like the way of using the elasticity

of carbon nanotubes to not only stop bullets penetrating

material but actually rebound their force without any trace of [18]damage. Some of the examples are listed below:

Develop covert nanomaterials for the tracking, labelling, and

authentication of high value items, Nano-sensors with the

ability to detect toxins or other harmful threats at the molecular

or even atomic level, Nanoelectronics and nanocomputing to

integrate transistor-like nanoscale devices into system

architecture to provide substantial advantages over current

technologies, Nanotechnology applications for the protection

of the soldier in the field. Nano Armour: Method for creating

super strong materials uses tungsten, not carbon, for the basic

material. It is five times stronger than steel and at least twice as

strong as any impact-resistant material currently in use as

protective gear. It has withstood the equivalent of dropping

four diesel locomotives onto an area the size of a fingernail.

Possible applications for this new Nanomaterial are ballistic

protection personal body armour, bullet proof vests, vehicle

armour, shields, helmets, and protective enclosures.

Smart body Armour: Another new Nano-armour is called

"smart" body armour. It weaves thin pads or cloth from fibres

that can sense the impact of a bullet or shrapnel and

automatically stiffen. This material would be even more

resistant to penetration and less cumbersome than the ceramic-[19]plate armour troops wear now.

Water proof and bulletproof vests: developed by professor

Karen Gleason. She and her researchers were able to create

ultra-hydrophobic surfaces using a technique called chemical

vapour deposition. With CVD they use nanolayers of Teflon.

Figure 12 : Working of Bullet Proof Vest

9. Gunshot Residue Analysis : Microscopic particles of

gunshot residues are often present on the hands of a shooter,

following discharge of a firearm. These GSR are partially

composed of nanoparticles of lead oxides crystalline

especially PbSb and Barium (Ba). Instead of analysing GSR

chemically from the shooters hand, the GSR can also be

characterized for identification by using SEM and AFM on the

basis of these nanoparticles present on it.

SUMMARY & CONCLUSION:

The insistence of nanotechnology designed materials is

rapidly increasing all around world. Its applications are giving

impact on various field of agriculture, food, industry,

biomedical science. Due to its sensitivity site targeting

properties and specificity, the nanoparticles senses as a boon

for identification, detection, determination of various


82

GunBullet

Layers of Nano-polymer of Teflon

evidences in forensic sciences. Here, in arena of forensic

science where sensitivity and specificity is crucial important

characteristic feature to identify sample. Without using any

distinctive method of analysis, such designed techniques lead

to one of the most compliance reliable method for

identification of forensic evidence. As nanoparticles are

known for their diverse properties like permeability, solubility,

adsorption, etc. It helps in collection, preservation and analysis

of forensic evidence. Furthermore this application will not

only improve the sensitivity analysis but will also aid in fast,

accurate less time consuming activities. Nevertheless several

types of issues and concerns are being raised for such

application of nanoparticles but, then role in forensic science is

marvellous which gives aid in investigation and criminal

justice system without ambiguity.

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https://www.ncbi.nlm.nih.gov/pubmed/?term=Whitehill%20DL%5BAuthor%5D&cauthor=true&cauthor_uid=9767727




https://en.wikipedia.org/wiki/Antihistamine



https://en.wikipedia.org/wiki/Guaifenesin

https://en.wikipedia.org/wiki/Guaifenesin

https://en.wikipedia.org/wiki/Dextromethorphan

https://en.wikipedia.org/wiki/Dextromethorphan

https://www.drugbank.ca/drugs/DB01364

https://www.drugbank.ca/drugs/DB01364

http://www.sciencedirect.com/science/article/pii/S0731708500005860

http://www.sciencedirect.com/science/article/pii/S0731708500005860

http://www.sciencedirect.com/science/journal/07317085/25/3

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https://www.childwelfare.gov/preventing/programs/whatworks/report/report.pdf




Suggestion for MPT act, “abortion on demand”? 1. Lalit Kumar, Associate Professor, Forensic Medicine, Sri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun

Correspondence

There is so much ambiguity in the MTP act 1971 for the some

points. By taking benefits of these ambiguities in MTP act

1971; so many doctors getting unreasonable monetary benefits

while doing MTPs and patients are satisfying their demands.

