Publication

JOURNAL OF
Punjab Academy of Forensic Medicine & Toxicology

ISSN: 0972-5687
Volume: 18, Number: 01 January to June Publication: Half Yearly
2018
A Peer Reviewed Journal on

Forensic Medicine, Toxicology, Analytical Toxicology, Forensic Science, Environmental Pollution,
Forensic Pathology, Clinical Forensic Medicine, Identi ication, Legal Medicine, State Medicine,
Medical Jurisprudence, Medical Ethics, Forensic Nursing, Forensic Odontology, Forensic Anthropology,
Forensic Psychiatry and other Allied branches of Medicine and Science
dedicated to administration of Justice.
Place of Publication: Bathinda (Punjab) India

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• JPAFMAT is also having PubMed/NLM catalogue number (NLM Unique ID: 101232466).
• Available online at Indian Journals.com and pafmat.com
• UGC Approved (Sr. No. 97, Journal No.19445)
J Punjab Acad Forensic Med Toxicol 2018;18 (1) ISSN : 0972-5687
PUNJAB ACADEMY OF FORENSIC MEDICINE AND TOXICOLOGY

(Registration No. 139 / 1998-99, Chandigarh)
HO: Department of Forensic Medicine, Govt. Medical College Patiala (Punjab) 147001
GOVERNING COUNCIL (2017 - 2019)

President General Secretary Joint Secretary
Dr. D. S. Bhullar Dr. Akashdeep Aggarwal Dr. Didar Singh Walia
Finance Secretary Vice President Web Master

Dr. Shilekh Mittal Dr. Rajiv Joshi Dr. Dildar Singh
Editor-in-Chief Joint Editor Assistant Editor

Dr. Parmod Kumar Goyal Dr. Amandeep Singh Dr. Satinder Pal Singh
Executive Members
Dr. Ashok Chanana Dr. Preetinder S. Chahal Dr. Amit Singla
Dr. Ishwar Tayal Dr. Puneet Khurana Dr. Ashwani Kumar
Dr. Dasari Harish Dr. Ajay Kumar Dr. Deep Rattan Mittal
Advisors
Dr. O.P. Aggarwal Dr. Gurmanjit Singh Dr. R.K. Gorea
Dr. S.S. Oberoi Dr. K.K. Aggarwal Dr. Vijaypal Khanagwal
Dr. Balbir Kaur Dr. R.K. Sharma
Special Invitee
Dr. Adish Goyal Dr. Mukul Chopra
FOUNDER GOVERNING COUNCIL OF PAFMAT

Patron President Executive Members
Dr Jagdish Gargi Dr. R. K. Gorea Dr A S Thind,
Vice President Dr Jagjiv Sharma,
Advisors Dr. D. S. Bhullar Dr Kuldeep Kumar,
Dr J. S. Dalal Secretary Dr I. S. Bagga,
Dr Harish Tuli Dr. Sat Pal Garg Dr Baljit Singh
Dr Maj. Gen (Rtd.) Ajit Singh Treasurer
Dr. Nirmal Dass
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: that it is not being considered for publication elsewhere.

ISSN-L: 0972-5687, p-ISSN: 0972-5687, e-ISSN: 0974- Submission of multi-authored paper implies that the consent
083X. of each author has been taken. Researchers/Authors should
adhere to publication requirements that submitted work is
Indexed with:
original, not plagiarized, ethical an has not been published
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hp?id=4715 elsewhere.
Every effort has been made not to publish any inaccurate or
Scopus (SCI): misleading information. However, the Editor-in-Chief, the
http://www.scimagojr.com/journalsearch.php?q=199001949 Joint Editor or any member of the editorial committee accept
14&ip=sid&clean=0 no liability in consequences of such statements. For any further
information/query please contact with Editor-in-Chief.
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):

drparmodgoyal@gmail.com
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 Dr Parmod Kumar Goyal
1
JOURNAL OF
ISSN: 0972-5687
Contents
*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
2
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
J Punjab Acad Forensic Med Toxicol 2018;18(1) ISSN : 0972-5687
Editorial
Theory of Relative Justice
1. 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
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.
Corresponding Author Article History:

Dr. Imran Sabri, Received: 17 January 2018
Received in revised form: 29 May 2018
Assistant Professor, College of Medicine, King Faisal Accepted on: 29 May 2018
University, Al-Ahsa, Kingdom of Saudi Arabia Available online: 1 July 2018
Contact : +966565554107
Email : imransabri@gmail.com, ikhan@kfu.edu.sa
KEYWORDS : Justice, Relative Justice,Theory
INTRODUCTION : Utilitarianism has been debatable as legal understanding may

A famous quote by William E. Gladstone is “Justice differ.
Delayed is Justice Denied”[1]. But what if the justice is not A 14 year old boy arrested in a country on complaint of school
done at all, or justice has been done in favour of accused which staff who suspects him to make a clock bomb later turns out to
obviously is injustice to the victim. Justice is defined according be a case of racial prejudice. This incidence was covered by
to dictionary.com as “the quality of being just; righteousness, media which highlighted profound private information[7]. Had
equitableness, or moral rightness.”[2]. Justice and injustice are there been a similar incidence occurred with a student of
relative terms, as justice for one may be injustice to the other different background, the fate could have been otherwise.
party. Absolute justice as per Merriam Webster dictionary is Other similar incidences are reported albeit the names of the
“free from imperfection”[3]. It can be interpreted that absolute accused/victim. In the above mentioned case the victim has
justice is a perfect trait, and, since only God is perfect hence been accused as criminal. Now the question arises that who is
only He can deliver it. As human beings could be imperfect in the criminal in actuality? or whom can we blame ? the media,
their judgment, it can impact criminal justice administration the school staff, the police or the society. In reality all of them
and absolute justice cannot be assured in true sense. In this are fulfilling their duties. Then who is the real culprit? In this
article we will look into a few imperfections prevalent in our instance it can be said that “Doctrine of Relative Justice” has
existing criminal justice administration system. “The Theory prevailed. In order to protect the rights of majority population,
of Relative Justice” implies that “we are living in a world of we have compromised the rights of the minority.
Relative Justice” which need not be necessarily absolute A certain country bans a particular dress[8], while another
justice. makes it mandatory[9]. In this situation, a particular dress is
Utilitarianism, on the other hand, deals with the concerns of legal in one country but illegal in other. Therefore a country
majority and cannot be regarded as justice, however it could be may take legal action against people wearing that dress while
labeled as an ethical term. Ethics and law differ in that ethics another country legally enforces the wearing of that dress.
are social guidelines based on moral principles and values Absolute justice states that everyone should have the freedom
while laws are rules and regulations that have specific penalties to wear the dress of their choice. The society however
and consequences when violated [ 6 ] . The practice of sometimes defines its dress code according to the norms set by
4
it and the rights of individual stand violated. Now in the afore webster.com/dictionary/absolute .
mentioned instance certain nations may actively discourage 4. John Rawls. A Theory of Justice By John Rawls-Revision
the full covering of the body or face and in a similar way, rules Edition . Massachusetts . Harvard University Press 1999.
governing sports activities may restrict use of clothing's. These Available from
issues could also be considered as violation of the rights of
https://books.google.com.sa/books?
individuals and hence doctrine of relative justice is also
id=kvpby7HtAe0C&printsec=frontcover#v=onepage&q
applicable here.
&f=false
DISCUSSION:
5. Henry R, West. [Internet] Utilitarialism [Cited on May 29,
Justice for one may be injustice to other, in the cases mentioned 2018]. Available from
above. Justice, Law, Ethics, Social Norms etc are applied in
https://www.utilitarianism.com/utilitarianism.html
relative context in the society. How is it possible that we have
different laws for same crime or different criminal justice 6. What Is the Difference Between Ethics and Law?
administration system for different sections of the society? [Internet]. Available from
This could only happen if criminal justice administration 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 -
system is biased on the bases of religion, caste, skin color, politics/difference-between-ethics-law-
seeking dominance, region etc. 1b772dd7ebc7cd74# [Cited on April 1, 2018].
“The Doctrine of Relative Justice” is an applied approach in 7. Ashley Fantz, Steve Almasy and AnneClaire Stapleton,
which the benefits of majority population are of paramount CNN. Muslim teen Ahmed Mohamed creates clock,
consideration and perhaps application of Relative justice may shows teachers, gets arrested [Internet] September 16,
not be a bad choice, as at least we are giving justice to the 2015. [Cited on April 1, 2018] Available From
majority population while restricting the rights of the minority. https://edition.cnn.com/2015/09/16/us/texas-student-
If it were to happen that the minority becomes the majority ahmed-muslim-clock-bomb/ .
“The Theory of Relative Justice” will still prevail. 8. Lizzei Dearden. China bans burqas and 'abnormal' beards
CONCLUSION: in Muslim province of Xinjiang [Internet] May 30, 2017
It could be concluded that “The Theory of Relative Justice” is [ 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
prevalent across the world. Absolute Justice seems to be http://www.independent.co.uk/news/world/asia/china-
merely a textbook term and doesn't seem to be practiced. “The burqa-abnormal-beards-ban-muslim-province-xinjiang-
Theory of Relative Justice” can be considered independent of veils-province-extremism-crackdown-freedom-
majority and minority status. Practicing relative justice may be a7657826.html
considered a better approach than practicing no Justice. 9. The Economist. [Internet] Saudi Arabia's dress code for
Absolute Justice may seem to be a utopian dream to some; women.[Cited on April 2, 2018] Available from
however it is desirable and achievable. h t t p : / / w w w. e c o n o m i s t . c o m / b l o g s / e c o n o m i s t -
Ethical approval : None/Not Applicable explains/2015/01/economist-explains-20.
Funding : None/Self-Funded
Conflicts of interest : No conflicts of interest.
REFERENCES :
1. "William E. Gladstone Quotes." BrainyQuote.com.
Xplore Inc, 2018. 29 May 2018.
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-
5
J Punjab Acad Forensic Med Toxicol 2018;18(1) ISSN : 0972-5687 DOI: 10.5958/0974-083X.2018.00001.8
Original Research Paper
Correlation Study Between Fingerprint Patterns and Rh Blood Group
1. Smitha Rani, Assistant Professor*
2. Balaraj BM, Professor*
*Department of Forensic Medicine and Toxicology, JSS Academy of Higher Education and Research, Mysuru, Karnataka,
India.
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.

Dr. Smitha Rani Received: 23 March 2018
Assistant Professor Received in revised form: 29 April 2018
Department of Forensic Medicine and Toxicology, Accepted on: 29 April 2018
Available online: 01 July 2018
J.S.S Medical College, , JSS Academy of Higher
Education and Research, Sri Shivarathreeshwara Nagar,
Bannimantap, Mysore-570015, Karnataka, India.
Telephone no: 09886673946
Email: smitharani@jssuni.edu.in
KEYWORDS : Rh Blood Group, Fingerprint Print Pattern, Identification.
INTRODUCTION : various comparative data techniques listed above, Personal

Identification means determination of the individuality of a identification through fingerprints has long been recognized
person based on certain physical characteristics unique to that and is regarded as the greatest contribution to the police force.
individual[1]. It is the most important component in medico Study of fingerprints as a method of identification is also
legal practice. Identity of a person may be absolute (complete) known as Dactylography or Dactyloscopy or Henry – Galton
or partial (incomplete). Complete identification is the absolute system of identification[3]. The finger print patterns are
determination of the individuality of the person. Incomplete or distinctive and permanent in individuals. The pattern is
partial identification is the ascertainment of only a few facts different even in identical twins.
whereas the other facts are unknown. Similar to fingerprints, blood as trace evidence is an extremely
The various comparative techniques for identification are important entity of medico legal practice. In Forensic Science
dental patterns and restorations, finger, palm and foot prints, and Medicine, the ABO and Rh blood group system have been
superimposition technique, neutron activation analysis, a major focus, since the record of this blood group system is a
anthropometry and trace evidence comparisons[2]. Among the very prevalent one. A, B and O (H) antigens on erythrocytes are
6
present since birth and can be determined from soft tissues, the blood group using SPANCLONE monoclonal antibodies
hair, nails, dental tissues and bone and in about 80 % of the (Blood grouping antisera).
individuals. They can be demonstrated in all body fluids except Fingerprint Recording :
the cerebrospinal fluid.
The subjects were asked to wash and dry their hands to remove
Aside from the antigens of the ABO system, those of dirt and grease. Inkless fingerprint pad, square in shape,
the Rh system are of the great clinical importance. The “Rh measuring 2 inch x 1.5 inch was used to obtain the fingerprints.
factor”, named after Rhesus monkey because it was first The subject was asked to keep his / her arm relaxed and not to
studied using the blood of this animal, is a system composed try to help in rolling the fingers as this may cause smearing.
primarily of the C, D and E antigens, although it actually Then the finger bulbs were rolled on the fingerprint pad – “the
contains many more. Unlike the ABO antigens, the Rh system thumbs were rolled towards the subject's body and the fingers
has not been detected in tissues other than the red cells. D is far were rolled away from the body, i.e. thumb in fingers out
the most antigenic component, and the term “Rh-positive” method” (Figure 1).
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
circulation[4].
Both Fingerprint pattern and blood group are
genetically determined. The inheritance of dermatoglyphic
Figure 1: Ink being smeared on the fingertip by rolling the
features is said to be polygenic, where individual gene
finger on inkless fingerprint pad.
contribute a small additive effect. Even the genetic basis for
inheritance of blood groups is well established. Fingerprint And then the rolled impressions of each finger were obtained in
pattern and blood group have been extensively but separately the allotted space for that finger on the Proforma (Figure 2).
studied. Hence the present study is aimed at studying the Single inkless finger print pad was used to record 800 rolled
correlation between these two important comparative data impressions.
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 Figure 2: Inked fingertip being rolled on the proforma to
written consent was obtained prior to taking the prints and obtain fingerprint.
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. Statistical Analysis:
Blood Group Determination : The data obtained was analyzed statistically using SPSS
(Statistical Programme for Social Sciences, version 16.0)
Blood samples were collected by finger prick with a sterile
computer software package. Descriptive statistics,
lancet, after cleaning the puncture site with 70% ethyl alcohol.
contingency co-efficient test were applied and p-value <0.05
Rapid slide test was done as an assay procedure to determine
was considered as significant.
7
RESULTS : past [5-7].

Distribution of cases according to Rh blood group The studies conducted in North Africa, Southern
469 (93.8%) subjects in the study were Rh positive, of which Nigeria, Kenya and Tanzania revealed similar findings[8-10].
159 (31.8%) belonged to blood group O, 149(29.8%) belonged However, our findings do not coincide with the study
to blood group B, 124(24.8%) belonged to blood group A and conducted in New Zealand which revealed more abundant
37 (7.4%) belonged to blood group AB. Among Rh negative whorls (55.6%) than loops (43.6%) in males and much higher
individuals, blood group B and O had same frequency frequency of whorls (65.6%) and lower frequency of loops
amounting to 2.2%. 9 (1.8%) subjects belonged to Blood group (33.7%) in females[11] .
A and none of the subjects in the study were AB negative. The universal distribution of pattern of fingerprint
Pattern of fingerprints among various studies conducted in India in the past is higher
frequency of loops, moderate of whorls and low of arches in
Fingerprint pattern analysis showed that, loops were the most
both Rh positive and Rh negative individuals[12-15].
common pattern ( 54%) followed by whorls (39%) and arches
(7%) in the study group . In this study, the percentage of loop was highest in
Rh-negative (59.7%) and lowest in Rh-positive (59%) which is
Distribution of various fingerprint patterns in Rh blood
dissimilar to findings recorded by Mehta and Mehta[16],
group
Kshirsagar et al[13] and Bharadwaj et al[12]. Whereas the
Loops amounted to 59%, whorls 39 % and the Arches 7 % in frequency of whorls was highest in Rh-positive (39%) and
the Rh positive individuals. Among the Rh negative subjects, lowest in Rh-negative individuals (37.4%), which correlated
the frequency of loops, whorls and arches were 59.7%, 37.4% with the findings of Mehta and Mehta[16] and was contrary to the
and 2.9% respectively. findings of Kshirsagar et al[13] and Bharadwaj et al[12]. The
Table No. 1 : Shows correlation between fingerprint percentage of arches was highest in Rh-positive (7%) and
pattern and Rh blood group, which shows P value of more lowest in Rh-negative (2.9%) which was in discord with the
than 0.05%. Hence, it can be inferred that a non significant findings of all the three aforementioned studies[12,13,16].
association exists between fingerprint pattern and Rh Two researchers in Indiastudied a sample size of 181
blood group. males and 147 females to establish the correlation between
dermatoglyphics and Rh blood group, observations made in
PATTERN TOTAL
the study showed that the distribution of fingertip patterns
Loop Whorl Arch among Rh positive and Rh negative blood group was not
RH Positive
2531 1827 332 4690 significant[17]. This is comparable with the present study.
54 % 39% 7.0% 100 % CONCLUSION :
Negative 185 116 9 310 The study concludes that the most frequent pattern of
59.7 % 37.4 % 2.9 % 100 % fingerprint in Indian population was loop followed by whorl
2716 1943 341 5000 and arch. There is no significant association between
TOTAL distribution of fingerprint patterns and Rh blood group. Hence,
54 % 39% 7% 100 %
the above finding indicates that these characteristics are
independent of each other and may be used independently in
DISCUSSION : the process of identification.
Fingerprints and blood groups are popular methods of REFERENCES :
identification in the field of anthropology worldwide. In the
1. Parikh CK. Identification. In, Parikh's Textbook of
present study, an attempt was made to study the distribution of
Medical Jurisprudence, Forensic Medicine and
fingerprint pattern in different Rh blood group and to ascertain
Toxicology for classrooms & courtrooms.6th ed. New
the association between pattern of fingerprints and Rh blood
Delhi: CBS publishers; 2006:2.2-2.14.
group.
2. Vij K. Identification. In, Textbook of Forensic
The present study reveals that loop was the most
Medicine and Toxicology, Principles and Practice. 3rd
frequently observed pattern of fingerprint followed by whorl
ed. New Delhi: Elsevier; 2005:60.
and arch in both males and females. Gender dimorphism was
not observed. The findings observed was similar to the studies 3. Nandy A. Identification of Individual, Identification
conducted on Indian population by various researchers in the from trace evidences and their other evidential
8
values. In, Principles of Forensic Medicine including 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

Toxicology.3rd ed. Kolkata: New Central Book dermatoglyphics in Rh blood group. Anatomica
Agency (P) Ltd; 2010: 89. Karnataka 2012;6(1):70-73.
4. Ganong WF. Review of Medical Physiology.22nd ed. Acknowledgement :
Singapore: The McGraw-Hill Companies;2005:537- Authors thank all subjects who volunteered to participate in
39. the study .
5. Gangadhar M R, Rajashekara R K. Finger Funding : Nil
dermatoglyphics of Adikarnatakas: a scheduled caste Conflict of Interest : Nil
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 M S 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.
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
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)

