Indian Journal of Forensic Medicine and Pathology

Background: In the Xhosa culture, suicide by hanging is viewed very negatively. However, recently hanging has been on the increase in the Transkei sub-region of South Africa. Poverty, unemployment, alcoholism and HIV may play a role in these deaths. Objective: To study 20 years’ (1996-2015) trend in suicide byhanging in the Transkei subregion of South Africa (1996-2015). Method: This is a retrospective descriptive study from the records of Mthatha Forensic Pathology Laboratory. Results: Over a period of 20 years (1996-2015), 24 693 medico-legal autopsies were performed in the Transkei sub-region of South Africa. Of these, 1 555 (6.3%) deaths were recorded as being the result of hanging. The average rate of hanging is 17.3 per 100 000of the population per year. The majority (88.5%) were males. The rate of hanging has increased from 8.3 per 100 000 in 1996 to 16.7 per 100 000 of the population in 2015. The male-to-female ratio is 1:7.7 (1376/179). The highest number of hangings, 484 (5.5/100 000),was recorded among males between 21 and 30 years, while among females of 11 to 20 years, 66 (0.75/100 00) such deaths occurred over a period of 20 years. Conclusion: The incidence of suicide by hanging has doubled in the Transkei sub-region of South Africa over a period of 20 years. It is more common among young adult males. This health crisis needs urgent attention.

Background: India launched the National Framework for Malaria Elimination to encourage surveillance and strategies towards ‘elimination’ rather than control by 2030. Considering the significant challenges on this path, regional variations in clinical and haematological manifestations are useful parameters to help shape national elimination strategies. Our study aims to compare the demographic, clinical and haematological parameters among severe malaria casesandhighlightmixedmalariainfection. Methods: A cross sectional study was carried out between January 2015 and May 2018. Diagnosis was done by peripheral smear microscopy, followed by immunochromatographicrapid test and finally quantitative buffy coat test. Patients were classified as severe and non-severe disease according to WHO major criteria. The relevant data of the study subjects was collected from inpatient case records and analysed. Results: A total of 403 inpatients with confirmed malaria were included in our study. Severe malaria was observed in 21.5% and these patients had a significantly longer stay in hospital of 6.08±3.78days.InfectionscausedbyP.falciparum(48.6%)andP.vivax(46.9%)werealmost equalinnumber.Acuterespiratorydistresssyndromewasobservedmorein21.4%(9/42)ofP. vivaxinfections.Mixedmalarialinfectionswereobservedin4.5%(18/403)oftotalpatientsand 33%ofmixedmalarialcasespresentedwithseveremanifestations. Conclusions: AttributingseveremalariatoP.falciparumorP.vivaxalonecanbemisleading especially in regions with complicated epidemiology, like India. Identification of malarial coinfectionsinfection are difficult without molecular diagnostic tools. Incorrect diagnosis may directly affect appropriate antimalarial therapy selection. Highlights • Clinical and haematological manifestations have not been observed as a malaria burden metric in all regions. • Identification of malarial coinfectionsinfection are difficult without molecular diagnostic tools. • Appropriatelaboratorydiagnosisofmixedmalarialinfectionsaidsinselectingantimalarial therapy. • Study of regional variations in malaria presentations can improve public health

Periampullaryadenocarcinomas(PAC)areraremalignanttumorswithworstsurvivalrates due to destructive route of the disease. It comprises distal bile duct, pancreatic, ampullary and duodenaladenocarcinomathatoriginatewithinperiampullarycomplex.Theprimaryorigin ofPACinthisareaisoftendifficultprevioustothesurgeryintopancreaticobiliary(PB-PAC), intestinal(I-PAC)andmixedtype(MT-PAC)asPB-PACcarriesbadprognosis. Objective:The main aim was to study the histomorphological features and immunohistochemical (IHC)expressionofCytokeratin(CK)7and20inPACandassesstheirexpressionwithknown histopathological prognostic parameters. Method: A total number of 31 resected pancreatoduodenectomy specimens were studied in the department of Pathology, in a tertiary care center, Karnataka, India for histomorphological featureswithCK7andCK20expression.Allthestatisticalmethodswerecarriedoutthrough theSPSSforWindows(version22.0).Ap-valueof≤0.05wastakentobestatisticallysignificant. Results: The cases were categorized into PB-PAC (CK7+), I-PAC (CK20+) and MT-PAC (CK7+ and CK20+) based on histomorphological and histomolecular typing. There was a positive association between histomorphology and histomolecular typing. The difference in the proportionofhistomolecularprofilingbetweentheexpressionswasstatisticallysignificantwith p-valueof≤0.001. Conclusions: TheconcordanceinPB-PAC,I-PACandMT-PACbyusualhaematoxylinand eosin microscopy and later confirmed by the immunophenotyping advocates sub typing to be incorporated in the routine histopathology report. The importance of correctly categorizing of the PB-PAC, I-PAC and MT-PAC is mainly for the prognosis and difference in administering of the targeted chemotherapy regimens

Myocardial infarction is the most common cause of sudden unexpected death.On autopsy the evidence of coronary artery narrowing and gross changes are important for the diagnosis. But gross changes took 24 to 48 hours to occur , So the histochemical staining on gross by TTC is more helpful, as it diagnose infarction within 6 hours of death , And also the area from which the section should be taken also can be decided.