Suggestions/Definite answer of the following matters :

1. “Abortion on demand” is Legal whether it is demanded by

married or unmarried /widows/ divorced female result of

contraceptive failure. (As 3.(2) in MTP act 1971,

explanation

2. Section 312 to 316 of the Penal Code provided that any

person performing an illegal abortion was subject to

imprisonment for three years and/or payment of a fine; if

the woman was “quick with child”, the punishment was

imprisonment for up to seven years and payment of a fine.

The same penalty applied to a woman who induced her

own miscarriage. In India, some statute provides certain

benefits to unborn child. For example: section.13 of

Transfer of Property Act.

Ref: Sec 312 IPC. Causing miscarriage.—whoever

voluntarily causes a woman with child to miscarry, shall,

if such miscarriage be not caused in good faith for the

purpose of saving the life of the woman.

2. What's about the pregnancies followed by consensual

sexual intercourse in unmarried females (Age >18 Years),

widows, divorced and recently married females not

willing/ prepared for kid?

They can demand for abortion or not?

If they can demand then what is the meaning for Section

312 to 316 of the Penal Code.

as 3.(2) in MTP act 1971, explanation 2, only married

word is used. There was no comment on unmarried above

18 years, widows and divorced.

3. As per law 3.(2) in MTP act 1971, explanation 1, only rape

word is used for grave injury to mental health, if

unmarried/ widow will continue the pregnancy then it will

not cause of mental trauma (may be a factor for suicidal

attempt) as it is not acceptable in our community.

As in current scenario all such abortions are done by

paying high charges to gynaecologist and gynaecologist

always fill MTP form – of the reason ii (in the order to

prevent grave injury to the physical and mental health of

the pregnant women). And no data or record is maintained

for that; it also increasing the number of unnoticed mental

trauma case.

Are they all saving the life of pregnant Women

(unmarried, widows, divorced and recently married

females)?

Is this not “abortion on demand”?

Then what's about The Indian Penal Code (Act No. 45

of 1860) permitted abortion only when it was justified for

the good faith purpose of saving the life of the woman.

One thing left is equal right of human beings as Article 2 of the

Universal Declaration of Human Rights states that “Everyone

is entitled to all the rights and freedoms set forth in this

Declaration, without distinction of any kind, such as race,

colour, sex, language, religion, political or other opinion,

national or social origin, property, birth or other status.

Then, how can we differentiate between the fundamental rights

of females being –married/ unmarried/ widows/ divorcees.

Copy To :

Ÿ PMO, New Delhi email: [email protected],

[email protected]

Ÿ Member-Secretary, Law Commission of India New

Delhi E-mail: [email protected]

Ÿ Member-Secretary, National commission for Women,

Delhi Email: [email protected], [email protected],lo-

[email protected]

Ÿ CEO (NITI Aayog ), Department of Health and

Family Welfare New Delhi Email: CEO - [email protected]

Ÿ Secretary, Department of Medical, health and family

welfare, Uttarakhand state.


Ÿ Secretary General, IMA Head Quarter. Email:

[email protected]

Ÿ Secretary General, The Federation of Obstetric and

Gyneco log i ca l Soc i e t i e s o f I nd i a Ema i l :

[email protected]

Ÿ State secretary, IMA Uttaranchal state branch, Email:

[email protected]


84

Correspondence


85

INTRODUCTION:

Punjab Anatomy Act and Rules were initially enacted in the year 1963 to supply unclaimed dead bodies to medical colleges for the

purpose of Anatomical dissections, surgical operation and research work . Since the year 1963, no major amendment in this Act has

been made. With the passage of time and as per requirement, the said act needs some changes/ amendments for proper

implementation of the aim of the act. A CME cum Conference was held by Department of Anatomy, Guru Gobind Singh

Medical College, Faridkot on 30th March 2017 to discuss the various shortcomings in Punjab Anatomy Act in present scenario. A

Panel discussion was held by eminent anatomists of the region to suggest changes in the Act. The Conference was held under the

aegis of SOCA (Society of Clinical Anatomists) and Punjab Medical Council. They discussed the present perspectives of the Act,

the shortcomings & the recommendations to modify the Act in accordance with the present scenario. Copy of the final

recommendations sent to Government of Punjab for bringing necessary amendments in the Punjab Anatomy Act has been

reproduced here for wider circulations and comments.