Dr. Neha Tomar, Received: 16 April 2018
Research Associate, Amity Institute of Forensic Sciences, Received in revised form: 15 June 2018
Amity University, Noida Accepted on: 15 June 2018
Contact No. : +91 81303-21327 Available online: 1 July 2018
E-mail : tomarne@gmail.com
KEYWORDS : Ephedrine, Pseudoephedrine, Phenyl, Propanolamine, Silica Gel-G Layers, Thin Layer Chromatography
INTRODUCTION: amphetamines and methamphetamines[1]. Ephedrine increases

Over the years,the use of Ephedrine, Pseudoephedrine and post-synaptic noradrenergic receptor activity by directly
Phenylpropanolamine [Figure 1-3] in drugs have been activating post-synaptic α-receptors and β-receptors.The bulk
increasing. These drugs are easily available as over the counter of its effect comes from the pre-synaptic neuron being unable
medicine acting as bronchodilators and have been found in to distinguish between real adrenaline or noradrenaline from
combination with paracetamol, antihistamines etc. for ephedrine[2]. The illicit use of these drugs is responsible for
treatment of various ailments in human and have direct impact large number of criminal cases being referred to forensic
on Central Nervous System. On account of its numerous science laboratories for analysis of samples. Such cases pose a
effects, there is an increase in manufacture of synthetic drugs serious challenge forensic chemists to choose an appropriate
where they are being prepared or modified for various illicit and easy protocol for rapid and accurate detection and
uses. These drugs are widely produced in clandestine determination of these drug. Thin layer chromatography is a
laboratories and used by athletes. The illicit use of these drugs versatile, fast, easy, robust and economical technique and thus
lies in their being used as Precursor Chemicals for the was chosen for separation and identification of these drugs.
preparation of Amphetamines and Amphetamine Type
Stimulants (ATS). These are similar in structure to
Figure 1: Ephedrine Figure 2: Pseudoephedrine Figure 3 : Phenylpropanolamine
10
MATERIALS AND METHODS : Figure 4 : TLC with ninhydrin and iodoplatinate
Standard / Sample solutions: The standard drugs were reagents
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
used for spotting[3-4]. All other chemicals used and were of
Analytical grade. Deionized water was used in all necessary
steps[5].
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].
Table : hRF values of Ephedrine, Pseudoephedrine and Phenylpropanolamine in different solvent systems
S. No. Solvent Systems Phenypropan Ephedrine Pseudo

olamine ephedrine
1. Ethanol : Methanol: Ammonia(25 %) - 85:10:5 v/v/v 48 30 32
2. Chloroform: Ethyl Acetate : Toluene : Methanol : Acetic Acid- 39:39:77:39:6 20 20 18
3. Toluene : Ethyl Acetate: Methanol: Formic acid- 10 : 3:1:2 01 01 02
4. Ethyl Acetate : Butanone :Formic Acid: H2O - 10:1:1:1 45 37 30
5. Chloroform: Methanol- 40 :1 05 02 03
6. n- Hexane : Ethyl Acetate - 9:1 02 03 02
7. Chloroform: Methanol- 7:1 18 21 22
8. n-butyl acetate : acetone : 1- Butanol: 5 M Ammonia: Methanol- 40 : 20 : 20 :10 : 10 54 80 91
9. Toluene : Ethyl Acetate: Methanol- 8:1:1 04 05 05
10. Chloroform : Cyclohexane : Acetic Acid- 4:4:2 07 10 10
11. Methanol: Ammonia - 100:1.5 46 32 35
12. Chloroform: Methanol - 9:1 04 05 04
13. Acetone 00 01 63
14. Methanol 00 10 09
15. Methanol : 1- Butanol - 60:40 00 65 02
16. Chloroform: Acetone - 80:20 00 01 01
17. Ethyl Acetate: Methanol: Ammonia --85:10:5 30 27 23
18. Ethyl Acetate 31 39 36
19. Ethyl Acetate : Ethanol- 90:10 01 01 00
20. Chloroform : Methanol: Propionic acid - 72:18:10 19 17 13
21. Cyclohexane : Toluene : Diethyl amine - 75 :15:10 03 08 58
22. Chloroform : Ammonia :2- propanol - 5:15:80
23. Ethyl Acetate : Methanol: Ammonia - 7:1.5:1 55 49 43
24. Methylene chloride: Ammonia: 2- Propanol – 5:15:80 75 68 71
25. n- hexane: Toluene: 1,4 dioxane–3:3:1 00 00 00
26. 1,4 dioxane: Methanol: Chloroform: Ammonia – 6:2:2:1 56 26 24
27. Ethyl acetate: n- heptane – 1:1 00 00 00
11
Sample Application: Micro capillary tubes were used for drug profiling.The method will be of high use, valuable and
spotting the sample solution to chromatographic plate for most suitable for Crime Laboratory Analyst and Forensic
analysis. Chemist receiving cases with increased attention from
Development Tank : Ascending technique is used for TLC judiciary.
separation with the respective solvent system in the Conflict of Interest: Nil
development tank. The top of the development tank was REFERENCES:
covered with an air tight lid to allow saturation of solvent
1. Fulton , C. (1969). Modern microcrystal tests for drugs. New
vapours for fifteen minutes. The plate was placed in York : Wiley Interscience.
development chamber at room temperature (25oC).
2. Swarbrick, J. (1986). Clarke's Isolation and identification of
The spotted TLC plates were developed in the solvent system drugs. In A. C. Moffat, Clarke's Isolation and identification of
shown in Table for 10 cm from the spotting point. The spots drugs (p. 1248). London: Pharmaceutical Press.
were visualized under UV light of 254 nm/366 nm followed by 3. Martin WR, Sloan JW, Sapira JD, Jasinski DR. Physiologic,
spray of chromogenic reagent. hRf values were calculated subjective, and behavioral effects of amphetamine,
using the formula: methamphetamine, ephedrine, phenmetrazine, and
methylphenidate in man. Clinical Pharmacology &
hRF= Distance travelled by solutex100/ Distance travelled
Therapeutics. 1971. 245-258.
by mobile phase.
4. Wishart D, Feunang Y, Guo A, Marcu L, Grant J, Sajed T, et al.
Preparation of visualizing reagent:.Chromogenic Reagent, Drug Bank 5.0: a major update to the Drug Bank database for
acidified potassium iodoplatinate reagent was used to visualize 2018. Nucleic Acids Research.
the plates after developing in the above mentioned 27 solvent 5. Makhija SN, Vavia PR. Stability indicating HPTLC method for
systems. The developed spots were of coffee brown coloured the simultaneous determination of pseudoephedrine and
spot. The spots were matched and tallied with standard of cetirizine in pharmaceutical formulations. Journal of
Ephedrine, Pseudoephedrine and phenyl propanolamine. pharmaceutical and biomedical analysis. 2001. 663-67.
RESULTS AND DISCUSSION : 6. Zakrzewska A, Parczewski A, Kaźmierczak D, Ciesielski W,
Kochana J. Visualization of Amphetamine and Its Analogues in
Selected solvent systems n-butyl acetate: Acetone: 1- Butanol: TLC. Acta Chimica Slovenica. 2007 Mar 1;54(1).
5 M Ammonia: Methanol (40 : 20 : 20 :10 : 10) was found to
7. Wills S. (1997). Drugs of Abuse. The Pharmaceutical Press, pp.
provide the best separation of these three drugs, as it gives clear
62-75.
oval shape dense spot separating all the three drugs. Another
8. Sinnema A, Verweij AM. Impurities in illicit amphetamine: a
better solvent system for separating these drugs is Ethyl
review. Bull. Narc. 1981 .37-54.
Acetate: Butanone: Formic Acid: Water (10:1:1:1 v/v/v/v).
9. Puthaviriyakorn V, Siriviriyasomboon N, Phorachata J, Pan-ox
Third being Ethyl Acetate: Methanol: Ammonia (7:1.5:1
W, Sasaki T, Tanaka K. Identification of impurities and statistical
v/v/v). classification of methamphetamine tablets (Ya-Ba) seized in
Separated spots were well visualized under UV light at 254 nm Thailand. Forensic Science International. 2002. 105-113.
and finally using chromogenic reagent acidified potassium 10. Makino Y, Kurobane S, Miyasaka K, Nagano K. Profiling of
iodoplatinate reagent giving coffee colored spot. The spots ecstasy tablets seized in Japan. Microgram Journal. 2003. 169-
from the extracted residues tallied with the spots of controlled 76
drug sample of Ephedrine, Pseudoephedrine and Phenyl 11. Adamowicz P, Chudzikiewicz E, Lechowicz W. Illicit “ecstasy”
propanolamine. tab lets in South ern Po land: a two-year re view. Problems of
Forensic Sciences. 2003. 100-106.
CONCLUSION :
12. Lim , M., Ng, K. H., & Lee, T. K. (2003). Abuse of amphetamine-
TLC is simple, accurate, reproducible,low-cost and fast type stimulants in Singapore. Forensic Science International,
method. Also, it is a very versatile technique due to the 136.
availability of a wide range of possible developing systems. As
13. Verweij, A. M. (1992). Impurities in illicit drug preparation: 3,4-
the similarity in structure and molecular weight pose a (metylenedioxy)- amphetamine and 3, 4-( metylenedioxy)-
difficulty in identification of these drugs (without methyl amphetamine. Forensic Science Review, 137-46.
derivatization) by using sophisticated instrumentation viz, 14. Sharma SP, Purkait BC, Lahiri SC. Qualitative and quantitative
GC-MS, the mobile phases were developed for easy and analysis of seized street drug samples and identification of
confirmatory determination. The present method can be source. Forensic science international. 2005. 235-40
routinely used for the analysis of Ephedrine, Pseudoephedrine
and Phenylpropanolamine and it will be valuable method in
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*, Sesen 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.
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.

Dr. Rajeev Varma Manukonda Received: 17 March 2018
Assistant Professor, Received in revised form: 25 March 2018
Accepted on: 25 March 2018
Govt Medical College, Ambikapur, Chhattisgarh. 497001 Available online: 1 July 2018
E-mail: rajeev.varma51@gmail.com
KEYWORDS : Thunderbolt lightning, Lightning deaths, Safety precautions, Litchenburg figures, Blast effect,
Mechanism of lightning.
INTRODUCTION : Earth. Statistical analysis to the data collected by OTD

“Lightning kills 25 amid extensive drought in East Africa: revealed that Earth receives nearly 1.4 billion flashes annually
Sudan Tribune, 27th July 2011.” This news in one of the online which are roughly 39-49 flashes per second. Analysis of the
news channels initiated the thought of studying deaths related data collected by OTD also revealed an interesting fact that the
to lightning in Tigray region of northern Ethiopia. The global ratio of flashes to land and water is nearly 10:1 which means
incidence of lightning is studied in some parts of the world but that the land experiences 10 times more flashes than water
no such studies have been done on the Tigray region of bodies. Ethiopia being a land locked country, is particularly
northern part of Ethiopia. The African continent as such vulnerable to lightning. The Congo basin, which includes
receives the highest lightning strikes with Congo basin toping Democratic Republic of Congo and Rwanda, is considered to
the list. have peak mean annual flash density of 80 fl km_2 yr_1 highest in
the African continent. Ethiopia has a mean annual flash density
The Optical Transient Detector (OTD) is a space-based
of 33.1 fl km_2 yr_1 is not further down the list[1].
instrument used to detect and locate lightning discharges to
13
Some of the news relating to lightning strokes which shook the May). Sixty one percent of the deaths occurred in the middle of
African continent and grabbed media attention are listed the week during Wednesday.
below[2]: Time Wise Distribution of Cases :
l Kenyans Alarmed as Lightning kills 20 people within one Majority of the death (52%) occurred between 12 pm to 6 pm
week : Julalo, 05th July 2011. followed by 35% of deaths occurring between 6am-12 pm and
l Lightning Kills 19 in Gombe, Yobe, Bauchi - Man Loses 6 pm -12 am.
Two Wives, Two Children : Vanguard, 29th June 2011. Blast Effect : Twenty one cases (91%) showed blast effect as a
l Lightning Kills 3 Children The New Times, 28th June 2011. result of lightning (Figure1).
l Lightning kills 7 school children in Darfur : Gulf News, Figure 1 : Blast Effect on Footwear
17th 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
Out of the 18 cases in which the lightning struck the thorax and
was analyzed with SPSS 16 software. Data was cross checked
shoulder, 17 cases (94%) showed blast effect. Lightning struck
to keep missing data to zero percent.
over the thorax and shoulder in 18 cases. In rest 5 cases, could
RESULTS : A total of 356 autopsies were performed during not be ascertained, the area of struck, with 100 percent
the study period, out of which 23 deaths were due to accuracy.
thunderbolt lightning. Among these cases male are 20 (87%)
Injuries Sustained : Fourteen cases (78%) out of 18 where the
and females are 3 (13%). Majority of the victims (47.8%)
lightning struck the thorax showed abrasions on various parts
belong to 31-40 years age group followed by 41-50 years. 31-
of the body. Eighty three percent (19 cases) of the cases
50 years accounted for majority of the victims (78.2%).
showed contusions. Fifteen cases (83%) out of 18 where the
Majority of the victims were farmers (87%) (Table 1).
lightning struck the thorax showed contusions on various parts
Table 1 : Age Wise Distribution of Cases of the body. Only six cases (26%) showed lacerations and there
Frequency Percent Valid Cumulative is no significant association between the point of entry of
Percent Percent lightning into the body and lacerations. Seventeen cases out of
0-10 Yrs. 2 8.7 8.7 8.7 23 (74%) had no lacerations. All the cases (100%) showed
burns ranging from superficial to deep burns.
21-30 Yrs. 1 4.3 4.3 13.0
Internal Findings : All the cases (100%) in which the point of
31-40 Yrs. 11 47.8 47.8 60.9 entry of high voltage lightning is head and neck showed
41-50 Yrs. 7 30.4 30.4 91.3 multiple fractures of the cranium. Majority of the cases (74%)
showed no specific findings internally. Twenty six percent of
51-60 Yrs. 2 8.7 8.7 100.0
the cases which showed specific internal findings ranged from
Total 23 100.0 100.0 petechial hemorrhages on the heart, lungs and brain to
fractures of bones. Seventy four percent of the cases did not
Month Wise Distribution of Cases : show any specific internal finding(Table 2).
Seventy four percent of the deaths occurred during the DISCUSSION : The male predominance in this study (87%)
Ethiopian summer months (June, July and August) followed can be understood by the fact that males form the major
by 22% of deaths during the autumn season (March, April and working group in Ethiopia and are constantly involved in
14
Table 2 : Internal Findings and Blast Effect
Blast Effect wave produced by the high voltage electric current of
Count Specific finding Total lightning. In the absence of specific findings, lack of proper
Absent Present
history and eye witnesses and presence of evidence of blunt
No. of Absent 1 16 17 trauma will create a very confusing picture.
Cases
Present 5 All the cases where the point of impact was the head showed
1 6
fractures of the cranium. Once the lightning strikes the head,
Total 2 21 23 the wave crosses the scalp which does not offer much
outdoor activities. Most of the victims (78%) belong to the resistance to reach a much resistant cranium. On the cranium
third and fourth decade of life. the electric current will spread in search of pathway which
offers least resistance. The cranial orifices allow the current to
Eighty seven percent (87%) of the victims were farmers and
enter the cranial cavity with ease. If the force of electric wave
most of them were struck by lightning while they were farming
exceeds the threshold of elasticity of the cranium, the bone
land or herding cattle. Most of the Ethiopian population
fractures. All the bones of the cranium should be properly
inherits land and cattle farming and herding cattle is the major
examined for fractures. Special attention should be directed
occupation in rural areas of Tigray[5].
towards the cranial orifices where the probability of finding
74% of deaths occurred during June-August followed by 22% hairline fractures is more[8].
of deaths during March-May. June-August are the typical
100% cases showed burns ranging from superficial to deep
Ethiopian summer months known as Kiremt or Meher during
burns. Ninety nine percent of these cases showed superficial
which Ethiopia experiences heavy rain fall and thunder storms.
burns. Because lightning contact is for a very short period of
March-May are the Ethiopian autumn season known as Tseday
time, in the order of milliseconds. Extensive tissue damage
with occasional showers. Most of the people will be working
with second and third degree burns will not be present. Second
outdoors especially in open fields farming land or herding
and third degree burns can only happen if the clothing of the
cattle during these seasons [6-7].
victim catches fire or any metal objects which are in contact
83% of the deaths happened during weekday with 60% with the victim gets heated up due to transfer of tremendous
occurring on Wednesday. Most people of Ethiopia work five amount of energy from lightning. In the latter case it is more of
days a week from Monday to Friday. During the weekends i.e., an imprint burn mark. All the burn injuries should be
Saturday and Sunday people will be spending time mostly thoroughly examined as in most of the cases it might be the
indoors with friends and family and attending church. Similar only finding[9,10]. The classical Litchenburg figures were
results were found in other studies[3-4]. observed in 26% of the cases in our present study.
Lightning struck between 12 pm to 6 pm resulting in majority Majority of the cases (74%) showed no specific findings
of deaths (52%). The rains in northern Tigray typically follow internally. Out of these cases without any specific internal
a timely pattern mostly showering at a particular time of the finding, 94% of cases showed blast effect on the body. These
day. Though for the purpose of the study 24 hrs of a day are numbers observed in the present study highlight the fact that
divided in to four groups with interval of six hours, 100% of the the external findings such as blast effect, superficial burns and
cases observed between 12pm to 6 pm occurred between 12pm blunt injuries could be the only possible finding at autopsy and
to 3pm. should not be missed. The aqueous nature of internal organs
91% of the cases showed blast effect which includes disruption and presence of many electrolytes provide a less resistant
of clothing, tears in shoes and blunt injuries on the body due to diffuse pathway for electric current preventing the occurrence
being blown away. The location where the lightning struck the of any gross finding of thermal damage[11,12].
body showed a strong association with blast effect. 94% of the MECHANISM OF LIGHTNING STROKE[8]:
victims who were struck on thorax and shoulder showed blast
Lightning occurs when there is discharge of electricity
effect. Sudden expansion of the explosive air around the track
between clouds, when this charge jumps between cloud and
of current is responsible for this type of blast effect. All the
earth, it is called Lightning strike. Each lightning stroke is
victims who were struck by lightning in an open field showed
actually a combination of strokes. The leader stroke is the
blast effect[8].
discharge originating from the clouds meeting the pilot stroke
Various types of injuries caused by blunt force impact such as originating from the earth and travelling towards the cloud.
abrasions (78%), contusions (83%), lacerations (26%) and Once the leader stroke and pilot stroke meet a return stroke is
fractures were observed on external and internal examination. formed which rises from earth to cloud completing a circuit.
The injuries were caused by the explosive force of the shock The entire process occurs so quickly in less than one-half of a
15
second the entire flash is perceived as one single stroke. Tigray region for various reasons such as, not all deaths due to
SAFETY PRECAUTIONS [13-14]
: lightning are being reported to police and not all reported cases
are being autopsied. The reason for this is most of the Tigray
1. If you are anticipating thunderstorm and the hair on
region has remote rural areas which don't have access to proper
your body stands or skin tingles, it indicates strong
and timely transport, the financial burden the family has to bare
electric field. Seek shelter immediately.
while transporting the body for examination and back to
2. The varied landscapes of Tigray region offer vast cremation ground back in the remote rural areas and lack of
open fields and high mountains. These open fields knowledge that such type of deaths need to be reported to
with high projecting objects should be avoided. police for postmortem examination.
3. If you are caught in open fields crouch down like a Funding: Nil
baseball catcher so that the smallest possible target is
Conflicts of Interest: None
presented and do not lay flat on the ground. The only
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precautions discussed above should be taught to the people of 12. Vij K. Text book of forensic medicine and toxicology.
remote areas who are most vulnerable. Principles and practice. 5th ed. India: Elsevier; 2011. p179 .
LIMITAIONS OF STUDY : 13. Zimmermann C, Cooper MA, Holle RL. L ightning Safety
Guidelines. Ann Emerg Med. 2002;(June):0–5.
During our study period of two years, 23 deaths occurred due
14. Col L, Nagesh I V, Col L, Bhatia P, Mohan CS, Lamba
to lightning were autopsied. This number cannot be used for
BNS. A bolt from the blue : Lightning injuries. Med J
calculating true prevalence rate of deaths due to lightning in armed forces india. 2015;71:134–37
16
Informed Consent in Medical Treatment – KAP Study
1. Nidhi Sachdeva, Assistant Professor*
2. Vivek Srivastava, Associate Professor*
3. Ashok Najan, Assistant Professor*
*Netaji Subhash Chander Bose Medical College, Jabalpur.
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.