Health is not merely the absence of disease but a state of physical, mental and social wellbeing. It encompasses all facets of human right, including the right to health automatically. In heerstwhileJammuandKashmirstateandnowIndianUnionTerritory(UT)hasbeenunder conflict situation resulting in assaults on health by conventional and rubber bullets, tear gas shells and pellet firearms in crowd control and security. The security forces during the last three decades to quell the discontentment and uprising have used power to the detriment of the people's health and well being. The access to health care and delivery assumes importance in conflict and peace situations equally being inalienable human right to life and health. The paper takes a legal stance on security-driven health issues and diseases in the human rights perspective in Kashmir

Sirenomelia is a lethal form of caudal regression anomaly which shows fusion of the lower limbs with a spectrum of anomalies affecting musculoskeletal, genitourinary and gastrointestinal systems.It resembles a mermaid in Roman mythology, with upper body of a human and the lower half resembling the tail of a fish.We report a case of anomalous fetus diagnosed at 18 weeks of gestation born to a non-diabetic mother.External phenotype showed fused lower limbs, no discernible external genitalia, imperforate anus,hypodactyly, ectopic cystic dysplastic kidneys and Potter’s syndrome with single umbilical artery. Maternal diabetes has been associated with caudal regression syndrome and sirenomelia. Here we report a case of Sirenomelia with Potter’s syndrome and cystic renal dysplasia not associated with gestational diabetes mellitus. The presence of cystic renal dysplasia in our case would further endorse the mesodermal defect in caudal regression syndrome. The possible use of genetic analysis will help to analyse the underlying molecular mechanisms of caudal regression syndrome associated with cystic renal dysplasia.

Participation of health-care professionals in the advertising business has been subject to a raging debate since days beyond recall. It has gained more acceptance but was despised in the past. The Code of Ethics of many National Medical Councils around the world has maintained that for a medical professional to engage in commercial advertising of himself or some other product is unethical-owing to the influence and the cultural authority that a health-care professional holds. This paper reviews instances where medical professionals and bodies have beenreportedtohaveexplicitlyortacitlylenttheirsupporttobrandendorsements.Malpractices within the advertising industry in relation to medical fraternity-such as untrue/conjectural claims, distortion of words of a reliable medical body etcetera have also been discussed.

Background:TraumaticSpinalCordInjury(TSCI)isserioushealthproblemamongadults.It leads to significant morbidity, mortality, permanent disability and socio-economic effect. The present study was conducted in Narayana Medical College, Nellore State Andhra Pradesh. Aims and Objectives: ToknowthecommonagegroupthatismostlypronetoTSCI,sex difference of TSCI,the area of distribution of TSCI cases, mode of injury, various management modalities like Surgical, ICU stay etc and their role in the prognosis of patients with TSCI,the site of injury commonly involved and GCS of patients admitted due to TSC.To know the mortality rate among TSCI patients. Type of study: This is a two years retrospective and oneyear prospective study. Place of study:Spinal cord injuries admitted in Narayana Medical College & Hospital – Nellore, during the years 1st October 2010 to 30th September 2013. Material and Methods: All patients admitted and managed for traumatic spinal cord injury were retrieved and data collected in a pre-designed proforma. Patient characteristics, details of etiology, mechanism of injury, level of injury, extent of neurological deficits, details of investigations, details of management and immediate outcome were recorded. Observations and Discussion: Themaximumcases40wereintheagegroupof41-50(26.31%). Themeanageis38.45+14.56.SCIcasesweremorecommonamongmales115(75.66%),thanin females37(24.34%)andalsothemostcommonagegroupwasbetween41-50years33(21.71%) followed by 21-30 years 30(19.73%). Male to female ratio was 4.18: 1.It was observed that maximum cases were in rural area 132(86.80%), followed by urban area 20(13.20%). It was observedthatmostcommoncausewasfallfromheight93(61.20%),followedbyroadtraffic accidents52(34.20%).Itwasobservedthatmostcommonsiteofinjurywascervical67(44.10%), followedbylumbar54(35.50%),thoracic29(19.10%),thoracolumbar2(1.30%). Conclusion: Traumatic spinal cord injuries affect young population and can leave these persons with significant functional and physical morbidity. Male persons are more commonly injured than females.