Recommendations Sent to Government of Punjab for Bringing Necessary Amendments in the Punjab Anatomy Act 1963

1. Priti Chaudhary, Professor and Head, Department of Anatomy, Guru Gobind Singh Medical College, Faridkot

2. Parmod Kumar Goyal, Professor and Head, Forensic Medicine, Adesh Institute of Medical Sciences and Research, Bathinda

Issue

1 . Voluntary body donation by the general public for dissection by s t u d e n t s o f MBBS/BDS/MS for research purpose.

Present Provision in the Act

The act is silent on this issue

Suggested recommendation

This clause should be added in the act. The authorized officer should be empowered to accept the pledge forms from general public. Later on as the person (who has pledged to donate his/her body) dies, his/her kins/ legal representatives should h a n d o v e r t h e b o d y t o the authorized officer.

Reason :

In 1963 when the act was enacted there was no such awareness in general public for voluntary donation of b o d y f o r s t u d y a n d research purpose. Now many NGO's are working on it, Even organ donation is in vogue. Moreover many new M e d i c a l & d e n t a l colleges have come up in state of Punjab. They all need dead bodies. So this clause needs inclusion in the act. The states like Karnataka, Maharashtra, Orissa and Gujarat have already done so. Even PGI Chandigarh is accepting voluntary body donations.


Dr. Priti Chaudhary,

Professor and Head,

Department of Anatomy, Guru Gobind Singh Medical

College, Faridkot Contact : 94440-47907

Contact : +91 98559-52965




86

2. Certificate of Cause of Death

(a) Unclaimed body when death occurs in hospital.

(b) Unclaimed body when dea th occu r s outside hospital and body i s b rought to hospital as “brought dead."

Present Provision in the Act

The attended physician can't give death certificate. As per law any dead body found in public place has to undergo postmortem to ascertain cause of death and to rule out any foul play. Many a times, a person dies due to excessive cold/heat or due to any other c a u s e a n d t h e b o d y i s unclaimed. If such bodies are subjected to postmortem examination, usually nothing comes out and they are not useful for dissection in anatomy department after postmortem. As Per Mr. Rajneesh Garg Advocate ( One of the panelist) only executive magistrate of that a r e a i s e m p o w e r e d t o abandon postmortem of such body

Suggested recommendation

No Problem

A provision is requested to be made in the act that when ever an unclaimed body is found where death has occur in public place & apparently there seems t o b e n o f o u l p l a y, t h e police should be directed to take permission from executive magistrate for not doing postmortem of such cases & body be handed over to the ana tomy depar tmen t fo r research & study purpose. The executive magistrate may be given clear cut instruction in the Act for this purpose.

Reason :

-----------

This will provide an ample no. of unclaimed bodies to the medical students for research & study purpose. Presently their number is very less but so many new medical and dental colleges have come up so more bodies are required. At present in GMC Patiala, the Police deptt. is giving unclaimed bodies but without taking any permission from executive magistrate . It should be included in the Act to make this procedure legally safe. OR

The police deptt. itself can be given powers to handover the body directly to Medical Col lege /denta l col lege without seeking permission from executive magistrate.

Death certificate is given by attending physician.

(c) When death occurs at home & no physician has attended the person. T h e d e c e a s e d h a s p l e d g e d t o d o n a t e his/her body / or the r e l a t i v e s w a n t t o donate body.

It happens so often that relatives come without death certificate. The act is silent about it. The fear of Anatomy department in such cases is the fear of foul play. Somebody might have murdered the old person and handover the body to the Anatomy department. How c a n A n a t o m i s t s s a v e themselves f rom such situations?