Dr. Nidhi Sachdeva, Received: 15 March 2018
Assistant Professor, Received in revised form: 25April 2018
Accepted on: 25 April 2018
Department of Forensic Medicine
Netaji Subhash Chander Bose Medical College, Jabalpur.
Contact : +91 95890-04138
Email : drnid2012@gmail.com
KEYWORDS : Informed Consent, Awareness, Medico-legal.
INTRODUCTION : development in the area (i.e., consent) appears to be almost

The element of consent is one of the critical issues in the area of complete when the apex court in India recently ruled that, it is
medical treatment today. It is well known that the patient must not just the 'consent' or 'informed consent' (as it is known
give valid consent to medical treatment; and it is his worldwide) but it shall also be 'prior informed consent'
prerogative to refuse treatment even if the said treatment will generally barring some specific cases of emergency. This
save his or her life. No doubt this raises many ethical debates places a medical professional in a tremendous dilemma.
and falls at the heart of medical law today. The earliest Hence, it is time to revisit the area of 'consent and medical
expression of this fundamental principle, based on autonomy, treatment' to understand the sensitive and underpinning
is found in the Nuremberg Code of 1947[1]. The code makes it elements. Informed consent is an integral part of patient-
mandatory to obtain voluntary and informed consent of human centered medical care. It occurs in almost every patient
subjects. Similarly, the Declaration of Helsinki adopted by the encounter. Documenting your discussion with the patient is
World Medical Association in 1964 emphasizes the important. In general, it is always useful to note that "patient
importance of obtaining freely given informed consent for understands plan" at the end of a patient note.
medical research by adequately informing the subjects of the Consent can be either expressed or implied. Expressed
aims, methods, anticipated benefits, potential hazards, and consent may be written or verbal. Implied consent is indicated
discomforts that the study may entail[2]. The circle of legal by the demeanor and behavior of the patient and is adequate for
17
routine general examinations but special examinations such as knowledge about informed consent while giving treatment to
vaginal, rectal etc, require express consent to be taken. For their patients. The questionnaire used has been included.
more complicated diagnostic and therapeutic procedures like Chi Square test applied, P value is significant if p<0.05 and
endoscopy or for surgical procedures, written consent is highly significant if p<0.01.
essential.
RESULTS : Questions and Answers are tabulated below :
Doctors are increasingly being criticized for imposing How do you obtain
treatment without adequate consent. Capacity remains the consent Total P Value
cornerstone of the Medico-legal doctrine of informed consent. before any treatment
Question No. 1 procedure?
Although capacity to consent is ultimately a legal construct, verbal or written
doctors of all specialties must assess their patient's capacity to
Incorrect
Correct
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 Age <35 11 78.6 3 21.4 14
[years] 0.058
for capacity, but may at times apply them incorrectly. >35 15 100.0 0 0.0 15
As far as possible, consent must be obtained after explaining F 15 93.8 1 6.3 16
Sex 0.42
the nature and consequences of the treatment procedure being M 11 84.6 2 15.4 13
contemplated in the presence of disinterested third party such
Clinical 19 90.5 2 9.5 21
as nurse or receptionist. This is termed as informed consent. Specialty 0.81
Non 7 87.5 1 12.5 8
Failure to take informed consent can expose a doctor to legal Clinical
action if anything goes wrong during a particular procedure.
Informed consent help patients make informed decisions about Whether consent is taken
their proposed treatments[11,12]. The concept of informed Question No. 2 in proper printed Total P Value
format or on plain paper
consents is rooted in moral, cultural, and legal principles[13,14]. or
Informed consents are often perceived as necessary for legal Patient own hand writing
protection against malpractice claims[15]. Present Study has
Incorrect
Correct
been conducted to know about level of theoretical knowledge % %
of doctors with the actual implementation in their routine
Age <35 6 42.9 8 57.1 14
practice and to compare actual and correct use of informed 0.013*
[years]
consent among medical and surgical fields. >35 13 86.7 2 13.3 15
MATERIALS AND METHODS : F 10 62.5 6 37.3 16
Sex 0.71
The present KAP study is a cross sectional & hospital based M 9 69.2 4 30.8 13
study performed on 29 randomly selected Medical Clinical 14 66.7 7 33.3 21
Specialty 0.82
practitioners (faculty members both young and old, males and Non 5 62.5 3 37.5 8
females, clinical and non-clinical, of the different specialties), Clinical
via a questionnaire after taking prior permission from dean and
medical superintendent. Doctors were very supportive, Before taking consent,
Question No. 3 what information is Total P Value
encouraging and enthusiastic while answering the given to the patient?
Questionnaire. Coding was done to interpret answers
statistically. 1- for yes, 2- for No. After preparing master
Incorrect
Correct
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. Age <35 14 100.0 0 0.0 14
[years] 0.017*
The questionnaire comprised of 19 questions, to test the >35 10 66.7 5 33.3 15
knowledge of how, when and in what form the consent has to
F 15 93.8 1 6.3 16
be taken, attitude of the physician, when they are taking the Sex 0.082
M 9 69.2 4 30.8 13
consent and to know the actual practice pattern which is being
practiced. 11 questions (1-11) were included to test the Clinical 18 85.7 3 14.3 21
Specialty 0.49
Knowledge, 3 questions (12-14) to test the attitude and 5 Non 6 75.0 2 25.0 8
questions (15-19) to know about how they practice their Clinical
18
In which languages do Have you attend any

Question No. 4 you explain and Total P Value Question No. 7 CME/Workshop? Total P Value
take consent form the
patient?
Incorrect
Correct % % Yes % No %
Age <35 14 100.0 0 0.0 14 Age <35 4 28.6 10 71.4 14

[years] 0.077 0.041*
>35 12 80.0 3 20.0 15 [years]
>35 10 66.7 5 33.3 15
F 15 93.8 1 6.3 16 F 8 50.0 8 50.0 16
Sex 0.42 Sex 0.83
M 11 84.6 2 15.4 13 M 7 53.8 6 46.2 13
Clinical 18 85.7 3 14.3 21 Clinical 9 42.9 12 57.1 21
Specialty 0.26 Specialty 0.12
Non 8 100.0 0 0.0 8 Non 6 75.0 2 25.0 8
Clinical Clinical
Do you know the Do you know what is the

Question No. 5 difference between Total P Value Question No. 8 role of ethical committee Total P Value
consent and informed in a medical College &
consent? amp: Hospital?
Yes % No % Yes % No %
Age <35 13 92.9 1 7.1 14 Age <35 3 21.4 11 78.6 14

[years] 0.16 0.15
>35 11 73.3 4 26.7 15 [years]
>35 7 46.7 8 53.3 15
F 14 87.5 2 12.5 16 F 6 37.5 10 62.5 16
Sex 0.45 Sex 0.71
M 10 76.9 3 23.1 13 M 4 30.8 9 69.2 13
Non 7 87.5 1 12.5 8 Non 4 50.0 4 50.0 8
Clinical Clinical
Do you know that: any

written consent taken Who will give consent
Question No. 6 Total P Value Question No. for treatment (Medical Total P Value
from a patient in a proper 9-A
format and manner can and Surgical): If the
save you from litigation? Patient below18 Years.
Incorrect
Correct
Yes % No % % %
Age <35 11 79 3 21 14 Age <35 13 92.9 1 7.1 14

[years] 0.25 0.038*
>35 14 93 1 7 15 [years]
>35 9 60.0 6 40.0 15
F 15 94 1 6 16 F 13 81.3 3 18.8 16
Sex 0.19 Sex 0.45
M 10 77 3 23 13 M 9 69.2 4 30.8 13
Clinical 19 90 2 10 21 Clinical 15 71.4 6 28.6 21
Non 6 75 2 25 8 Non 7 87.5 1 12.5 8
Clinical Clinical
19
Who will give consent Is consent thought

Question No. for treatment (Medical Total P Value Question No. electronic media valid? Total P Value
9-B and Surgical): If Patient 11 (a) Email (b) Whatts app
above 18 Years. (c) Video conferencing
(d) SMS
Incorrect
Incorrect
Correct
Correct % % % %
Age <35 13 92.9 1 7.1 14 Age <35 6 42.9 8 57.1 14

[years] 0.038* [years] 0.022*
>35 9 60.0 6 40.0 15 >35 1 6.7 14 93.3 15
F 15 93.8 1 6.3 16 F 7 43.8 9 56.3 16
Sex 0.033* Sex 0.031*
M 8 61.5 5 38.5 13 M 1 7.7 12 92.3 13
Non 7 87.5 1 12.5 8 Non 2 25.0 6 75.0 8
Clinical Clinical
Who will give consent Do you explain youself,

Question No. for treatment (Medical Total P Value about treatment procedure
9-C and Surgical): If Patient Question No. /surgical procedure when Total P Value
between 12 patient is under
12-18 Years. your care before obtaining
consent?
Presents
No Ans.
% %
Incorrect
Correct
% %
Age <35 12 85.7 2 14.3 14
[years] 0.12 Age <35 13 92.9 1 7.1 14
>35 9 60.0 6 40.0 15 [years] 0.58
>35 13 86.7 2 13.3 15
F 12 75.0 4 25.0 16
Sex 0.73 F
Sex 14 87.5 2 12.5 16
M 9 69.2 4 30.8 13 0.62
M 12 92.3 1 7.7 13
Clinical 14 66.7 7 33.3 21
Specialty 0.26 Clinical 18 85.7 3 14.3 21
Non 7 87.5 1 12.5 8 Specialty 0.25
Clinical Non 8 100.0 0 8 8
Clinical
In emergency situation
Question No. do you think that Total P Value Will you take consent Total P Value
10 consent is from all indoor patient or
necessary? selective patient?
Question No.
13
Incorrect
Incorrect
Correct
Correct
% % % %
Age <35 2 14.3 12 85.7 14 Age <35 8 57.1 6 42.9 14

[years] 0.68 [years] 0.19
>35 3 20.0 12 80.0 15 >35 5 33.3 10 66.7 15
F 3 18.8 13 81.3 16 F 7 43.8 9 56.3 16
Sex 0.81 Sex 0.89
M 2 15.4 11 84.6 13 M 6 46.2 7 53.8 13
Non 0 0.0 8 100.0 8 Non 4 50.0 4 50.0 8
Clinical Clinical
20
Do you take informed consent Have you faced any

(a) Before any surgical procedure? litigation Because of not Total P Value
(b) In case of poor prognosis Question No. taking proper informed
(c) For staying in a hospital with Total P Value consent?
Question No. available facilities 18
14 (d) All indoor patients.
(e) All of the above. Yes % No %
Incorrect
Correct
% % Age <35 1 7.1 13 92.9 14

[years] 0.29
>35 0 0.0 15 100.0 15
Age <35 12 85.7 2 14.3 14
[years] 0.027* F 1 6.3 15 93.8 16
>35 7 46.7 8 53.3 15 Sex 0.54
M 0 0.0 13 100.0 13
F 11 68.8 5 31.3 16
Sex 0.41 Clinical 1 4.8 20 95.2 21
M 7 53.8 6 46.2 13 Specialty 0.53
Non 0 0.0 8 100.0 8
Clinical 9 42.9 12 57.1 21 Clinical
Specialty 0.031*
Non 7 87.5 1 12.5 8
Clinical
How do you take consent While examining the

in victim of rape, informed Total P Value
(a) Proper Format Question No. consent should be
Question No. (b) Plane Paper Total P Value
19-A taken or not?
15 (c) Approved
Printed Format
Yes % No %
Incorrect
Correct
% %
Age <35 11 78.6 3 21.4 14
[years] 0.56
Age <35 6 42.9 8 57 14 >35 13 86.7 2 13.3 15
[years] 0.039*
>35 12 80.0 3 20 15 F 14 87.5 2 12.5 16
Sex 0.45
F 10 62.5 6 38 16 M 10 76.9 3 23.1 13
Sex 0.63
M 7 53.8 6 46 13 Clinical 18 85.7 3 14.3 21
Specialty 0.49
Clinical 11 52.4 10 48 21 Non 6 75.0 2 25.0 8
Specialty 0.26 Clinical
Non 6 75.0 2 25 8
Clinical
Do you think format Total P Value While examining the

for all treatment is same Accused of rape, informed Total P Value
Question No. or different Question No. consent should be
16 19-B taken or not?
Incorrect
Correct
% % Yes % No %
Age <35 10 71.4 4 28.6 14 Age <35 8 57.1 6 42.9 14

[years] 0.31 [years] 0.59
>35 13 86.7 2 13.3 15 >35 10 66.7 5 33.3 15
F 13 81.3 3 18.8 16 F 10 62.5 6 37.3 16
Sex 0.72 Sex 0.96
M 10 76.9 3 23.1 13 M 8 61.5 5 38.5 13
Specialty 0.17 Specialty 0.023*
Non 5 62.5 3 37.5 8 Non 3 37.5 5 62.5 8
Clinical Clinical
21
DISCUSSION :
While examining the
drunken person brought by Total P Value In the present KAP study, it was found that when questionnaire
Question No. police, informed consent was given to access the knowledge level of various medical
19-C should be taken or not?
practitioners (both clinical and non-clinical), of different
Yes % No % specialties, maximum number of correct answers about the
way consent is taken prior to treatment was given by doctors
Age <35 1 7.1 13 92.9 14 age more than 35 years of age on one hand. On the other hand,
[years] 0.038* it was found that proper information about the treatment
>35 6 40.0 9 60.0 15
procedure was provided by the practitioners, who are less than
F 4 25.0 12 75.0 16
Sex 0.73 35 years of age. This shows that in the present scenario doctors
M 4 30.8 9 69.2 13 of age less than 35 years, take consent by giving detailed
Clinical 4 19.0 17 81.0 21 information to the patient in their local language.
Specialty 0.91
Non 4 50.0 4 50.0 8 As per judgement passed in Samira case, it was said that
Clinical 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
While examining an insane 35 years, only 73.3 % knew about the difference between
person, informed consent Total P Value
should be taken or not? consent and informed consent. In Doctors of more than 35
Question No.
19-D years of age, 92.9 % knew the difference. Female doctors were
found to be more aware about the difference than the male
Yes % No % doctors. There was no significant difference found between the
clinicians and Non-clinicians.
Age <35 1 7.1 13 92.9 14
0.018* This shows that there is a needs to be constant training and
[years]
>35 7 46.7 8 53.3 15 education sessions for the up gradation of medico legal
F 5 31.3 11 68.8 16 knowledge among doctors of all specialties, which can save
Sex 0.97
M 4 30.8 9 69.2 13 them from any unwanted litigation.
Clinical 5 23.8 16 76.2 21 There are lot of CME and workshops, which are conducted by
Specialty 0.17 various Medico legal consultants as well as by doctors with
Non 4 50.0 4 50.0 8
Clinical 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
2/3rd of those more than 35 years of age were aware about these
workshops. This difference was found to be statistically
For the post mortem significant.
examination Total P Value
Question No. of MLC case, who has died Knowledge about the age of giving valid consent was found to
19-E in the hospital, be more among doctors of age less than 35 years as compared
consent is needed or not? to the doctors of age more than 35 years. The difference was
Yes % No % found to be statistically significant.
As per various Supreme Court judgement and MCI guidelines,
Age <35 4 28.6 10 71.4 14 it is clear that consent is not necessary in Emergency situations.
[years] 0.91
>35 4 26.7 11 73.3 15 It is important to save the life of the patient first. But as per
F 4 25.0 12 75.0 16 present study only 14.3 % of the doctors of the age less than 35
Sex 0.72 yrs and 20 % of the age more than 35 yrs gave correct answer,
M 4 30.8 9 69.2 13
which is really very low. This shows very poor knowledge
Clinical 5 23.8 16 76.2 21 among doctors about correct use of consent. None of the Non-
Specialty 0.46
Non 3 37.5 5 62.5 8 clinicians gave correct answer and only 23.8 % of the doctors
Clinical
in clinical field gave correct answers.
22
Consent through Electronic media viz Teleconferencing, clinicians are different. This is unethical and therefore more
SMS, what's app etc. is not valid as per present Supreme Court and more doctors are landing themselves in the litigation.
judgement till date. No valid literature regarding the same is Format to take consent for different treatment procedure,
available. should be different. It should cover all aspects of the treatment
The treating physician should explain to their patient and complications related to a particular procedure. Then only
themselves, about the treatment procedure as patient is under it can be held valid. 71.4 % of the doctors of age less than 35
his duty of care. If patient is not able to understand anything, years of age and 86.7 % of the doctors more than 35 years of
patient has the right to get his doubts clear from the treating age are aware of this concept.
physician. The treating physician should tell about all the In the present study only 1 clinician less than 35 years of age,
possible complication that can occur due to the procedure or had to face litigation for not taking proper informed consent.
due to the disease per se, otherwise if any untoward None of the doctor more than 35 years of age faced any such
complication arise, then the treating physician is held litigation.
negligent for the same. In the present study, only 92.9 % of the
Every medical practitioner in their undergraduate curriculum
doctors of age less than 35 years explain the procedure and
are taught about the concept of informed consent, which is
related complications to the patient themselves and only 86.7
covered under Medical Law and Ethics, with various relevant
% of the doctors of age more than 35 years does the same. It
to them, in actual practice. But in the present study, on the
should be 100 % and nothing less is acceptable.
whole only 70 – 80 % doctors are aware about how to proceed
Very few percentage of the female practitioners explain the in situations like examination of rape victim, examination of
procedure themselves to their patient as compared to the males. rape accused, examination of drunken people, examination of
When the clinicians were compared with the non- clinicians insane person and death of Medico Legal case in a hospital.
the ratio was (85.7 % vs. 100 %).
As per section 164 A of CrPc, doctor does not need to take
Taking informed consent in a proper format and in the proper consent while examining a person accused of rape, but the
manner is more important for the treating physician. While consent is mandatory while examining a victim of rape.
non-clinical doctors generally take consent before doing any
An Insane person cannot give a legal consent. The valid
survey for Research purposes. This shows lack of awareness,
consent can only be given by the immediate guardian of the
knowledge or the underutilization of the knowledge, which the
insane person.
doctors gain in their under graduation level by studying the
subjects regarding medical law. Under section 53 of CrPc, consent is not needed before
examining a drunken person brought by the police.
In our country, where the number of litigation cases are
increasing day by day, doctors are growing towards practicing Consent is not necessary from the next of kin of deceased
defensive medicine compared to preventive medicine. Doctors person involved in a MLC case. Consent is mandatory before
are always tense at the back of their mind. It is very important pathological autopsy and not before Medico legal autopsy.
for them to save their neck and practice with proper CONCLUSION :
precautions to avoid unnecessary mental and financial The present study was conducted to know the level of
harassment. Therefore proper informed consent, in the awareness, knowledge and actual practice pattern of the
language the patient understands should always be taken, informed consent among all age groups of practicing doctors
before starting treatment procedure of all the indoor patients. (both clinical and Non-clinical branches)
Ideally informed consent should be taken before any treatment It was found that none of the senior doctors have faced any
procedure. If the prognosis is poor and the hospital has limited litigation as compared to the junior doctors. This shows that the
facilities, this should be properly explained to the patient and risk of practioners facing litigation is increasing day by day.
proper informed consent in the proper format should be taken. The following points are concluded from the present study.
In the present study, it was found that only 46 % of the doctors
1. There is lack of application of the theoretical
above 35 years of age and 85.7 % of the doctors less than 35
knowledge and correlation in various situations
years practice this. This difference was found to be statistically
among practioners.
significant (p value = 0.027)
2. The consent are not being taken in a proper format,
Very few doctors in the clinical field actually practice this, on
because of the lack of knowledge and sheer
the contrary 87.5 % of the clinicians are aware about the same.
carelessness of the practitioners. So in this changing
So it is clear that knowledge and the actual practice of the
era, one need to be extra careful about all these legal
23
things, because these things can result in both mental the patient?
as well as financial harassment. Q.5 Do you know the difference between consent and
informed consent.
3. As the medical profession has come under the
(a) Yes (b) No
umbrella of Consumer Protection act, more and more
Q.6 Do you know that: any written consent taken from a
dissatisfied patients file complaints to retrieve their
patient in a proper format and manner can save you from
money. The patients are more educated and aware of
litigation.
their rights than before, so the practioners needs to be (a) Yes (b) No
more careful and legally sound. The doctor- patient Q.7 Have you attend any CME / Workshop?
relationship has undergone a sea change, and the Q.8 Do you know what is the role of ethical communities in a
patients are more of a customer/client to the doctor. medical College & Hospital?
Now a days the ethical committee plays a very important role Q.9 Who will give consent for treatment (Medical and
in an institutional setup. There is a continuous need of up Surgical): If the Patient age is:
gradation of Medico legal knowledge in the form of CMEs, (a) Below 18 Years. (b) Above 18 Years.
workshops. Medico-legal lectures in other platforms like (c) Between 12-18 Years.
specialized conferences etc. Q.10 In emergency situation do you think that consent is
necessary?
REFERENCES : (a) Yes (b) No
1. Shaha KK, Patra AP, Das S. The importance of informed Q.11 Is consent thought electronic media valid?
consent in medicine. Sch J App Med Sci. 2013; 1(5):455- (a) Email (b) What's app
63. (c) Video conferencing (d) SMS
2. Samira Kohli versus Dr Prabha Manchanda (2008) 2 ATTITUDE
Q.12 Do you explain yourself to the patient about treatment
SCC1:2008 ACJ 747: AIR 2008 SCI 385: JT 2008(1)
procedure / surgical procedure when patient is under your
SC399 (2008)1 Scale 442
duty of case before obtaining consent?
3. Shukla V, Tripathi R. Chikitsa Sthana. Ch. 13, Verse (a) Yes (b) No
no.176- 177, Part-II.2007. Charaka Samhita; p. 314. Q.13 Will you take consent from all indoor patient or selective
4. Valiathan MS. Bioethics and Ayurveda. Indian J Med patient?
Ethics. 2008; 5:29–30. Q.14 Do you take informed consent-
(a) Before any surgical procedure.
5. Nandimath OV. Consent and medical treatment: The legal
(b) In case of poor prognosis.
paradigm in India. Indian J Urol. 2009; 25:343–7.
(c) For starting in a hospital with available facilities
6. Kumar NK. Bioethics activities in India. East Mediterr (d) All indoor patients.
Health J. 2006;12:56–65. (e) All of the above.
7. Kumar N, Ravindran GD, Bhan A, Srivastava JS, Nair PRACTICE
VM. The India experience. J Acad Ethics. 2009; Q.15 How do you take consent in
6:295–303. (a) Proper Format (b) Plain Paper
(c) Approved Printed Format
KNOWLEDGE
Q.16 Do you think format for all treatment is same or different?
Q.1 How do you obtain before any treatment procedure?
Q.17 Have you come across any circumstance: When you have
(a) Verbal Consent (b) Written Consent
taken consent:
Q.2 Whether consent is taken in proper printed format or on
(a) During the procedure. (b) After the procedure.
plain paper?
Q.18 Have you faced any litigation Because of not taking proper
(a) Printed Format (b) Plain Paper
informed consent?
(c) Patient own hand written Consent
Q.19 In the under mentioned medical legal conditions informed
Q.3 Before taking consent, what information is given to the
consent should be taken or not:
patient?
(a) Examination of victim of Rape.
(a) All relevant information about ailment and treatment
(b) Examination of accused of Rape.
option.
(c) Examination of a drunken person brought by police.
(b) Significant risk Involved in procedure.
(d) Examination of an insane.
(c) All available alternative treatment option.
(e) Death in a hospital of an MLC case followed by –
(d) All of the above.
Body to be sent for post mortem examination.
Q.4 In which languages do you explain and take consent form
24
Profile of Medico Legal Cases at Netaji Subhash Chandra Bose Medical College
Jabalpur, Madhya Pradesh
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.

Dr. Ashok Najan Received: 1 March 2018
Assistant professor, Received in revised form: 2 March 2018
Department of Forensic Medicine, NSCB Medical Accepted on: 2 March 2018
College Jabalpur
Contact : 97522-12017
Email: ashoknajan@gmail.com
KEYWORDS : Medico Legal Case, Casualty, Profile
INTRODUCTION : emergency department of NSCB Medical College and

A medico-legal case is “a case of injury or illness where the Hospital Jabalpur. Documentation of age, gender, manner,
attending doctor, after eliciting history and examining the number of departments referred or from which opinion is
patient, thinks that some investigation by law enforcement sought, type of cases was confirmed from the hospital and also
agencies is essential to establish and fix responsibility for the police records. The data was collected and analyzed. The
case in accordance with the law of the land”[1]. Emergency objectives of the study was to know cause, manner and
department plays a vital role in functioning of any hospital. profiling of medico legal cases.
Ours is a tertiary care hospital providing medical care to vast OBSERVATIONS:
population in Mahakaushal region of Madhya Pradesh. A large Out of 912 cases, 301 (33%) were in the age group of 21-30
number of cases of these are medico legal cases which mandate years followed by 31-40 years (21.49%) (Table 1).
compulsory documentation after emergency
In respect to gender distribution, 694 (76.09%) were male as
treatment.Medico legal cases constitute substantial proportion
compared to 215 (23.15%) female and male to female ratio was
of workload in tertiary care hospitals. Study of profile of
3.22:1 in this study (Table 2).
medico legal cases is helpful to know the burden of medico
legal cases on different specialty departments of the hospital, to Manner of blunt injuries other than road traffic accidents, in
identify load of preventable medical emergencies and also to maximum cases i.e.153 (57.73%) is homicidal, followed by
know the crime in particular area. accidental i.e. 110 cases (42.96%) which include fall from
height, cow goring, dog bite, human bite cases. (Table 3)
MATERIAL AND METHODS :
Manner of sharp injuries in maximum cases is homicidal 18
After getting approval from IEC, present retrospective study
(69.23%) cases (Table 4)
was conducted on 912 medico-legal cases attended on OPD
basis and admitted in the month of September 2017 in the Maximum cases reported were of road traffic accidents 323
25
Table 1 : Age Wise Distribution of Medical Legal Cases

Age (yrs) 0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90
51 149 301 196 109 60 37 07 02

Number (05.59%) (16.13%) (33.00%) (21.49%) (11.95%) (06.05%) (04.05%) (0.76%) (0.21%)
Table 2 : Gender Wise Distribution of Cases Table 3 : Manner of Blunt Injuries (other than Road
Sex Males Females Traffic Accidents)
Homicidal 153 (57.73%)

Number 110 (42.96%) 02 (23.57%)
Accidental 110 (42.96%)
(35.41%) followed by fall from height 100 (10.96%) snake
bite72 (07.89%) poisoning 56 (06.14%) (Table 5). Suicidal 02 (00.75%)
Maximum medico legal cases were referred to Surgery
Table 5 : Type of Medical Legal Cases Table 4 : Manner of Sharp Injuries
Type of Case No. of Cases Homicidal 18 (69.23%)
Road Traffic Accident 323 (35.41%) Accidental 7 (26.92%)
Fall From Height 100 (10.96%) Suicidal 1 (03.84%)

Snake Bite 72 (07.89%)
Poisoning 56 (06.14%) department i.e.492 (53.94%) followed by orthopedics

257(28.17%) cases, Medicine 189 (20.72%) cases, ENT
Brought Dead 32 (03.50%)
department 68 (07.45%) cases (Table 6).
Burns 26 (02.85%)
Dog Bite 21 (02.30%) Table 6 : Opinion Sought per MLC from other Specialty
Department
Alcohol Poisoning 21 (02.30%)
Departments Referred No. of Cases
Scorpion Bite 07 (00.76%)
Surgery 492(53.94%)
Cow Goring 06 (00.65%)
Orthopedics 257(28.17%)
Hanging 05 (00.54%)
Human Bite 03 (00.33%) Medicine 189(20.72%)
Unconscious 3 (00.33%) ENT 68(07.45%)
Drowning 2 (00.22%) Ophthalmology 19(02.10%)

Electric Shock 2 (00.22%)
Pediatrics 08(00.87%)
Fire Cracker 01 (00.10%)
CMO 07 (00.76%)
Fox Bite 01 (00.10%)
Obstetrics & Gynecology 02 (00.20%)
Hot Oil Burns 01 (00.10%)
Dentistry 01 (00.10%)
Injection Cellulitis 01 (00.10%)
26
In 736 (80.70%) cases CMO sought opinion from one Orthopedics and Medicine department which is consistent
department and in 146 (16.00%) cases they sought opinion with workload of these departments in other studies[2].
from more than one department. (Table 7) Cases of sexual assault are dealt with at other civil hospitals in
Table 7 : Opinion Sought Departments Jabalpur and not at our medical college.
CONCLUSION:
Number of Departments No. of Cases
Most commonly males in young age group are involved in
One 736 (80.70%) medico legal cases. Most common injury involved in these
cases is blunt injury. Excluding road traffic accidents most
More than one 146 (16.00%) commonly blunt injuries are homicidal in nature. In cases of
sharp injuries manner of production is commonly homicidal in
DISCUSSION: nature.
In our study most common age group involved in Medico-legal Cases of road traffic accidents are most common cause of
cases was 21-30 years as this age group is socially and medico legal cases.
occupationally involved in outdoor activities. This outdoor Most commonly medico legal cases were handled by Surgery
activity and active life style make this age group more and Orthopedics departments Opinion of single department is
vulnerable to such hazards. This finding is similar to findings most commonly sought by CMO's.
of the studies done by Garg V and Verma S K[2], Salgado MS
Conflict of interest: None
and Colombage SM[3], Sahdev P and Lacqua MJ[4], and Singh B
and Dogra[5]. Source of funding: Self
Male to female ratio was 3.22:1 which is not consistent with REFERENCES :
finding of the study done by Garg V and Verma S. K[2]. 1. Dogra TD, Rudra A. Lyon's Medical Jurisprudence &
Most common medico legal cases were RTA followed by fall Toxicology. 11th Ed. Delhi Law House. 2005:367.
from height, snake bite.This finding is consistent with findings 2. Garg V, Verma S.K. Profile of Medico-legal Cases at
of other studies [2,6,7]. This could be due to the fact that Jabalpur Adesh Institute of Medical Sciences and Research,
is a divisional headquarters and daily a large population is Bathinda, Punjab J Indian Acad Forensic Med, 2010.
moving towards and away from Jabalpur with heavy traffic. 32(2); 150-52.
Most of the surrounding districts of Jabalpur are agriculturally 3. Salgado MSL, Colombage SM. Analysis of fatalities
highly active which expose the population to insecticidal in road accidents. Forensic Sci Int. 1998; 36: 91-96.
poisons and snake bites. Besides cases of burns, dog bite, and
4. Sahdev P, Lacqua MJ, Singh B, Dogra TD. Road
alcohol poisonings are also common.
Traffic fatalities in Delhi: causes, injury patterns and
In our study blunt injuries were observed n 595 (65.24%) case incidence of preventable deaths. Accidental Ann
Similar finding differs from study done by Arif M, Rasool SH, Prev. 1994; 26: 377-84.
Ali SMH[7] who observed that almost two third of the victims
5. Friedman Z, Kungel C, Hiss J, Marganit B, Stein M,
suffered from blunt injuries (64.77%). Blunt injuries other than
Shapira S. The Abbreviated injury scale – a valuable
road traffic accident were observed in 272 (29.82%) cases.
tool for forensic documentation of trauma. Am J
Manner of blunt injuries other than road traffic accidents, in
Forensic Med Pathol. 1996;17(3):233-8
maximum cases i.e. 110 (42.96%) is accidental (Table 3),
which include fall from height, cow goring, dog bite, human 6. Malhotra S., Gupta R.S. A study of the workload of
bite etc. the casualty department of a large city hospital.
Health and Population - Perspectives & Issues.
Sharp injuries were found in 27 (02.96%) cases in which
1992.15(l&2); 68-76.
predominant manner of death was homicidal i.e.18 cases
(69.23%)(Table 4). Our findings differ from those of study 7. Mahajan A, Dhillon S, Sekhon H. Profile of Medico
done by Arif M, Rasool SH, Ali SMH[7] who observed sharp Legal Cases in Shimla (June 2008- December 2008).
weapon injuries in 8.8% cases. Medico-Legal Update, 2011. 11 (2); 64- 66.
Single department opinions were most commonly sought but 8. Arif M, Rasool SH, Ali SMH. Profile of medicolegal
more than one department opinions were also sought. cases; accident & emergency department of services
hospital, Lahore. Professional Med J.
Maximum opinions were sought from Surgery followed by
2017;24(3):366-369.
27
Gaps in Nursing Training on Biomedical Waste Management and Handling:
Situational analysis at a Tertiary Care Public Hospital
1. Ravinder Nath Bansal, Deputy Medical Superintendent, GGS Medical College Hospital, Faridkot.
2. Sonu Gupta, Lecturer, Dashmesh Institute of Research and Dental Sciences, Faridkot.
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.

Dr Sonu Gupta Received: 29 April 2018
Lecturer, Received in revised form: 19 June 2018
Accepted on: 19 June 2018
Dashmesh Institute and Research Dental Sciences, Faridkot. Available online: 1 July 2018
Contact : +91 92176-66699
Email : sonu@drbansal.in
KEYWORDS : Hospital, Healthcare, Medical College, Public Sector, Bio-Medical Waste training
INTRODUCTION: defines the colour coding and end point requirements from the
Growing health care industry has been seeing parallel growth HCO's; it becomes imperative for the organizations to define
of generated bio-medical waste which requires scientific their systems, processes, responsibility assignments and
approach for its management. Many studies have been done on monitoring systems. B M W M H have left it for the
Bio-Medical Waste (BMW) management in the past assessing organization to educate and endow adequate training to their
and describing knowledge, attitude and practices at various employees and staff generating and handling Bio-Medical
Health Care Organisations (HCO). Hospitals have been Waste (BMW). BMWMH training is a part of nursing study
working hard to maintain standards for biomedical waste curriculum[5], additionally nursing students are required to
management as notified by Government of India[1]. Studies attend their clinical postings on regular basis. Post
have reported that potential infectious waste to be segregated employment in-service training must include two components;
as BMW is approximately 340 gm to 2 kg per bed[2]. Typically one to inform about BMWMH rules with respective
inpatient general wards at medical colleges with 30 beds are organization policies and second to provide conceptual clarity.
likely to generate 9-15 kg of bio-medical waste, which when While earlier studies were focused on knowledge, attitude and
divided into 3 shifts shall translate into 3-5 kg of BMW to be practices at various organizations, current study focuses to
segregated in each shift. This again gets divided among doctors identify reasons for possible lapses in BMWMH.
and nurses on duty at a particular time. Successful OBJECTIVES:
implementation of Bio-Medical Waste (Management and This study was conducted to assess the differences in
Handling) Rules (B M W M H)[3-4] requires sincere conceptual clarity on BMWMH among diploma and graduate
implementation efforts in terms of training, administrative nurse and identify areas requiring management focus.
focus and uniformity across organizations. While BMWMH
28
MATERIALS AND METHODS: BMWHM rules and 74% nurses assessed their confidence
For the purpose of study GGS Medical College, Faridkot, levels to be more than 50% (Table 3).
Punjab (a tertiary care public sector) was selected by choice Table 1: Time When Last Trained/Orientation Session
being easily accessible to the researchers. This institute was Delivered
established more than 35 years ago and currently has an Training in BMW n %age
average OPD of more than 1800 patients per day with more
Never 39 16.25
than 36000 admissions per year supported by 700 plus beds
and being manned by 1000 plus personnel including more than < 1 year 108 45.00
280 nurses. Government Medical College was chosen
> 1 year ago 75 31.25
expecting higher awareness levels being teaching institution.
Following NULL hypothesis was formed H01: that is there is No response 18 7.50
no significant difference in knowledge and awareness levels Total 240
between diploma holder and graduate nurses.
STUDY INSTRUMENT: Table 2 : Training Session Delivery Trends
Based on the previous studies, available guidelines and Trainer N %age
applicable rules, a structured questionnaire was formed.
Questionnaire was got validated out and pilot study was Administrator 90 37.5
conducted. Consent was obtained from the college. BMW Coordinator 18 7.5
Questionnaire consisted of two parts namely: respondent's
Faculty/Doctor/HOD 18 7.5
demographic profile and awareness on BMWMH rules.
Questionnaire was specifically framed to assess the clarity on Infection Control Nurse 30 12.5
basic concepts behind the BMWMH. No Response 42 17.5
SAMPLE SIZE AND SAMPLING:
Nurse of that Area 42 17.5
All the nurses at the college were contacted and a cross
sectional study was performed. Pre-defined questionnaire was Grand Total 240
distributed to all the nurses. They were met in small groups,
Table 3 : Pre Test Confidence Levels
consent was obtained and study objectives were explained
while ensuring confidentiality of responses. Confidence GNM B.Sc N %
STATISTICAL ANALYSIS: 100% 33 3 36 15.00
After the survey responses were fed in Microsoft Excel 75% to 100% 81 60 141 58.75
software. Further assessment was done applying mean,
median, t-test using statistical package (SPSS, Ver.20). 50% to 75% 48 9 57 23.75
RESULT : < 50% 3 3 1.25