When ever a donated body is brought to Anatomy department where death has occurred at home, it should be accompanied by a letter/ undertaking from relatives that the person has died a natural death, so body is being h a n d e d o v e r t o a n a t o m y department. It should be attested by minimum 2 persons of the village (or city) comprising of Sarpanch and the NGO through which the body is being brought. Further a committee must be made at college level comprising of an Anatomist and a Forensic expert to examine the body externally and to declare that "apparently there seems to be no foul play". Ifsuspected, the Anatomy department must have right to reject the body and report t h e m a t t e r t o p o l i c e f o r postmortem.

1. To avoid the situation of foul play by relative and send body silently to Anatomy department.2. To save the Doctors in Anatomy department (who accept the body) from any untoward litigations later on.

(d) When death occurs at home & death certificate is given by physician

Act is silent In such cases also the body should be examined by a committee of Anatomist & Forensic expert as in (2 C) above.

When death occurs in a village the a t tending physic ian ( u s u a l l y R M P ) g i v e s c e r t i fi c a t e t h a t p a t i e n t declared dead giving no cause of death. So again to rule out any foul play the body should be examined by committee.


87

Issue Present Provision in the Act Suggested recommendation Reason :

3. Authorized officers to r e c e i v e u n c l a i m e d bodies.

Principal of Govt. Medical Colleges Patiala & Amritsar and Faridkot i.e. Govt. Institutes.

May be extended to Principals of all Private Medical & Dental Colleges as well.

In 1963 only 3 state Govt. Medical Colleges were there but now many new private Medical & Dental Colleges h a v e c o m e u p & they are facing scarcity of dead bodies. Since all of these are approved by the state Govt., BFUHS & MCI/DCI, So they come under the definition of “Approved Institutes" under the Act. The students of these colleges are presently at a back foot for want of dead bodies so these institutes should also be authorized to accept unclaimed and / or donated bodies. However they should also adopt t h e s a m e p r o c e d u r e f o r accepting such bodies as is suggested above for Govt. Institutes in Para 2 (c) above.

4. Whether body should be accepted in Anatomy d e p a r t m e n t a f t e r autopsy or not.

Act is silent. But practice is that such bodies are not accepted as these are not fit for dissection.

1. If no foul play is found and death is declared by forensic expert to have occurred by natural way, there is no harm in accepting the body by anatomy department for preparation of bones which may be used by students for study purpose & research.2. Virtual autopsy is another alternative in such cases (unclaimed bodies) so that b o d y c a n b e s a v e d f o r dissection by students.

Currently original human's skeletons are almost not avai lable . These are an important aspect of teaching & r e s e a r c h i n M e d i c a l field. Students are buying skeletons made of fiber but these are no where close to original ones. So provision s h o u l d b e m a d e i n the Act to allow handing over unc la imed bod ies a f t e r a u t o p s y t o a n a t o m y department for preparing skeletons. But it should be at the l ibe r ty o f Ana tomy department whether they need such bodies for skeletons or not.

5. Whether a donated body can be returned after it is received in Anatomy department for dissection.

Act is silent should not be allowed A s e m b a l m i n g i s d o n e immediately after receiving of body in Anatomy department. Moreover relatives donate body by their own will.

6. Whether relatives can be allowed to see the body after it is donated & r e c e i v e d i n t h e Anatomy department.

Act is silent should not be allowed 1.It may wake up the motions of the relatives to take body back.2.They visit mortuary where so many other bodies are lying. It may weaken them emotionally

INSTRUCTIONS TO AUTHORS

Preparing a Manuscript For Submission to Journal of Punjab Academy of Forensic Medicine and Toxicology

Unpublished, Ethical, Un-Plagiarised original manuscript written in English should be sent to: Dr. Parmod Kumar Goyal,

Editor-in-Chief, Journal of Punjab Academy of Forensic Medicine and Toxicology by email at:

[email protected]

The Publication Particulars

The JPAFMAT is the official publication of the Punjab Academy of Forensic Medicine & Toxicology, published since

2001.