Feedback was received from 240 nurses with females being No Response 3 3 1.25
91% (n=291). Graduate nurses were 69% and the rest were
Grand Total 165 75 240
diploma (GNM) holders. It was found that almost all the
participants were in regular job and had been in the profession On comparing the self assessed confidence levels significant
for more than 1 year. No formal training was received by 16% (p=0.00) differences were found between Diploma and
of them even though they had completed nursing studies Graduate nurses with graduate nurses responding as being
including diploma and graduation course and had been in job more confident. Following this respondents filled the
for more than 1 year. Only 45% of the nurses had received questionnaire and the last question asked the respondents to
training session within last one year (Table 1). specify if, they felt that they required further training on
Nurses trained by nursing incharges were 30% and by BMWMH (Table 4).
administrators 37% (Table 2). Paired t-test was run to identify if, there were significant
Before starting filling specific questions, respondents were differences in confidence levels before the start of test and felt
asked for self assessment (the first question of the training needs after the test. It was found that there was
questionnaire) of their confidence on knowledge about the significant differences with p=0.000.
29
Respondents were asked as to why BMW management, Table 6 : Variation in knowledge on handling and treatment
segregation and proper disposal was required, with expected of BMW by CBMWTF
answer as to prevent cross infection through reuse of items Correct Response P p<0.05*
(Table 5). Diploma Graduate Value Nurse Nurse
Nurse Nurse GNM B.Sc.
Table 4 : Post Test Self Assessment of Need for Further n=165 n=75
A What are modes of disinfection used by outsourced contractors?
Incineration 48 45 .000 *
Felt Training GNM BSC G. Total %
Need Autoclaving 63 27 .747
Shredding 33 24 .043 *
Chemical 72 36 .531
Strongly Agreed 60 42 102 42.50 Disinfection
Burial 57 27 .828
Mutilation 24 3 .003 *
Partly Agreed 48 24 72 30.00 B What is done to waste is yellow bags by outsourced agency?
Incinerated 72 63 .000 *
Not Agreed/ Autoclaved 0 3 .010 *
12 6 18 7.50 Crushed and 15 0 .000 *
Not Required
Autoclaved
Disinfected with *
72 12 .000
No Response 45 3 48 20.00 Hypochlorite
and then buried
C What is done to waste is Blue bags by outsourced agency?
Grand Total 165 75 240 Incineration 30 9 .202
Autoclaved 21 15 .175
Chemical 60 27 .957
Table 5 : Cross Infection Through Reuse of Items Disinfection
Deep Burial 33 9 .104
Shredding 18 12 .302
GNM B.Sc Total *
Mutilation 0 6 .013
Yes 120 39 159 D What is done to sharps by outsourced agency?
Incineration 30 21 .106
No Response 45 36 81 Autoclaved 3 6 .066 *
Chemical 54 30 .275
and significant differences were found between the response Disinfection
Deep burial
by diploma and graduate nurses with p=0.003. 33 12 .464
Shredding 27 15 .494
Independent t-test was applied to test the differences in 9 0 .002 *
Mutilation
perception on mentioned items being bio-medical waste or not
Results are based on two-sided tests assuming equal variances with
between graduate and diploma holder nurses. Significant significance level .05.
differences were found in response for following items: Group with the higher correct scores has been '*' marked.
syringe wrappers and consumables (p=0.003), vegetarian food
(p=0.000), non-veg food waste (p=0.028), paper (p=0.000), nurses fared better.
removed plasters (p=0.014) and amputated body parts Subsequent section pertained to BMW handling and
(p=0.01). No significant difference was found for item 'expired segregation in clinical areas: tasks which nurses are expected
medicines and tablets' (p=0.175) with graduate nurses with to be performing on day to day basis. Significant differences
higher correct responses. were found for items pertaining to awareness on rules and
Generated BMW is picked up from the hospital by Common policy applicable between diploma and graduate nurses.
Bio-Medical Waste Treatment Facilities (CBMWTF). Graduate nurses had overall higher scores. Tests performed
Segregation of BMW is linked to treatment options being were adjusted for all pair wise comparisons within individual
exercised by the CBMWTF. Questions were asked to variable.
respondents to assess their awareness on treatment being given DISCUSSION: With 61% of the nurses having not received
by CBMWTF. Significant differences in responses were any training/reorientation session in the last 1 year, Medical
observed for between diploma and graduate nurses (Table 6). College needs to focus more on implementation of BMWMH.
Tests were adjusted for all pair wise comparisons with in In a similar study at another Government Medical College of
individual variable using Bonferroni correction and graduate the same state, 50.2% staff had received training in the last one
30
year[6] while the national average among tertiary care hospitals then errors in the form of non-compliances are bound to
has been reported at 66.7%[1]. As shown in Table 2 structured happen. The question that arises is how can there be variation
training programs were found to be lacking with some of the in practice within the same organization? This variation needs
nurses being trained by nurse trainers, some by faculty and rest to be dealt with by the HCO's to bring down their errors which
trained by administrators. There seemed to be no uniformity in can result into non-compliances. Further structured induction
training/trainers pattern. It is possible that different program is one solution should be mandatory in HCO's to
instructors/trainers have different teaching content: leading to bring down variation rates within the organization.
difference in opinions/perceptions among nurses. Training CONCLUSION: Organizations need to define their standard
programs had no fixed timing and schedule. On discussion operating procedures for BMWMH. While the required
with the hospital head it was found that there was no defined outcomes in terms of color coding have been defined under
BMW coordinator, train the trainer program and thus no BMWMH for ensuring uniformity in terms of colour coding of
uniformity in trainings. Felt training need were found to be bags and collection bins, what needs to be addressed is the
significantly more than the pretest confidence levels. uniformity in implementation and forming Standard Operating
Questionnaire was designed specifically to assess the Procedures (SOP's). Organizations need to define their
conceptual clarity. Post test nurses realized that there is lot training teams, train their trainers and empowering trainers
more for them to know and be aware of. This possible gap is with sufficient material for information and educating staff
likely to be due to deficient training programs which possibly members on regular basis and through induction program.
cover only portion of BMWMH and training being provided Difference in SOP's and implementation plans among various
on need to know basis only instead of comprehensive training. organizations may lead to confusion to employees switching
Lack of clarity on overall picture limits the staff's decision their jobs and students moving to another institution,
making ability which can result in lapses.Significant difference especially when subsequently joined organizations do not
was found in confidence levels of diploma and graduate nurses conduct induction sessions. Medical college may be taking the
with graduate nurses having higher confidence levels. This implementation of BMWMH heedlessly by being inadequate
difference can be attributed either to higher education status, in forming SOP's, structured training, implementation and
better curriculum of graduate course or better faculty of higher review programs. Scenario is likely to be same in other similar
education institutes. Pre test nurses assessed their awareness institutions. Organizations not having structured training
levels at higher levels which could be based on their teams and programs are likely to have non-compliances which
assumption on knowledge of limited tasks which they have can be measured either by organizational audit or by assessing
been performing on day to day basis and post test they felt that the staff awareness levels. Training program should not be
more information and training was required. Such difference limited to awareness on ward level functions but must be
was found to be statistically highly significant (p=0.000) using comprehensive covering all aspects to improve nurse's
paired T-test. Gaps identified require to be bridged by decision making skills. Success lies in imparting training while
comprehensive training programs. Studies have shown medicos and paramedics are still students. Conceptual clarity
significant increase in awareness in the hospital setup after can help staff and students understand with reasoning thus
training[7]. providing better knowledge, ability to correlate the rules and
With respect to tasks being performed by CBMWTF graduate act with organization policies and enabling them to take
nurses fared better and there were significant difference in the informed decision in all situations.
knowledge levels. With little training programs at the current Acknowledgement: We express our gratitude and thanks
work place (which shall be same for diploma and graduate towards all who have directly or indirectly helped us to
nurses), such difference can be attributed to their nursing complete this study and to the participating respondents.
education curriculum. Items with significant differences
Limitations of the Study: 1. Individual bias of the
highlight and specify the portion of training program which
respondents. 2. Study being conducted at a single institution.
need to be covered better. Nursing curriculum has been found
to include teaching on BMWMH[5]. Gaps in the training and Conflict of interest: There is no conflict of interest.
education programs as identified in the studies includes REFERENCES:
training on management by CMBTF, colour coding for 1. INCLEN Program Evaluation Network (IPEN)
segregation for uncommon items, logic behind color coding. study group. Bio-medical waste management:
While it has been discussed above that there were significant situational analysis & predictors of performances in
differences in diploma and graduate nurses. Yet it needs to be 25 districts across 20 Indian States. Indian J Med Res
noted that even if one of staff members has a different thought
31
2 0 1 4 ; 1 3 9 ( 1 ) : 1 4 1 - 5 3 . Av a i l a b l e a t :
h t t p : / / w w w. n c b i . n l m . n i h . g o v / p m c / a r t i c l e s
/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): D C 01-3.
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 M L, Oberoi S, Singh A.
Biomedical waste management at tertiary level
hospital–Rajindra Hospital [Government Medical
College], Patiala-A situational analysis. Int J Med
Res Rev 2016;4(11):2054-8.
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
A Study of Completed Suicide Among Women in the Reproductive Age Group From
Coastal Karnataka
1. 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.

Dr. Prashantha Bhagavath, Received: 2 April 2016
Received in revised form: 30 April 2016
Forensic Advisor, Accepted on: 16 May 2016
International Committee of the Red Cross, New Delhi Available online: 1 July 2018
Contact : +91 94486-24014
Email : dr_bhagvath@yahoo.com
KEYWORDS : Suicide, Women, Reproductive age group, South India
INTRODUCTION : Germany, France and Ukraine)[2]. More than one hundred

Suicide not only affects the single individual who takes his life, thousand people (1,25,017) in India lost their lives by
but also his/her immediate circle community at large. It may be committing suicide during the year 2008 with an overall
anticipated that everyone during the “intolerable moments” in suicide rate of being 10.8 per 100,000 population[3]. Karnataka
his or her life will succumb to the idea to put an end to it all. In state in South India had a suicide rate of 21.2/100000 which is
fact suicidal thoughts, threats and attempted suicide are a nearly double the national average for the year 2008[3]. These
common human phenomena [1] . Given the size of the statistics reveal that suicide is a major problem faced not just
population, almost 30% of all cases of fatal deliberate self- by the developed world but even the developing countries.The
harm worldwide are seen in China and India. The number of causes and methods of suicides vary greatly between males
incidents of fatal deliberate self-harm in India is comparable to and females[4]. Though in absolute numbers more men commit
those put together in the four European countries with the suicide than women, there are various complexities associated
highest number of fatal deliberate self-harm incidents (Russia, with female suicides. Self-inflicted injuries accounts for 6-7%
33
of all the deaths worldwide in females in the age group between The youngest victim was 11 years old and the oldest victim was
fifteen and forty-four years[5-6]. It has been observed that 48 years. The motive behind the suicides are shown in Table
economic and social influences and factors have led most No. 2.
Indian males to commit suicide. The situation is different Table No. 2 : Motive for Suicide
among women. Emotional and personal causes have been the
main contributors to incidents of fatal deliberate self-harm in Motive Number (n=44)
Indian women[3]. Women specific factors include societal Motive unascertainable 11 (25%)
influences; marital status and stressors associated with it, Heath related issues 16 (36%)
failed relationships, socio-economic inequality are just a few Relationship related issues 8 (18%)
of the factors that influence suicidal behaviour in women[7].The Depression/Frustration 6 (14%)
proportion of female victims by 2008 in India was Academic 2 (5%)
comparatively more under the heads 'Dowry Dispute' (98.1%), Unemployment 1 (2%)
'Illegitimate Pregnancy' (91.6%), 'Physical Abuse (Rape,
Incest etc.)' (72.8%), 'Barrenness/Impotence (Not having In 11 cases (25%) the motive was either not mentioned or could
children)' (65.5%), 'Divorce' (62.2%),'Cancellation/Non- not be ascertained. Out of the remaining 33 victims, the most
settlement of marriage' (53.5%) and 'Suspected/Illicit common reason for committing suicide was health related
Relations' (50.8%). The present research was undertaken to issues as reported in 16 victims (36%). In two victims the
study the factors affecting completed suicides among the health related issue was specific to uterine pain. In one case, it
women in the reproductive age group from a coastal region of was stated that the victim could not cope with the health
South India. problems of her husband. The next most common motive for
MATERIALS AND METHODS : committing suicide was relationship related issues among
The material for the study comprised of cases involving eight victims (18%). For relationship related issues, three
women in the reproductive age group (from onset of victims cited reasons of loneliness due to the loss of/ being
menarche till menopause) who died as a result of fatal away from a loved one. Three victims were involved in failed
deliberate self-harm and whose autopsies were performed at romantic relationships; while one victim cited family discord
the mortuary of the Department of Forensic Medicine, and the other marital discord as the motives behind the suicide.
Kasturba Medical College, Manipal during January 2010 and Six victims (14%) committed suicide due to either
September 2011. The confirmation of the reproductive age frustration/depression. The underlying reason for the
group was based on correlation of age and histological features frustration/depression was not mentioned/ could not be
of the uterus in the reproductive age group. Women outside the ascertained. For two victims (5%), the suicide was a result of
reproductive age group, and cases wherein the manner of death academic failure and one victim (2%) committed suicide as a
was in doubt were excluded from the study. Data regarding age result of being unemployed and unable to find work.
of the victim, date of suicidal attempt, method adopted to Among the methods of fatal deliberate self-harm adopted by
commit suicide, place of occurrence, whether hospitalized or the victims, poisoning was the most common, seen in 28 of the
not, the date of death and survival period were collected from victims (64%) as shown in Table 3.
the information furnished by the Karnataka State Police and
Table No. 3 : Methods Adopted by the Victim
the hospital records of Kasturba Hospital, Manipal.
Method adopted Number (Total n = 44)
RESULTS :
Poison consumption 28 (64%)
During the study period, a total of 44 women who were in the
reproductive age group as confirmed from histological Hanging 10 (23%)
examination of the uterus were included in the study. Thirty- Self-immolation 4 (9%)
one of the victims (70%) were adults over the age group of 19 Run over by a train 1 (2%)
years and 13 of the victims (30%) were adolescents (Table Fall from height 1 (2%)
No.1).
The next most common method adopted was hanging in10
Table No. 1: Age Distribution of the Study Group
victims (23%). Four of the victims (9%) died due to self-
11-19 years 20-48 years Total (n=44) immolation. One victim (2%) resorted to being run over by a
train while in another (2%) the method was fall from height.
13 (30%) 31 (70%) 44 (100%) In 41 cases (93%) the place of occurrence of the incident was
34
indoors while in three cases (7%) it was outdoors. Thirty of the by the above-mentioned workers wherein the health related
victims (68%) were hospitalized while the other 14 (42%) issues dominated followed by relationship related issues,
were not. Of the hospitalized patients, 25 of the admitted cases frustration/depression, academic failure and unemployment.
(83%) were after consumption of poison, hanging accounted This lower incidence of depression, a well-documented and
for three (10%) and the self-immolation for two cases (7%). researched risk factor for destructive self-harm worldwide has
Information regarding time interval between suicide attempt been previously documented in poisoning self-destructive
and death i.e. the survival period could only be ascertained for mortalities in the region [ 2 1 ] . In India, studies using
admitted cases. Among the cases admitted after poison psychological autopsies have reported that suicide is related to
consumption the minimum period of survival was a couple of interpersonal conflicts, marital discord, alcoholism, financial
hours and the maximum period of survival was 17 days. In the problems and unemployment[22]. A study undertaken in
three hospitalized hanging cases, one victim survived for a Singapore also ascertained that illness (51%) was the
couple of hours and another survived for five days. Among the predominant factor associated with suicide[23]. However the
two cases admitted for burn injuries following self- study included both physical and mental illness as a single
immolation, the period of survival was five days and eight entity.With regards to the suicide with unemployment as the
days, respectively. motive, suicide rates are high in people without gainful
DISCUSSION : employment.The reasons for this relationship are however
complex[12]. As previously mentioned, high rates of suicide are
The main gender difference seen in suicidal behavior
associated with mental illness. Mental illness can thus be seen
worldwide, is that the rate of completed suicides in women are
as a common factor of both unemployment and suicide[24].
lower than men, the exception being China[9].The same is true
in India as well. However the reported sex ratio of 4:5.8 in Among the methods of fatal deliberate self-harm adopted by
India is low when compared internationally[10,11]. The reasons the victims, poisoning was the most common, followed by
for this seem to be diverse[10,12]. The higher suicide rate in the hanging, self-immolation etc. This is in agreement with the
male gender has been stated, as being due to the more rigorous study done by Banerjee et al which stated that poisoning with
subjection of men variations and stressors of daily living and insecticides was the most common mode of suicide among
life when compared to females[13,14]. Suicide is best studied and Indian women[25]. This also in accordance of the fact that as a
researched as a multi-factorial event, with biological, generalization, men may be said to have a tendency to choose
relationship, psychological, social and cultural factors, to more violent means of self-destruction (such as shooting).
name just a few[10,15,16]. Women on the other hand may be seen to prefer less violent
methods to end their lives (such as poisoning)[26]. It has been
According to an earlier analysis of the National Crime Records
observed that in the less developed and agricultural hinterland
Bureau, fatal deliberate self-harm is among the top ten causes
of many developing countries, intake of pesticides is the
of death in India. Fatal deliberate self-harm is also among the
method of choice for self-destruction. This may be due to the
top three causes of death in India between the ages of sixteen
perceived advantages of easy availability, enhanced toxicity
and thirty-five[17]. It can therefore be deduced from the present
and poor storage[27]. As many as thirty percent of global self-
study that people in the early stages of their lives are more
destruction deaths might involve intake of pesticides[27]. In
predisposed to getting affected by the turmoil of life. They
concurrence of our findings, females of Geneva, Brazil and
then unfortunately opt for self-harm over trivial issues.
Israel adopted common methods like poisoning and fall from
It is known that the mortality risk for fatal deliberate self-harm height for committing suicide[28-30]. It has been observed in the
associated with a psychiatric illness such as depression is many Southern Part of India and in countries like Pakistan, Japan,
times the risk faced by the general population[18]. The WHO Austria and England that the commonest method used by
suicide statistics suggest that mental disorders (depression and females for committing suicide was by hanging[31-35]. Chao et al,
substance abuse) are associated with more than ninety percent in their study on changing trends of suicide by poisons in
of all cases of suicide. Also psychological autopsy approach to Singapore, points out that until the early sixties, corrosive
death investigation has revealed that psychiatric disorders are acids and alkali, inorganic chemicals, heavy metals and plant
present in about ninety percent of people who are victims of alkaloids were the mainstay of poisons principally used[36]. The
fatal deliberate self-harm. These people also contribute seventies and eighties witnessed a swing towards
between forty-seven to seventy-four percent of the population pharmaceutical products. The early nineties saw a peak of
at risk of suicide[19]. So also a study in Wolverhampton alcohol, insecticides such as malathion, paraquat and
ascertained a positive psychiatric history in 64.5% cases of household items such as detergents, and antiseptics[36].
suicide[20]. Our findings are in contrast to the findings observed According to the study conducted by Bhatia et al and Agarwal
35
et.al, the common methods used in suicide include drowning, 9. Philips MR, Liu H, Zhang Y. Suicide and social change
hanging, poisoning and burning [37-38] . Methods of self- in China. Cult Med Psychiatry 1999; 23(1):25-50.
destruction and self-harm can be said to echo the availability of 10. World Health Organisation. World report on violence
these methods. Pattern of self-destruction in the vicinity and health. Geneva: WHO; 2002.
depends upon a multitude of factors and their interplay. These
11. Girdhar S, Leenaars AA, Dogra TD, Leenaars L,
include obtainability and access of the method, the socio-
Kumar G. Suicide notes in India: what do they tell us?
economic status and also not to forget the prevailing socio-
Arch Suicide Res 2004; 8:179-85.
religious influences. Knowing the pattern of suicide in an area
not only helps in early management of such cases but also 12. Hawton K, Van Heeringen K. The international
allows taking early preventive measures[39]. Forty one out of handbook of suicide and attempted suicide. Chichester:
forty four females preferred to commit suicide inside the four Wiley; 2000.
walls of the house. This high incidence at home can be 13. Stack S. Suicide: a 15 year review of the sociological
attributed to the preference of the victims for a familiar home literature. Part II: modernization and social integration
environment. This is in agreement with a study reported from perspectives. Suicide Life Threat Behav 2000; 24:
Southern India[33]. 362–74.
It is necessary for the death investigators to be knowledgeable 14. Girard C. Age, gender and suicide: a cross national
of the many scenarios, stressor and risk factors, methods, analysis. Am Sociol Rev 1993; 58: 553–74.
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16. Leenaars A. Psychotherapy with suicidal people.
health not responding to treatment, as a possible manifestation
Chichester: Wiley; 2004.
of underlying psychiatric disease. Left untreated or
misdiagnosed, many women may be committing suicide for 17. Vyas JN, Ahuja N. Text book of Postgraduate
manageable psychiatric conditions. Psychiatry. New Delhi: Jaypee Brothers Medical
Publishers; 1999.p.527-550.
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Cambridge: University Press; 1990.p.1-20.
19. Cavanagh JTO, Carson AJ, Sharpe M, Lawrie SM.
2. Bertolote JM, Fleischmann A. A global perspective in
Psychological autopsy studies of suicide: a systematic
the epidemiology of suicide. Suicidologi 2002; 7(2): 6-
review. Psychol Med 2003; 33: 395–405.
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20. Scott KW Suicide of Wolverhampton (1976-1990).
3. National crime records bureau. Accidental deaths and
Med Sci Law 1994; 34 (2), 99-105.
suicides in India: ADSI. 2008. Available from:
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mortalities in Southern India: gender differences. J
Sept30].
Forensic Legal Med 2008; 15 :7–14.
4. Kanchan T, Menon A, Menezes RG. Methods of choice
22. Gururaj G, Isaac MK, Subbakrishna DK, Ranjani R.
in completed suicides: gender differences and review
Risk factors for completed suicides: a case–control
of literature. J Forensic Sci. 2009;54:938-42.
study from Bangalore, India. Inj Control Saf Promot
5. World Health Organisation. Facts and Figures about 2004; 11:183–91.
suicides. Geneva: WHO; 1999.
23. Peng KL, Choo AS. Suicide in Singapore, 1986. Aust
6. Monk M. Epidemiology of suicide. Epidemiol Rev NZ J Psychiatry 1992; 26 (4): 599-608.
1987; 9:51-69. 11.
24. B l a k e l y TA , C o l l i n g s S C D , A t k i n s o n J .
7. Roy A. Suicide. Baltimore: Williams & Wilkins; Unemployment and suicide: evidence for a causal
1986.p.17-40. association? J Epidemiol Community Health 2003; 57:
8. Young people's health: a challenge for society. Report 594–600.
of a Study Group on Young People and Health for All 25. Banerjee G, Nandi DN, Nandi S, Sarkar S, Boral GC,
by the Year 2000, Technical Report Series. Geneva: Ghash A. The vulnerability of Indian women to suicide:
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26. Denning DG, Conwell Y, King D, Cox C. Method

choice, intent, and gender in completed suicide.
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27. Gunnell D, Eddleston M, Phillips MR, Konradsen F.
The global distribution of fatal pesticide self-
poisoning: systematic review. BMC Public Health
2007; 7: 357.
28. La Harpe R. Suicide in the Geneva canton (1971-1990).
An analysis of the forensic medicine autopsy sample.
Arch Kriminol 1995; 195(3-4): 65-74.
29. Leon ML, Barros MB. Suicide mortality: gender and
socio-economic differences. Rev Sande Publica 2003;
37 (3), 357-63.
30. Nachman R, Yanai O, Goldin L, Swartz M, Barak Y,
Hiss J. Suicide in Israel: 1985-1997. J Psychiatry Neuro
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31. Saeed A, Bashir MZ, Khan D, Iqbal J, Raja KS,
Rehmon A. Epidemiology of suicide in Faisalabad. J
Ayub Med Coll Abbottabad 2002; 14 (4):34-7.
32. Yamamoto Y, Yamada M, Fukunaga T, Tatsuno V.
Statistical studies on suicides in Shiga Prefecture
during the 15-year period, 1974 to 1988. Nippon
Hoigaku Zasshi 1990; 44 (2), 190-8.
33. Namboodiri VMD.Conscise Text book of Psychiatry.
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35. Cooper PN, Milroy CM. Violent suicide in South
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39. Kumar A, Krishan Vij. Trends of poisoning in
Chandigarh - A six year autopsy study. Journal of
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)
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 H2O2. followed by rinsing in water, drying in shade followed by
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.

Dr. Parmod Goyal, Received: 7 March 2018
Professor & Head, Forensic Medicine Received in revised form : 8 June 2018
Adesh Institute of Medical Sciences & Research, Bathinda Available online: 1 July 2018
(Punjab)
Contact No. : 98760-05211
E-mail : drparmodgoyal@gmail.com
KEYWORDS : Extraction, Cleaning, Bones, Burial, Buried bodies
INTRODUCTION : students , ENT surgeons and oral and maxillofacial surgeons.

The human bones are an integral tool in the study of anatomy. If a first year mbbs student has dry bones in his hostel room, it
Bones are necessary not only for teaching anatomy but also help in better understanding of anatomical structures
provide three dimensional instructions in osteology as well as especially of limbs and head and neck.
understanding the sites of soft tissue insertion and the course of The insufficient number of dry bones is due to absence of any
neurovascular structures in a region. Knowledge of bones also guidelines for extraction of bones from cadavers. Bones
required for planning of various surgeries and assessing the require soft tissue removal, bleaching and colouring before
efficacy of orthopaedic devices [1-2]. being used for teaching purpose. Various methods mentioned
In the absence of original human bones, artificial bones made in literature for bone cleaning are boiling, maceration, use of
of plaster of paris or glass fibre or plastic replica are used in enzymes, insect and burial excavation etc[4-11]. We have used the
many health care institutions, which do not provide the actual burial excavation method. In our institute authors had
picture especially of bone ridges/elevations/tubercles etc but at conducted a previous study[2] and found use of hydrogen
the same time too much costly[1-2]. The source of original peroxide as a useful tool for cleaning of bones. But over a
human bones is human bodies only. With the efforts of many period of time, authors felt that although cleaning of bones
Non Governmental Organisations (NGO’s) and inclusion of with hydrogen peroxide is a good method but many times
voluntary body donation clause in the Anatomy acts, especially in long bones and skull, small tag of soft tissue
successful Body donations programmes are running in many remain intact and over times some part of bones become
medical institutions of the country. As a result many medical brittle.So we experimented with an alternative method of bone
institutions are receiving even excess of cadavers[3]. But it has cleaning. Although present method is lengthy, more time
been seen that even in such medical instituitions, sufficient consuming and required comparatively more hard work but the
number of dry bones are not available for studying, for First ultimate recovered bones were more clean, completely devoid
Year MBBS students, orthopedics faculty, post graduate of soft tissues, more appealing to the eyes and nice to touch.
38
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) 3 4
for the enhancement in the learning of anatomy especially for
first professional MBBS students[12]. 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 5 6
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:
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 7
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 8

colouring (Fig 8,9,10)
1 2 9 10
39
RESULT : 7. Motz VA ,Garner , Schultz B. Defleshing of Embalmed

The bones obtained after this procedure were clean, intact and Human Cadaveric Bone in situ. Available from http:/
their quality was better compared with the bones extracted /www.lifescitrc.org/resource.cfm? submissionID =2230
with previous technique. Application of wood primer resulted (last accessed on 20 April 2018).
in consumption of less amount of wood paint so the cost 8. Sullivan LM, Romney CP. Cleaning and Preserving
involved in cleaning got reduced. Animal Skulls. The University of Arizona-A Cooperative
LIMITATIONS : E x t e n s i o n . Av a i l a b l e f r o m h t t p : / /
extension.arizona.edu/sites/extension.arizona.edu/
Since the wood primer was of white colour, Resultant bones
files/pubs/az1144.pdf (last accessed on 20 April 2018).
seem to be of white colour. Next time we shall try to procure
transparent wood primer. 9. Fenton TW, Birkby WH, Cornelison J. A fast and safe
non-bleaching method for skeletal preparation. J Forensic
CONCLUSION :
Sci.2003;48:274-6.
Although the procedure may appear to be labour requiring but
10. Mishra S Rj, Singh R, Shukla R, Passey J, Singh S,
it is comfortable, cost effective, ecofriendly and suitable
Sushobhana. Burial, Excavation and Chemical Cleaning -
method for obtaining the human bone specimens from the
An Economical Approach for Extraction of Human Bones
cadavers. Bones obtained looked good, strong and suitable for
from Embalmed Dissected Cadavers in India.
teaching purpose.
International Journal of Anatomy, Radiology and Surgery
ACKNOWLEDGEMENT : 2016;5(3): 14-18
l The Families and the deceased for donating the bodies for 11. Okada DM, De Sousa AM, Huertas RA, Suzuki FA.
noble contributions toward the mankind. Surgical simulator for temporal bone dissection training.
l Dera Saccha Sauda Sirsa organization and Taraksheel Braz J Otorhino laryngol. 2010;76:575–78. ( Plastic
Society, Punjab for motivating peoples regarding replica)
voluntary body donations. 12. Goyal PK, Gupta M, Kaur J.Autopsy as a tool for learning
l Management and Staff of Adesh University for their gross anatomy during 1st year MBBS. Int J Appl Basic
continuous support, guidance and encouragement. Med Res. 2016;6(3): 230–32.
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 - S E A B I R D O S T E O L O G Y.
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.
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
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.

Dr. Jagadish Biswas, Received: 26 May 2018
Assistant Professor Received in revised form: 18 June 2018
Department of Forensic Medicine and Toxicology, North Available online: 1 July 2018
Bengal Medical College, Sushruta Nagar, Darjeeling.
KEYWORDS : Ethical Doctor, Restructure of selection process for Medical students, Reducing unethical practice by doctors.
INTRODUCTION: than anything else.

There has been a rise in unethical practices by doctors. These It is expected that the principles of ethics would either come
have been brought to light by the print and electronic media, from within or that budding doctors would imbibe morality
and have given rise to an atmosphere of scepticism in society. from parents at home.Among the earliest influences on child
Doctors are probably no longer considered noble professionals behaviour are the attitudes and behaviours of the parents.
or healers who would always do the patient good. Rather, they Therefore, parental behaviours have a strong influence on
are service providers, and the patients the service users. This children. Studies have shown that parental and environmental
change may have come about partly because of the corrupt and influences have a significant role in promoting pro-social
unethical practices of a few doctors, resulting in a loss of trust behaviours among children[3]. Parental role has a significant
in the doctor–patient relationship[1]. influence on moral values of children.
Some of disturbing recent news include: June 10, 2017-Doctor Ethics is moral conduct of right and wrong in a civil society,
injured in nursing home attack after patient's death, Aug which comes from within. It is a branch of Philosophy.
13,2015-2 junior doctors beaten up at SSKM Hospital, Jan Medical Ethics guides doctors in dealing with their patients,
11,2016-A PG trainee at R G Kar admitted in ICU after he was for the best possible outcome. Unlike Law which is enforced
assaulted by a mob, Jun 22,2016- Junior doctor assaulted at on an individual after commission of crime, ethics prevents
SSKM Hospital, Mar 24, 2017- Doctors attacked at RG Kar individual from committing wrong. As per Definition:
Medical College, Feb 15, 2017-Mob vandalism at CMRI Medical ethics deals with moral principles which should
Hospital[2]. The attacks on doctors are more due to lack of guide the members of medical profession, in dealing with
doctor-patient relationship or understanding of medical ethics each other, with patients and with the state[4]. India can boast
41
of its own code of ethics proposed by Charaka roughly 4700 Table 1 : Topics Covered and Marks Obtained.
years ago” ethics prevented physicians to eat meat, drink Number of
alcoholic beverages and commit adultery. Physicians should Sr. Topics Covered students with Percentage
not harm their patients and be solely devoted to patient care, No. correct
answer
even if this puts their lives in danger [5]. In Western world,
medical ethics had its foundation as Hippocratic Oath. The 1 Charaka 70 57.3%
examination of moral issues in medicine largely began in 4th Ancient Indian
2 Ethics followed 60 49.1%
century BC by the great Greek physician Hippocrates 2500 years age
(sometime between 460-377 BC the accepted life period)[6]. Contribution of
Historically, India is a country of ethics. In 5th and 4th Century 3 Hippocratic 95 90.4%
BC, teaching of Buddha consisting of Sila or ethics of life. in medicine
Ethics was practiced not only by doctors but also common Medical ethics is
man. Sila or ethics practiced by common men had Five 4 followed for benefit 69 56.55%
of: Patient/Doctor
Precepts[7]: To abstain from killing of any living being, To
International
abstain from stealing, To abstain from sexual misconduct, To 5 Committee 65 53.2%
abstain from wrong speech, To abstain from all intoxicants. of Red Cross
OBJECTIVE: To evaluate core ethical knowledge among 6 WHO 70 57.3%
students, before the subject of Medical Ethics was taught to
them by teachers. If ethical awareness is found less, a method First Noble Prize
7 was given 63 51.63%
be suggested to curb unethical practice. to founder of ICRC
MATERIAL AND METHOD: After taking approval from
8 Aim of Doctor 72 59.1%
Institutional Ethics Committee and consent from participants
present cross sectional study was conducted on 122 students of 9 Function of MCI 68 55.73%
MBBS (3rd Semester) at Department of Forensic Medicine and
Should a doctor
Toxicology from 1st August 2015 to 31st July 2016. Students learn self defense
were properly briefed about the study and its objectives and 10 to protect himself 25 20.4%
informed not to disclose personal identity. 10 Pre-designed and from patient
pre-tested questionnaire were asked. Correct answer was given
Table No. 2 : Distribution of Study Population According to
1 mark and wrong answer was given '0' mark. Data collected
Father's Education
and analysed.
RESULTS : Mean age of students was 20 years. Majority Under Graduate 12%
(71%) of the students were from English medium school and
rest from non-English medium schools. Topics covered and Graduate 38%
marks obtained by students are as per Table No. 1.
Total average score obtained: 51.80%. Highest score obtained Post Graduate 19%
was: 10/10. Lowest score obtained was 04/10. Distribution of
Study Population according to Father's Education is depicted MBBS/MD, MD, BDS, MDS 1%
in Table No. 2.
DISCUSSION : Total average score obtained: 51.80%. Out Total 100%
of every 2 doctors 1 does not have core ethical background.
This is an alarming situation, unless the students learn ethics in India, revealed that though medical students agreed that an
class, chances of them becoming ethical doctor is remote. awareness of ethics was important, their knowledge was
Study questionnaire were on objective medical knowledge and deficient and there was no increase in their scores
medical ethics and not based on psychological assessment. corresponding to additional years of medical education[9].
Our study indicate that medical students have difficulty in Another study found that when medical students recorded the
understanding ethics in class. A study done in 2013 in South ethical issues encountered by them, the most common issues
India, indicated there are major deficiencies in the were related to ethics in medical education, professionalism,
understanding of medical ethics among medical confidentiality, the doctor–patient relationship, informed
undergraduates[8]. A cross-sectional study in West Bengal, consent and the doctor–peer relationship[10]. Students may be
42
either unaware of the code of conduct or the principles of 5. English V et el. Medical ethics today. The BMA hand
ethics, or unable to translate the knowledge into actual book of ethics and law. 2nd edition, page 25
practice.Education of father was taken into account, since vast 6. Nandy A. Principals of Forensic Medicine including
part of, ethics and morality is taught at home. Education of Toxicology, 3rd edition reprint, New Central Book
father may serve as a pointer to condition at home. In USA and Agency(P) Ltd, Kolkata 700009, 2010 page 24
Europe students have to pass MCAT a multiple-choice 7. Lay U K. Manual of Vipassana Meditation. 3rd edition
examination where Physical science, biology, critical thinking, reprint, Vipassana Research Institute, Dhamma Giri.
and verbal skills are all tested in a 5-hour computerized test[11]. Igatpuri422403, 2010 Page 40.
This is followed by interview which finds ethical knowledge, 8. Arun Babu T, Venkatesh C, Sharmila V. Are tomorrow's
self less service provided by the students in addition if the doctors aware of the code of medical ethics? Indian J Med
student is honest, humble, temperate, generous, and hard- Ethics. 2013 Jul-Sep;10(3):192-4.
working. In ancient India Sushruta Samhita describes in detail 9. Chatterjee B, Sarkar J. Awareness of medical ethics
the internal character and external built of a pupil who are to be among undergraduates in a West Bengal Medical College.
admitted as a medical student. This admission process was Indian J Med Ethics. 2012 Apr-Jun;9(2):93-100.
very stringent. A medical student was expected to be honest, 10. Fard NN, Asghari F, Mirzazadeh A. Ethical issues
humble, temperate, generous, and hard-working[12]. He was not confronted by medical students during clinical rotations.
supposed to be enamored with women or engage in gambling Med Educ. 2010 Jul;44(7):723-30.
or hunting. His memory and academic performance were also 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
given importance[13]. doctor.html.downloaded on 10 Oct. 17
CONCLUSION: 12. Nuraliev YN. Doctor's ethics in ancient east written
classics and in the works of middle age medical scientists.
This study is an eye opener. Almost 50% of students of Medical
In: Abdi WH, Asimov MS, Bag AK, Khairullayev MM,
College so not have core ethical knowledge. Other studies also
Mikulinsky SR, Mukherjee SK, et al., editors. Interaction
points out that it is difficult to obtain knowledge on ethics from
between Indian and Central Asian Science and
Medical College. Time has come to change the process of
Technology in Medieval Times. Medicine, Technology,
selection of Medical Students to have ethical doctors in our
Arts and Crafts, Architecture and Music. Vol. II. New
Country. It can be done in the way as was done in past by
Delhi: Indian National Science Academy; 1990. pp. 11–8.
ancient Indian Doctors, which is followed by many Countries
13. Lochan K. Varanasi: Chaukhambha Sanskrit Bhawan;
of west except our country.
2003. Medical education. Medicines of Early India: With
Stringent selection criteria can be adopted coupled with Appendix on a Rare Ancient Text. Ch. 4; pp. 90–103.
interview, projects and work done for the service of ill and
PROFORMA
unwell person in addition to multiple-choice examination Sex: Age: Religion :
where Physics, Biology, Chemistry, Critical Thinking and Name of School/ Location :
Verbal Skills can tested in a computerized test. If the selection Medical of Instruction in School : English/ Hindi/ Bengali
of Medical Students can be stream lined, only can we expect Education and Occupation of Father :
ethical doctor population. Q 1. India has its own Code of Medical Ethics, composed by
Charaka: Yes/ No
REFERENCES:
Q2. In Ancient India, Ethics was strictly followed , who
1. Chattopadhyay S. Corruption in healthcare and medicine: contributed : Buddha/Patanjali/ Both
why should physicians and bioethicists care and what Q3. What is Contribution of Hippocratic in Medicine : Ethics/
should they do? Indian J Med Ethics. 2013 Jul- Oath
Sep;10(3):153-9. Q4. Medical Ethics is followed for benefit of : Patent/Doctor
2. The Times of India, Kolkata, Saturday, June 10, 2017, Q5. International Red Cross says-treat enemy soldiers also:
page 39, column 1 Yes/No
Q6. Where is HQ of WHO : Geneva / New York
3. Knafo A, Plomin R. Prosocial behavior from early to
Q7. First Noble Prize was given to founder of : WHO/
middle childhood: genetic and environmental influences International Red Cross
on stability and change. Dev Psychol. 2006 Q8. Aim of a Doctor : Cure / Prevention / Teach
Sep;42(5):771-86. Q9. Function of MCI : Recognize Medical College/ Set Medical
4. VV Pillay .Textbook of Forensic Medicine and syllabus/ Both
Toxicology, 18th edition, Hyderabad Paras Medical Q10. Should a doctor learn Karate (self defense) to protect himself
Publisher. 2017 page 30 form patients: Yes/ No
43
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
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.