The Contents of the Journal

The journal accepts a range of articles of interest, under several feature sections as follows:

Original Papers: Includes conventional observational and experimental research.

Commentary: Intended for Reviews, Case Reports, Preliminary Report and Scientific Correspondences.

Letter to the Editor

Designed to be an avenue for dialogue between the authors of the papers published in the journal and the readers

restricted to the options expressing reviews, criticisms etc. It could also publish letters on behalf of the current

affairs in the field of Forensic Medicine in the country.

Editorial

Intended as a platform, for the Editor-in-Chief and for others with a keen interest in forensic medicine that wished

to comment on the current affairs.

Special Features

In the History of Indian Forensic Medicine, Book Review, Abstracts, Announcement etc, which appear frequently,

but not necessarily in every issue.

News and Notes

Intended for providing information of members and activities of the Academy and other such other organizations

affiliated to the Academy may appear frequently and not in every issue.

General Principles

The text of observational and experimental articles is usually (but not necessarily) divided into the following sections: Introduction,

Methods, Results, and Discussion. This so-called “IMRAD” structure is not an arbitrary publication format but rather a direct

reflection of the process of scientific discovery. Long articles may need subheadings within some sections (especially Results and

Discussion) to clarify their content. Other types of articles, such as case reports, reviews, and editorials, probably need to be

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Authors should number all of the pages of the manuscript consecutively, beginning with the title page, to facilitate the editorial

process.

International Uniform Requirements

Please visit http://www.icmje.org/ for detailed instructions for manuscript submission.

Note : Manuscript handling charges Rs. 1000/- to be paid after acceptance.

88


Format of Application for Membership

To

The General Secretary

Punjab Academy of Forensic Medicine & Toxicology (PAFMAT)

Dear Sir,

I wish to become a Life Member / Annual Member of PAFMAT. I am furnishing the required particulars below with a

request to enrol me in the academy. The fee of Rs. 1000 / Rs. ---- for Life Membership / Annul Membership is enclosed as a Demand

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89


90


LM/PAFMAT/1/1998 Dr. R.K. Gorea

LM/PAFMAT/2/1998 Late Dr. Sat Pal Garg

LM/PAFMAT/3/1998 Dr. D.S. Bhullar

LM/PAFMAT/4/1998 Late Dr. A.S. Thind

LM/PAFMAT/5/2001 Dr. Hakumat Rai

LM/PAFMAT/6/2001 Dr. K.K. Aggarwal

LM/PAFMAT/7/2001 Dr. Jaswinder Singh

LM/PAFMAT/8/2001 Dr. Karamjit Singh

LM/PAFMAT/9/2001 Dr. Harjinder Singh

LM/PAFMAT/10/2001 Dr. Virender Pal Singh

LM/PAFMAT/11/2001 Dr. Ashok Chanana

LM/PAFMAT/12/2002 Dr. J.S. Dalal

LM/PAFMAT/13/2002 Dr. Jagdish Gargi

LM/PAFMAT/14/2002 Dr. R.S. Parsad

LM/PAFMAT/15/2002 Dr., Ajit Singh

LM/PAFMAT/16/2002 Dr. Harish Tuli

LM/PAFMAT/17/2002 Dr. S.K. Bal

LM/PAFMAT/18/2002 Dr. S.S. Sandhu

LM/PAFMAT/19/2002 Dr. Akashdeep Aggarwal

LM/PAFMAT/20/2002 Dr. Kuldeep Singh

LM/PAFMAT/21/2002 Dr. Vishal Garg

LM/PAFMAT/22/2002 Dr. S.S. Oberoi

LM/PAFMAT/23/2002 Late Dr. Ram Lubhaya

LM/PAFMAT/24/2003 Dr. Amandeep Singh

LM/PAFMAT/25/2003 Dr. Harkirat Singh

LM/PAFMAT/26/2003 Dr. I.S. Bagga

LM/PAFMAT/27/2004 Dr. Harpreet Singh

LM/PAFMAT/28/2004 Dr. Parminder Singh

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LM/PAFMAT/31/2006 Dr. Gaurav Sharma