Dr. Anudeep Singh Received: 2 April 2018
Senior Lecturer, Received in revised form: 18 June 2018
Department of Anatomy, Faculty of Medicine, Saujana Available online: 1 July 2018
Putra Campus, MAHSA University, Jenjarum, Selangor,
Malaysia. 42610
Contact No. : +60163546930
E-mail : anudeep@mahsa.edu.my
KEYWORDS : Hand and foot measurements, Stature estimation, Forensic anthropometry, Forensic anthropology, Central India.
INTRODUCTION : There is currently a dearth of gender based studies done among

Anthropometric data collected from different races, age and the population from central India. Thus, the purpose of the
sex groups is greatly useful for designing products for present study was to analyse the relationship between the
ergonomics, biomedical engineering, surgery and especially in measurements of the hand and foot dimensions and the stature
forensic medicine[1-3]. Anthropologists have always been and to devise linear and multiple regression equations for each
interested in computing stature using measurements of gender. There are differences among populations due to
different parts of the body, as stature is one of the most variations of race and ethnicity thus region based study of
important factors in profiling the individuals[4-8]. These data are subjects is necessary to have population specific forensic
extremely useful in countries where techniques like DNA or standards[30-33].
dental markers, which can be used for identification, are MATERIALS AND METHODS :
expensive or not easily available. After taking approval from research review committee of the
The human remains, as the result of wars, airplane crashes, university and informed consent from participants the study
traffic accidents, criminal mutilation and dismemberment and was conducted in Bhopal, India which is a region in central part
other mass disasters, are present in different forms. The of India. All the measurements were taken in centimeters in a
primary challenge for any medico-legal investigator in reasonably well lit room by author himself to avoid inter-
identifying unknown human remains is the development of a observer error in methodology. 140 healthy subjects (70
biological profile via the estimation of race, sex, age and female and 70 male) between the age group of 20 to 25 years
stature[9-10]. Using population specific standards is the most were chosen randomly. Sliding calliper was used for hand/feet
accurate and generally accepted method[11]. measurements and Stadiometer was used to measure vertical
The estimation of stature from various skeletal parameters has height for stature estimation. The subjects were made to stand
been performed in different studies[12- 18]. Studies have also been on the level platform barefoot and erect against the stadiometer
done where stature as well as gender is estimated from bar with head in the Frankfurt plane for stature. Length and
dimensions of hands and feet [19-29]. width of hand and foot were measured separately of the left and
44
right sides of each individual.

(Figure 2)
• 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. (Figure 1)
• 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 RESULTS :
aspect of head of fifth metatarsal. (Figure 2) Table I shows the descriptive statistics for hand and foot
dimensions for both sexes. All the measurements were found
STATISTICAL ANALYSIS: to be significantly larger for males as compared from females.
Right hand length (RHL), right hand width (RHW), right foot Sex specific Pearson's correlation of coefficients showed
length (RFL), right foot width (RFW), left hand length (LHL), statistically significant correlation of hand and foot
left hand width (LHW), left foot length (LFL), left foot width dimensions with stature (P- value <0.01) (Table 2). The
(LFW) were measured. The data was subjected to statistical highest correlation in males was observed for the right hand
analysis using statistical package for social sciences (SPSS- length and least with left foot length while among females the
20). The independent t-test was used to test for differences highest correlation was with left foot length and least with right
between the mean measurements. The strength of correlation hand width.
between hand and foot dimensions were calculated using The linear regression equations were calculated for the stature
Pearson's correlation coefficients (r). Linear and multiple estimation for both the sexes for each individual measured
regression equations for stature estimation were developed variable as shown in Table 3 for males and Table 4 for
using the hand and foot dimensions[30]. females. The Standard Error of Estimate (SEE) was also
Table 1 : Descriptive Statistics of Stature, Hand and Foot Dimensions (cm) for both sexes.
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*
45
Table 2 : Pearson’s Correlation Between Stature and Hand and Foot Dimensions.
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 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
calculated. It predicts the deviation of the estimated stature Multiple regression equations (Table 5 and 6) were derived to
from the actual stature (lower values indicate more reliable assess whether using multiple variables would increase the
stature estimates). The SEE was between ±3.55 (right hand accuracy of predicting stature. This showed a reduce SEE,
length) and ±5.46 (left foot length) for the males and was ±3.37 for males and ±0.86 for females. The regression
between ±2.42 (right hand length) and ±3.35 (right hand formulae were developed for all hand and foot, in case
width) for the females. The regression coefficients were found individual hand or foot of either side are found to be
to be statistically significant for all of the derived equations. dismembered.
46
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
The SEE values using multiple regressions for each hand and hand breadth. The correlation of coefficient for stature and foot
foot dimension showed improved values in both the sexes. dimensions were greater for foot width in males (0.630 right
DISCUSSION : 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
The limb dimension is valuable in forensics especially for
left foot length). This result is in agreement with Kanchan et al
estimation of stature. Many previous studies have established a
who also found higher correlation was exhibited by foot
positive relation between hand and foot dimensions and stature
breadth. However, the results of present study are not in
estimation[40].
concordance with findings among rajbanshi[42] population
Each person has a unique shape and size of hand and foot [29, 39] where the foot length was found to have higher positive
as they show ethnic and regional variations due to congenital correlation with stature in both sexes. These variations could
and climatic conditions. Physical activities, nutritional be attributed to biological and environmental factors affecting
conditions and the foot wear worn also affect the shape and size the studied populations.
[31]
. This study was done with 140 subjects between the age
The standard error of estimation was found to be least for right
group of 18 and 25 years. The results of our study showed that
hand length (± 3.55) and left hand length (± 3.0) in males as
stature and all measured dimensions of hand and feet are
while it was lowest for the right foot length (± 1.66) and left
significantly greater in males as compared to females. This is in
foot length (± 1.38) in females.
agreement with the results shown in previous studies[33, 35, 36, 41].
This is attributed to late skeletal maturity in boys as compared The standard error of estimation is lesser when using the
to girls which gives them more time to grow. In addition to this, multiple regression equations as compared with linear
climate, geography and nutritional stature also play a role in regression as is shown is previous studies. It is also less in
stature growth[42]. Studies have shown that general shape and females when compared to males for all the variables. Thus the
size of foot remains permanent throughout life once reaching accuracy of with multiple regressions is higher in females as
age of 16 years in males and 14 years in females, however foot compared to males which is similar to the findings in previous
breadth may be affected due to the spread of the toes due to studies [43-44].
shoe wearing habits, physical activity and nutritional status[30, 41, CONCLUSION :
43, 44]
. Estimation of stature is essential for determining dismembered
While evaluating for the correlation, all the measurements of bodies especially in natural disasters or an accident like plane
hand and feet of both sides were found to be significantly crash leading to severed body parts. Expensive procedures like
correlated with stature in both sexes. The correlation DNA analysis are not always possible due to economic
coefficient between stature and hand dimensions were higher reasons. In present study multiple regression equations have
for hand length on both the sides for both males (0.778 right been derived from limb measurements. These equations can be
hand length and 0.756 left hand length) and females (0.900 used to determine the sex and stature. One of the limitations of
right hand length and 0.902 left hand length) as compared to the study is the age group. In future studies a wider age group
47
can be studied. anthropometry. Indian J Dent Res.2008;19(2): 150-4.

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49
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.

Dr Seema Rani Pathak, Received: 13 April 2018
Professor and Head, Received in revised form: 25 April 2018
Department of Chemistry, Biochemistry and Forensic Available online: 1 July 2018
Sciences, Amity School of Applied Science (ASAS), Amity
University, Gurugram, Haryana- 122413, India.
Contact : +919871803613
Email : srpathak@ggn.amity.edu
KEYWORDS : Homogenous Strokes, Three-Dimensional Analysis, Ball Point Pens, Gel Pens.
INTRODUCTION : examples are blank paper signatures, addition in security

Forensic Document examination is one of the oldest branch of documents like cheques, etc. The dispute could be settled if we
Forensic sciences and till now being used for investigation of could determine the sequence of writings when they are
the documents. One of the most challenging part in Forensic intersecting (whether the paragraph was written first or the
Questioned Document is the determination of sequence of signature). The importance of sequence of strokes Forensic
strokes or in other words sequence of two intersecting lines Questioned Documents was first mentioned by Albert S
placed on a writing surface[1]. Sequence of strokes means, the Osborn in his book “Questioned Documents”. He stated that
sequence in which words or alphabets are placed or written on “in various situations it is not possible to tell the correct
writing surface. The need for investigation of sequence of chronological order of two crossed lines and under these
strokes arises when it is alleged that a statement is written after situations a strong evidence should be made. This evidence
a signature was done on the document, the two handwritings should be supported by observations from instruments. These
touch at the same point or this examination can be performed to observations should be clear enough that a layman is able to
learn which of the two writings that touch was last written. The conclude the correct sequence of crossed lines”. Albert S
examination of sequence determination is very important job Osborn also said that the time interval between two writing is
to fix the accountability of the document.There are many cases also an influential factor. Examining the sequence of stroke is
in which the signatory claims that the document he signed may not easy because there are several factors which affect the
be disputed as the paragraph or sentence written just above his analysis process like, writing instrument, types of ink, the
signature was not present when he signed it. The most common number of intersections, the color intensity of the lines
intersecting each other, the color of the ink and much more[2].
50
Many studies are done and still going on sequence of explains the protocol which was applied for making samples.
intersecting lines. The study on sequence of strokes is done by
1 was added Area to be
examining one factor at a time. For Instance, Cheng et al. used after the signature examined under
laser scanning electron microscope for determining the was placed on Docucenter Nirvis
the paper
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
point of intersection[3]. Saini et al. studied the physical Figure 1 : Model Sample
characteristic of the ink as phenomena for examining the
sequence of intersecting lines using Digital microscope and Homogeneous Intersected Lines
(50 Samples)
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
reflection[4].” Vaid et al. used VSC 2000 HR for examining the Homogeneous strokes made Homogeneous strokes made
sequence of strokes by studying the reflectance spectra of the by Cello pin point ball pen by Cello butter flow gel ball
(25 samples) pen (25 samples)
ink[5].
Examination of sequence of strokes made from same type and Figure 2 : Graphical Representation illustrating the
color of ink is very difficult. The dispersal of homogenous ink Protocol of Producing Samples
particles from one line into another makes the analysis even RESULT AND DISCUSSION :
more tedious[6]. Luminescence and gloss of the ink also affect
Analysis of sequence of homogenous intersected strokes
the analysis process[7]. Blobbing cause excess of penetration of
under Docucenter Nirvis : After examining each sample
the ink on the paper and that affects the interpretation part of
under Docucenter Nirvis, the authors found that the
the analysis as it gives the wrong impression about the
composition of ink played an essential role in concluding the
sequence of the latter and former line as heavy ink line appears
results. Table 1 represents the analysed result of the 50
on top position[2]. These are some of the factors which produces
samples under all the nine lights present in Docucenter Nirvis.
confusion in the minds of the Forensic Document Examiner.
Table 1 : Observations of Docucenter Nirvis Depicting the
In the present study, two instruments are used. One is
Positive Outcomes.
Docucenter Nirvis and second one is Nikon A1 Confocal
Microscope. Docucenter Nirvis is most commonly used in all Cello Cello
Forensic Science laboratories. The objective of the study is to Type of Pin Point Butter Flow
ink Ball Pen (Black) Gel Pen (Black)
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 White Light 4% 0%
aid all the Forensic Document Examiner so that they could find
Topside Light 8% 8%
out the correct chronological sequence of the lines placed on
the paper despite of color and type of the ink used. Coaxial Light 0% 0%
MATERIAL AND METHODS :
50 samples examined on A4 sheet of Trident Spectra IR Light 0% 0%
Photocopier Papers of 7x3 inches dimensions using Black Oil
Side Left Light 100% 96%
based and liquid ink and Cello Pen Point/Gel Pen (Cello Butter
flow). Figure 1 represents one of the samples used for analysis. Side Right Light 92% 84%
On the sample, primarily 5000 was written, and then signature
was placed above 5000. Then one was added between 5 and the UV-A 365 Light 0% 0%
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 Bottom UV-A Light 0% 0%
type of sample preparation is the case of 'addition,' and it is
LumiBP Light 100% 88%
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
51
LumiBP filter light was found to be most reliable light for Observations from Top side, Coaxial light, UV-A 365 light,
qualitatively examining the fluorescence imparted by the ink. and Bottom UV-A light were found to be not so definite, in
The LumiBP filter 570 of excitation 530-570 nm and emission other words, authors were not able to draw a positive inference.
was 570 nm, and LumiBP filter 590 of excitation 550-590 nm As the intersected lines were made of same type and color, UV-
and emission 590 nm was used. It was observed that Cello Pin A 365 and Bottom UV-A light are generally used to determine
Point ball pen gave maximum fluorescence, which was different types of ink used in making fraudulent documents.
followed by Cello Butter flow gel pen ink. Side oblique left, Hence, UV-A 365 light and Bottom UV-A light can be used in
and right light also found to be efficient and reliable for determining sequence of heterogeneous ink lines. Coaxial
determining the sequence of homogeneous intersections. The light and top side also failed to impress the authors in analysis
success of the oblique light depends on the depth of the groove process. White light and IR light were established to be
formed on the paper by the writing media due to the pressure inefficient for analyzing the sequence of homogeneous
applied while writing. The depth of the groove is associated to intersected lines.
the amount of the pressure applied. The oblique light gets filled Analysis of sequence of homogenous intersected strokes
into the grooves; the continuity of filling of light in the line will under Nikon A1 Confocal Microscope : About 88 percent of
be seen disturbed when the former line is intersected the latter the samples gave confident result and the rest were belonged to
line.The observations of the samples under LumiBP filter, side non-confident category. The result of the samples are presented
oblique right light and Bottom UV-A can be seen in Figure in Table 2.
3(a), 3(b) and 3©.
Table 2- Observations of Nikon A1 Confocal Microscope
Figure 3 : Docucenter Nirvis Observation on Intersected Depicting the Outcomes
Homogeneous Strokes Under (a) LumiBP Filter Light, (b)
Side Right Light and (c) Bottom UV-A Light Cello Cello
Type of Pin Point Butter Flow
ink Ball Pen (Black) Gel Pen (Black)
Ball Point Pen Ink
Fluorescing Under
LumiBP Filter Positive Outcome 84% 92%
Inconclusive 12% 8%
Negative Outcome 4% ----
3 (a)
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
3 (b) 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.
4 (a) 4 (b)
3 (c)
52
Three dimensional feature of the Nikon A1 Confocal crossed strokes. In Questioned Document (pp. 375-
Microscope aided the authors to draw a definite conclusion 393). The Lawyer's Co-operative publishing Co.
irrespective of color and type of ink used. The three- 3. Cheng K, Chao C, Jeng B, Lee S. A New Method of
dimensional image was handy, as the depth of the grooves Identifying Writing Sequence with the Laser
made by the writing media on the paper was observable and the Scanning Confocal Microscope. Journal of Forensic
sequence of writing media strokes made on the paper could be Sciences J. Forensic Sci. 1998;43(2)348-52.
recognized.Pen pressure created by the writer also helped in
4. Saini K, Kaur R, Sood N. Determining the sequence
the analysis process. Higher the pen pressure, higher the ability
of intersecting gel pen and laser printed strokes — A
to find the sequences of overlapping pen strokes.
comparative study. Science & Justice2009;49:286-
Figure 5 : Confocal Microscope Observation on 291.
Intersected homogenous strokes made by black Cello
5. Vaid B A, Rana R S, Dhawan C. Determination of
Butterflow gel pen (a) image captured in TD channel and
sequence of strokes through reflection spectra.
(b) a three dimensional image of intersection.
Problems of Forensic Sciences,2017;LXXXVII:
193-203.
6. Claybourn M, Ansell M. Using Raman
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
5 (a) 5 (b) R, Cantu A A. Use of Synchrotron Reflectance
Infrared Spectromicroscopy as a Rapid, Direct, Non-
CONCLUSION : destructive Method for the Study of Inks on Paper.
Overall, the Nikon A1 Confocal microscope is a versatile Applied Spectroscopy, 2002; 56(6):800-803.
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
53
A Study On Waste Disposal Management In A Tertiary Care Hospital
1. Pratik V Tarvadi, Professor & Head, Department of Forensic Medicine and Toxicology, Pacific Institute of Medical
Sciences, Ambua Road, Umarda, Udaipur
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.