LM/PAFMAT/32/2006 Late Dr. Madhur Tayal

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LM/PAFMAT/34/2006 Dr. Didar Singh

LM/PAFMAT/35/2006 Dr. Kuldeep Singh

LM/PAFMAT/36/2006 Dr. Pankaj Gupta

LM/PAFMAT/37/2007 Dr. Karam Singh

LM/PAFMAT/38/2007 Dr. Baljit Singh

LM/PAFMAT/39/2007 Dr. Puneet Khurana

LM/PAFMAT/40/2007 Dr. Puneet Arora

LM/PAFMAT/41/2007 Dr. Prabhsharan Singh

LM/PAFMAT/42/2007 Dr. Dildar Singh

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LM/PAFMAT/44/2007 Dr. Shilekh Mittal

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LM/PAFMAT /46/2007 Dr. D.Harish

LM/PAFMAT /47/2007 Dr. Krishna D. Chavali

LM/PAFMAT /48/2007 Dr. Ashwani Kumar

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LM/PAFMAT /50/2007 Dr. Kirpal Singh

LM/PAFMAT /51/2007 Dr. Gurbachan Singh

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LM/PAFMAT /53/2008 Dr. Sukhbir Singh Chauhan

LM/PAFMAT /54/2008 Dr. Parminder Singh Bhatti

LM/PAFMAT /55/2008 Dr. Rakesh Kumar

LM/PAFMAT /56/2008 Dr. Jagbir Singh

LM/PAFMAT /57/2008 Dr. Karnveer Singh

LM/PAFMAT /58/2008 Dr. Rajiv K. Chowdhary

LM/PAFMAT /59/2008 Dr. Parmod Kumar Goyal

LM/PAFMAT /60/2008 Dr. Ajay Kumar

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LM/PAFMAT/64/2010 Dr Vijal Pal Khangwal

LM/PAFMAT/65/2010 Dr Rajiv Joshi

LM/PAFMAT/66/2010 Dr Manpreet Kaul

LM/PAFMAT/67/2010 Dr Sheikh AnayatUllah

LM/PAFMAT/68/2010 Dr Satinder Pal Singh

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LM/PAFMAT/71/2011 Dr Imran Sabri

LM/PAFMAT/72/2011 Dr Bindu Aggarwal

LM/PAFMAT/73/2011 Dr Adish Goyal

LM/PAFMAT/74/2011 Dr Charak Sangwan

LM/PAFMAT/75/2011 Dr Pardeep Singh

LM/PAFMAT/76/2011 Dr Ishwer Tayal

LM/PAFMAT/77/2011 Dr Ripan Chanana

LM/PAFMAT/78/2012 Dr Gurvinder Singh Kakkar

LM/PAFMAT/79/2012 Dr Ravdeep Singh

LM/PAFMAT/80/2012 Dr Rohit Kumar Singal

LM/PAFMAT/81/2012 Dr Prabhdeep Singh

LM/PAFMAT/82/2012 Dr Jasbir Singh

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Life Members (PAFMAT)

91


Life Members (PAFMAT)

LM/PAFMAT/85/2013 Dr Iram Khan

LM/PAFMAT/86/2013 Dr Charanpreet K. Pawar

LM/PAFMAT/87/2013 Dr Mukul Chopra

LM/PAFMAT/88/2013 Dr Mohit Gupta

LM/PAFMAT/89/2013 Dr Rahul Chawla

LM/PAFMAT/90/2013 Dr Maneel Grover

LM/PAFMAT/91/2014 Dr Y.S. Bansal

LM/PAFMAT/92/2014 Dr C.S. Gautam

LM/PAFMAT/93/2014 Dr S.P. Mandal

LM/PAFMAT/94/2014 Dr Murli . G

LM/PAFMAT/95/2014 Dr Anil Kumar Mittal

LM/PAFMAT/96/2014 Dr G.A. Sunil Kumar Sharma

LM/PAFMAT/97/2014 Dr Abhishek Yadav

LM/PAFMAT/98/2014 Dr Jagdev Kullar

LM/PAFMAT/99/2014 Dr Gurpreet Kaur Randhawa

LM/PAFMAT/100/2014 Dr Gursirat Singh Khokhar

LM/PAFMAT/101/2014 Dr Saginder Samara

LM/PAFMAT/102/2014 Dr Saginder Samaraj

LM/PAFMAT/103/2014 Dr Neha Sharma

LM/PAFMAT/104/2014 Dr Sunil Mahajan

LM/PAFMAT/105/2014 Dr Harshdeep Kashyap

LM/PAFMAT/106/2014 Dr Kiran Kumar

LM/PAFMAT/107/2014 Dr Swati Tyagi

LM/PAFMAT/108/2014 Dr Mini

LM/PAFMAT/109/2014 Dr Mandeep Kaur

LM/PAFMAT/110/2014 Dr Gurinder Singh

LM/PAFMAT/111/2014 Dr Minal

LM/PAFMAT/112/2014 Dr Kanchan Jyoti Heera

LM/PAFMAT/113/2014 Dr Manpinder Kaur Bhullar

LM/PAFMAT/114/2014 Dr Arashdeep Singh

LM/PAFMAT/115/2014 Dr Chamandeep Singh Bains

LM/PAFMAT/116/2014 Dr Maninder Singh

LM/PAFMAT/117/2014 Dr Akhilesh Agarwal

LM/PAFMAT/118/2014 Dr Guneet

LM/PAFMAT/119/2014 Dr Hitesh Bhatia

LM/PAFMAT/120/2015 Dr. Deep Rattan Mittal

LM/PAFMAT/121/2015 Dr. Arun Kumar Maria

LM/PAFMAT/122/2015 Dr. S Valliappan

LM/PAFMAT/123/2015 Dr. Preet Inder Singh

LM/PAFMAT/124/2015 Dr. Harvinder Singh Chhabra

LM/PAFMAT/125/2015 Dr. Bhoj Kumar Sahu

LM/PAFMAT/126/2016 Dr. Amarnath Mishra

LM/PAFMAT/127/2016 Dr. Shekhar Chumber

LM/PAFMAT/128/2016 Dr. Navroz Goyal

LM/PAFMAT/129/2016 Dr. Gurjeet Singh

LM/PAFMAT/130/2016 Dr. Deepika Kanwar

LM/PAFMAT/131/2016 Dr. Mohd. Amjad Bhatt

LM/PAFMAT/132/2016 Dr. Nikhil Mehta

LM/PAFMAT/133/2016 Dr. Charan Kamal

LM/PAFMAT/134/2016 Dr. Amit Singla

LM/PAFMAT/135/2017 Dr. Sukhdeep Singh

LM/PAFMAT/136/2017 Dr. Munish Kumar

LM/PAFMAT/137/2017 Dr. Arindam Chatterjee

LM/PAFMAT/138/2017 Dr. Ranjodh Jeet Singh

LM/PAFMAT/139/2017 Dr. Kanika Kohli

LM/PAFMAT/140/2017 Dr. Vinka Maini

LM/PAFMAT/141/2017 Dr. Ravi Tejpal

LM/PAFMAT/142/2017 Dr. Preet Mohinder Singh

LM/PAFMAT/143/2017 Dr. Satbir Singh

LM/PAFMAT/144/2017 Dr. Kamaljit Singh

LM/PAFMAT/145/2018 Dr. Mrinal Kanti Jha

LM/PAFMAT/146/2018 Dr. Vijay Arora

LM/PAFMAT/147/2018 Dr. Vivek Srivastava

LM/PAFMAT/148/2018 Dr. Pankaj Chhikara

LM/PAFMAT/149/2018 Dr. Lalit Kumar

LM/PAFMAT/150/2018 Dr. Prem Chandra Srivastava

LM/PAFMAT/151/2018 Dr. Niraj Kumar

LM/PAFMAT/152/2018 Dr. Om Parkash Saini

LM/PAFMAT/153/2018 Dr. Rajesh Kumar Verma

LM/PAFMAT/154/2018 Dr. Shailender Kumar

LM/PAFMAT/155/2018 Dr. B.L. Chaudhary

LM/PAFMAT/156/2018 Dr. Parmod Kumar Saini

LM/PAFMAT/157/2018 Dr. Rajendra Singh Kulhari

LM/PAFMAT/158/2018 Dr. Nidhi Sachdeva Agarwal

LM/PAFMAT/159/2018 Dr. Rajeev Varma

LM/PAFMAT/160/2018 Dr. Pragnesh Bharatkumar

Parmar

LM/PAFMAT/161/2018 Dr. Yatiraj Singi

LM/PAFMAT/162/2018 Dr. Navpreet Kaur

LM/PAFMAT/163/2018 Dr. Kunal Khanna

LM/PAFMAT/164/2018 Dr. Smitha Rani Shetty

LM/PAFMAT/165/2018 Dr. Vivekanshu Verma

LM/PAFMAT/166/2018 Dr. B.V. Naga Mohan Rao

92


Glimpse of Mid Term CME on Medical Negligence & Assault on doctors

DEPARTMENT OF FORENSIC MEDICINEPUNJAB INSTITUTE OF MEDICAL SCIENCES, JALANDHAR

Organized by:Organized by:Organized by:

On Saturday, 12th May, 2018


Editorial Board

NationalAdvisoryBoardDr T.D. DograDr J.S. DalalDr R.K. GoreaDr O P AggarwalDr K K AggarwalDr Balbir KaurDr K. VijDr Dalbir SinghDr Sanjoy DassDr E.J. RodrigeusDr Gurudatta PawarDr D.S. BadkurDr Jagadeesh. N.

EditorialCommittee:Dr S. S. OberoiDr Sangeet DhillonDr Ishwar TayalDr Kuldeep SinghDr Harjinder SinghDr Harpreet SinghDr Parul KherDr Antara DebBarmanDr Gurpreet S. Sandhu

Dr OP MurtiDr V. V. PillayDr Shiv KochharDr R.K. SharmaDr N K AggarwalDr Amitabh ShrivastvaDr Shankar M. BakkannavarDr Mukesh YadavDr C.B. JaniDr. Vijal Pal KhanagwalDr. Samita SinhaDr. Manjot KaurDr. Karan MaheshwariMrs. Ritika Gupta, FSL Bathinda

SubscriptionInformationMembers of PAFMAT will receive the journal free of cost.

SubscriptionratesforNon-MembersandInstitutionsforYear2018Personal: Rs. 1,000/- Institutions: Rs. 3,500/-

Abroad : Postal Charges Extra

l Subscription request be sent on email to [email protected]

l Payments be made in Bank Account of Journal of Punjab Academy of Forensic Medicine (A/c No. 65075504236, State Bank of India, Branch Rajindra Hospital Patiala, IFS Code SBIN0050263

A copy will be sent free to the

member / subscriber provided the

claim is made within 2 months of the

publication of the issue and Rs.

100/- deposited in the Journal

account as postal Charges.

ClaimsforMissingIssue

Printed&Publishedby:Dr Parmod Kumar Goyal

Professor & Head,Department of Forensic Medicine & ToxicologyAdesh Institute of Medical Sciences & Research,

Bathinda (Pb.) India M. 9876005211, 0164-5055073E-mail: [email protected]

Printedat:Subhash Mittal Printing Press

Hospital Bazar, BathindaM. 99880-11022

e-mail: [email protected]

Editor-in-ChiefDr Parmod Kumar Goyal

Joint EditorDr Amandeep Singh

Assistant EditorDr Satinder Pal Singh

Web MasterDr Dildar Singh


Dr. Vivek SrivastavaDr. Sanjoy DasDr. Pardeep SinghDr. Monika GuptaDr. Navita AggarwalDr. Tanvir Kaur SidhuDr. Sandeep KaurDr. Priti ChaudharyDr. Vijay SuriDr. Saranpal SinghDr. Lovleen MarwahaDr. Tanuj KanchanDr. Raghuvendra K. Vidua

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