Dr Pratik V Tarvadi, Received: 10 May 2018
Received in revised form: 10 May 2018
Professor & Head,
Accepted on: 22 May 2018
Department of Forensic Medicine and Toxicology, Pacific Available online: 1 July 2018
Institute of Medical Sciences, Ambua Road, Umarda, Udaipur
Contact : +91 98453-06634
Email : drpratiktarvadi@gmail.com
KEYWORDS : Biomedical Waste, Knowledge, Management
INTRODUCTION : assistants, maintenance personnel, support personnel for waste

Biomedical waste or infectious waste or medical waste is handling, transportation and laundry) working at these places,
defined as solid waste generated during the diagnosis, testing, patients and their visitors, and waste management facility
treatment, research or production of biological products for employees and scavengers are at high risk of exposure to
humans or animals. Biomedical waste includes syringes, live nosocomial infection resulting from biomedical wastes. The
vaccines, laboratory samples, body parts, bodily fluids and management of the wastes plays a vital role in its management.
waste, sharp needles, cultures and lancets[1]. While biomedical The management involves the following steps: generation,
waste management means a technique, of dealing with segregation, collection, on-site transportation, on-site storage,
biomedical waste, from the point of generation to the disposal offsite transportation (optional), treatment and disposal of the
of waste. As per the reports from developing countries waste, with Segregation being the most important step in the
approximately 1-2 kgs per bed per day, whereas in developed process of biomedical waste management [1-6].
countries approximately 1-5 kgs of waste / bed / day is Improper handling of biomedical waste increases the airborne
generated. In India it is estimated to be 2.0 kgs /bed/day[2]. pathogenic micro-organisms, which would affect the hospital
Biomedical Wastes in health care facilities are generated environment and the community. Improper disposal of
commonly from wards, delivery rooms, operating theaters, Biomedical waste also carries a vital importance. If it is
emergency, outpatient services, laboratories, pharmaceutical disposed in open dumps, it increases the risk of injury from
and chemical stores. Hospital staff (doctors, nurses, health care sharps and the spread of infectious diseases to waste handlers
54
and scavengers; uncontrolled burning of wastes also increases 3. Study the awareness amongst the hospital staff, about
the risk of exposure to hazardous emissions [4-10]. biomedical waste management, so that policies for
Medical waste is responsible for serious health hazards and the improved status be formulated in future.
law requires hospitals to follow procedures that protect the MATERIAL AND METHODS :
public from coming into contact with it, for which it has come After taking Institutional Ethical clearance, the study was
out with Bio-Medical Waste (Management and Handling) conducted at a tertiary level centre Hospital at Dakshina
Rules and Regulations, 1998 and amendments[6]. Training of Kannada, Karnataka This is a full-fledged 800 bedded hospital
employees regarding biomedical waste management has with adequate medical, paramedical staff and equipped with
become a necessity to combat the problems associated due to modern facilities. The data was collected through observation
biomedical waste generated at the health care facilities. It will and interview with the help of a validated questionnaire
help the authorities to create strategy for improving the status prepared for staff, doctors, nurses and employees of operation
in future [4,6]. theatres, laboratories, laundry and central sterilization
Aims and Objectives : departments of the hospital. The primary data was collected by
1. To collect information on the collection, treatment, observation and structured validated questionnaire and
handling, hauling, and disposal of medical wastes secondary data was collected from literature.
2. Determine the type of hazardous medical wastes RESULTS:
produced in hospital The data collected at the interview was Tabulated as:
Table 1: Interviewed Questions at Different Departments
S. W C LR HK A%
No. Topic
F N F N F N F N 4/4
Knowledge on hazardous nature of
1 biomedical waste 1 1 1 1 1 1 1 1 100
Knowledge on transportation facilities

2 for biomedical waste 0 1 0 1 1 1 1 1 50
Is the training given enough in case of

3 biomedical waste management 1 1 0 1 0 1 0 1 25
Are you provided with adequate protective measures to

4 protect yourself from biomedical waste 0 1 1 1 1 1 0 1 50
Are the biomedical wastes being disposed

5 as per guidelines 0 1 0 1 1 1 0 1 25
6 Are your health records being maintained 1 1 1 1 1 1 1 1 100
Are the workers provided with

7 immunization
0 1 0 1 0 1 0 1 00
Is the standard color coding method

8 used for biomedical waste segregation
1 1 1 1 1 1 1 1 100
Knowledge on apparatus used for 0 1 0 1 0 1 1 1 25

9
disposing the waste
*‘1' indicates positive answer or Yes *'0' indicates negative answer or No

W – Wards F – Finding in our study
C – Casualty / Emergency Medicine N – Normal standard result
L 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.
55
Table No. 1 indicates the awareness of biomedical waste and DISCUSSION :

about its management among the hospital staff. It is very clear As per Biomedical Waste Management Rules, 1998[6], “every
from the table that though they have the knowledge about hospital generating biomedical waste needs to set up requisite
biomedical waste but due to inadequate training given to them, Biomedical waste treatment facilities on site or ensure
they do not have the practical application and knowledge of requisite treatment of waste at common treatment facility”.
waste management. From our findings, it was interpreted that Management of these waste is very important in all hospitals
the institution is playing its part in waste management, but the and also important is the hospital staff having adequate
application is not there at the action level. information regarding hospital waste and its management and
Table No. 2 enumerates the wastes produced in each also be adequately trained for hospital waste management to
department. avoid nosocomial infections arising due to biomedical waste in
Table 2 : Types of Biomedical Waste the hospital. In our study we observed that the hospital staff
though had the knowledge of the hazardous effects of the
S. biomedical waste but lacked the knowledge regarding its
Topic W C LR OT
No.
transportation and were not adequately trained in biomedical
Human anatomical 1 1 1 1 waste management.
1 waste
In our study we observed that, adequate protective clothing
2 Animal waste 0 0 0 0
were though provided, but were not used, which can result in
3 Microbiological Waste 1 1 1 0 infection to self while managing or transporting biomedical
wastes. As per Biomedical waste Management and handling
4 Waste sharp 0 1 1 0 rules 1998[6], Health care waste management workers should
Discarded medicine & be given proper protective clothing, provide immunization and
5 cytotoxic drugs 1 0 1 0 training to them. The hospital is doing its part, but inadequacy
from the workers in following the guidelines was noted.
6 Solid waste 1 1 1 1
In our study we observed that, sparing animal waste, all the
7 Liquid waste 1 1 1 1 types of wastes are produced in our hospital, specifically the
departments we did our study on. These include general and
8 Incineration ash 1 1 0 1 hazardous, which implies that it is very vital for the hospital
9 Chemical waste staff to be adequately trained and prepared in handling and
1 1 1 1
disposal of these wastes.
In our study we observed that the hospital was following the
In our study, we observed that the frequency of collection of
Rules book in terms of maintaining color coded containers for
waste from each department was twice a day, Morning
proper segregation of waste material, but apart from the data
between 8.00 am to 9.00 am and evening 4.00 pm to 5.00 pm,
about colour coding it was observed that the hospital staff did
and transported to storage place. From the storage place to
not have adequate information regarding the disposal of
disposal center, the waste is collected on alternate days. The
wastes.
general waste is shifted to Vamchur, while the hazardous waste
is shifted to Mulky, for its further treatment and disposal. As per handling of biomedical waste management[10-11], it is
(Table 3) mentioned that the color coded bags in the wards should be
emptied at-least once a day, preferably twice a day and the
Table 3: Transportation Timings wastes should be sent to the disposal at-least on alternate days.
It was observed in our study that the transportation of the waste
S. Topic was done twice a day and at the time which did not interfere
W C LR OT
No.
with other activities like peak working hours and meal times.
Frequency of Also the wastes were transported from the hospital storage
1 Collection Twice Twice Twice Twice
Time of Collection place to the disposal place for further treatment every alternate
2 – Morning 8-9am 8-9am 8-9am 8-9am day.
Time of Collection CONCLUSION AND RECOMMENDATIONS:
3 – Evening 4-5pm 4-5pm 4-5pm 4-5pm
Biomedical waste management deals with biomedical waste,
from the point of generation to the disposal of waste. Our study
56
dealt with the departments where the most infectious encouragement, constructive criticism, continuous
biomedical waste is generated. Among all the wastes, only motivation and personal attention throughout this study.
animal wastes are not generated at our hospital. Ÿ D r. S a m p a t h K u m a r , D r. S h e r l e y , N u r s i n g
In our study we observed that the studied departments Superintendent and all the participants, who spent their
followed proper color coding segregation and collection valuable time for their kind help and assistance in
procedure. The frequency of waste collection was twice in a answering my questionnaire for the data collection.
day and the transport of waste from the department to the area REFERENCES :
of disposal was on alternate days. Disposal of these wastes was
1. Mathur P, Patan S, Shobhawat S. Need of Biomedical Waste
being done in accordance to the guidelines. As the hospital is Management System in Hospitals - An Emerging issue - A
providing proper training to the staff, they are well aware about Review. Curr World Environ 2012;7(1):117-124
the nosocomial infection due to improper biomedical waste 2. Grover P.D. Management of Hospital Wastes – An overview.
management. As no research or any statistical study is present Proceedings of National workshop on Management of Hospital
regarding any nosocomial infection resulting from Biomedical Waste;1998:16-18.
wastage, we are of the opinion that a study is required to be 3. S. Saini, S.S. Nagarajan, R.K. Sarma, Knowledge, Attitude and
done to keep the hospital updated about the relation between Practices of Bio-Medical Waste Management Amongst Staff of a
Tertiary Level Hospital in India, Journal of the Academy of
nosocomial infection and biomedical waste management.
Hospital. 2005; 17(2): 01-12
Our team also had observed that the hospital is providing the 4. World Health Organization. Preparation of National Health-
necessary basic protective measures but due to lack of training Care Waste Management Plans in Sub-Saharan Countries.
the hospital staff is not well aware about the safety measures Guidance Manual (Cited 20 February 2018). Available from:
they need to comply to. Hence it is of paramount importance http://www.who.int/water_sanitation_health/medicalwaste/en/
that all the hospital staff should be provided adequate training guidancemanual.pdf
5. World Bank. Health Care Waste Management in India. (Cited 25
regarding biomedical waste management. Also it is important
February 2018). Available from:
that hospital management should depute few paramedical
http://siteresources.worldbank.org/INTRANETENVIRONM
staff, properly trained in courses that provide training for ENT/1705736-1127758054592 / 20677728 / HCWMText.pdf
biomedical waste management who can work as supervisors in 6. Ministry of Environment and Forests. Government of India.
biomedical waste management, to give a healthy hospital ( 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 :
atmosphere and prevent nosocomial infection to the hospital http://envfor.nic.in/legis/hsm/biomed.html
staff, in particular workers of biomedical waste management 7. World Health Organization. Management of solid health-care
team. waste at primary health-care centres. A Decision-Making guide.
(Cited 25 February 2018). Available from:
The hospital authority should also look into re-design a
http://www.searo.who.int/entity/emergencies/documents/List_
separate lift or stair case to transport the wastes other than of_Guidelines_for_Health_Emergency_solid-health-
patient circulation area, so as to prevent the exposure of care_waste.pdf?ua=1
biomedical waste to the already weakly immunized patients 8. World Health Organization. Health Care Waste Management.
present in the wards. Guidance for the development and implementation of a National
Action Plan (Cited 25 February 2018) Available from:
We observed in our study, that with certain limitations and
http://www.who.int/water_sanitation_health/medicalwaste/en/
shortcomings also, the hospital is trying their level best to
napguidance.pdf
effectively handle the Biomedical waste management and to 9. Mathur V, Dwivedi S, Hassan M, Misra R. Knowledge, attitude,
protect themselves and the patients from the hazardous nature and practices about biomedical waste management among
of the biomedical waste. healthcare personnel: A cross-sectional study. Indian J
LIMITATION OF STUDY : Community Med. 2011;36(2):143–5
10. International Committee of the Red Cross. Medical Waste
Ÿ The study is limited to only one hospital Management. (Cited 1 March 2018). Available from:
Ÿ Short study period https:/www,icrc.org/eng/assets/files/publications/icrc-002-
4032.pdf
FUNDING: None
11. World Health Organization. Safe Management of Bio-medical
ACKNOWLEDGEMENTS: Sharps Waste in India. A Report on Alternative Treatment and
Ÿ My teacher and guide, Dr. Mahabalesh Shetty, M.D., Non-Burn Disposal Practices. (Cited 1 March 2018). Available
Professor and Head, Department of Forensic Medicine, K S from:
https://www.healthcare-waste.org /
Hegde Medical Academy, Mangalore for his constant
fileadmin/user_upload/resources/Safe-management-bio-
medical-sharps-waste-India-2005.pdf
57
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.

Dr Thanka J, Received: 21 April 2018
Professor, Received in revised form: 4 June 2018
Department of Pathology, Sri Ramachandra Medical Available online: 1 July 2018
College & Research Institute, Porur, Chennai – 600116
Contact : 94440-47907
Email : thanka7paul@gmail.com
KEYWORDS : Gross Changes, Histopathology, Dating of Abrasions.
INTRODUCTION : Indian setting, generally, we adopt the “naked eye

A wound or injury is defined as damage to any part of the body examination” method to date an injury. It is difficult to
due to application of mechanical force[1]. Forensic experts are determine exactly the age of an injury on the basis of its
frequently asked to comment on the age of injuries and the appearance by the naked eye[5]. Hence this study of wound
interpretation may have significant medico-legal dating of abrasions from macroscopic and microscopic level
consequences [2] . Three basic lesions are recognized: was taken up in our set up, to look into the accuracy by
Abrasions, Contusions and Lacerations[3]. Age of wounds can comparing with the age determined by colour changes and
be determined by (i) Gross changes (ii) Histopathology microscopic examination with that of the known time of
(iii)Enzyme histo-chemistry and Immuno-histochemistry[4]. In infliction of injury.
58
MATERIALS AND METHODS : Margination of neutrophils was observed between 0-4h.

After clearance from Ethical committee, the present study was Prominent neutrophilic infiltration was observed in injuries
carried out on cases with well demarcated abrasions and above 12 hrs old. It was noted earliest at 14h and progressive
known time of injury, which were subjected to medico legal increase was noted in the injuries of 24-72 h old. Mononuclear
autopsy in the Department of Forensic Medicine of Sri cells infiltration was first noted at 14h. The earliest
Ramachandra Medical College from May 2015 to Oct 2016. regenerative change of epithelium was noted at 24hrs.
Consent for tissue section was obtained. Abrasions were Fibroblasts were evident at 24 hrs in a male without any co
grouped under 7 different time intervals : Injuries of 0-4 h, morbid conditions. The granulation tissue deposition was
4-12 h, 12-24 h, 24-72 h, 4-6 days, 7-14 days and more than 2 noted in 6 injuries, which were more than 3 days old. Collagen
weeks old. The representative areas of injury were subjected to tissue was noted in injuries more than 1 week old.
Abrasion - Complete re - Abrasion - Skin with well
histopathological examination along with control samples epithelization. formed scab. H&Ex100
from normal skin. After tissue processing, embedding, Infuammatory granulation
tissue in the
sectioning, H&E staining and cover slipping, slides were upper dermis. H&Ex100
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 Correlation of gross changes with microscopic changes
noted only after 6 days. (Table 3-4) :
Microscopic changes (Table No. 2) : 19 abrasions of red colour showed no appreciable
17 abrasions showed haemorrhage/congestion of vessels, 11 of inflammatory response. 5 abrasions with reddish scab showed
them were 0-4 h old. Oedema was noted between 0-4h. early inflammatory changes. 4 among 5 abrasions with
brownish scab showed predominant neutrophilic infiltration.
Table No. 1 : Distribution of Abrasions by its Gross Changes
Gross Changes
Red Reddish Brownish Dark Brown Black Scab fallen Scab fallen Total
scab scab scab scab off off
partially completely
0-4h 17(45.9%) 0 0 0 0 0 0 0
4-12h 2(5.41%) 0 0 0 0 0 0 0
12-24h 0 4(80%) 1(20%) 0 0 0 0 0
24-72h 0 1(20%) 4(80%) 1(50%) 0 0 0 0
4-6 days 0 0 0 1(50%) 1(50%) 1(33.3%) 0 1(33.3%)
7-14 days 0 0 0 0 1(50%) 2(66.6%) 0 2(66.6%)
>2 weeks 0 0 0 0 0 0 1(50%) 0
Total 19(100%) 5(100%) 5(100%) 2(100%) 2(100%) 3(100%) 2(100%) 3(100%)
59
Table No. 2 : Distribution of Abrasions by its Microscopic Changes
Age of Microscopic Scoring

Injury
0 1 2 3 4 5 6 7 8 9
0-4h 11 2 2 0 0 0 0 0 0 0
4-12h 0 0 0 0 0 0 0 0 0 0
12-24h 4 0 0 0 2 1 0 0 0 0
24-72h 2 0 0 0 5 1 1 1 0 0
4-6 days 0 0 0 0 2 1 3 3 0 0
7-14 days 0 0 0 0 2 3 2 2 1 0
>2 weeks 0 0 0 0 4 0 0 0 1 0
Score : 5- Predominant mononuclear cell infiltration
0- Haemorrhage and/or Congestion of vessels 6- Fibroblast formation
1- Oedema formation 7- Granulation tissue with rich leucocyte infiltration and much
2- Margination of polymorph cells fibroblasts
3- Early infiltration of neutrophil cells 8- Collagen tissue deposition
4- Predominant neutrophil infiltration with poorly 9- Cellular reaction subsides, fibroblast are more active with
differentiated mononuclear cells. increased collagen formation (regression phase)
Table No. 3 : Correlation of Gross Changes with microscopic Changes in Abrasions
Gross Microscopic Scoring

Changes
0 1 2 3 4 5 6 7 8 9
Red 11 2 1 0 0 0 0 0 0 0
Reddish Scab 3 0 0 0 2 1 0 0 0 0
Brownish Scab 1 0 0 0 4 1 1 1 0 0
Dark Brown 1 0 0 0 2 0 1 1 0 0
Black Scab 0 0 0 0 1 1 1 1 0 0
Scab Fallen Off Partially 0 0 0 0 2 2 2 1 1 0
Scab Fallen Off Completely 0 0 0 0 1 0 0 0 1 0
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
60
1 among 2 abrasions with dark brown scab showed predominantly noted after 5days.Collagen tissue formation
granulation tissue, macrophages and congestion . 2 abrasions was noted in a wound more than 10 days old.
with black scab showed granulation tissue. One among 3 By comparing gross with microscopic changes, injuries of 4-6
abrasions with scab fallen off partially showed collagen tissue days old with dark brown & black scabs showed granulation
deposition . Scab was fallen off completely in one abrasion tissue formation, which confirmed their age to be more than 4
which showed granulation tissue. days old.
By comparing gross changes with microscopic changes, all the Scab were fallen off completely and dense collagen tissue with
injuries of 4-6 days duration showed grossly dark brown decreased cellular reaction were seen in abrasions of more than
except one which was black, whereas all their histological 2 weeks old. Deposition of granulation tissue was observed
pictures showed granulation tissue formation, which routinely by 4-6days.
confirmed the age of injury to be more than 4 days old. Scab
This observation is in agreement with the author - granulation
was fallen off completely in more than 2weeks old abrasions
tissue formation is seen by 5-8 days[8] and another author also
and showed dense collagen tissue with decreased cellular
quotes the similar finding[1]. There may be significant delay of
reaction.
fall of scab in septicaemia.
DISCUSSION :
CONCLUSION :
Maximum Number of cases observed were males and most of
The pattern of healing of abrasions by both gross and
the injuries were due to RTA. Maximum number of cases were
microscopic appearance was uniform. For Indian population
observed in the age group between 21-30 years. 17 out of 19
with dark skin, gross changes by naked eye examination for
abrasions showing red colour were below 4 hrs of age. This
dating the injuries gives a rough estimate, thus subjecting the
was in agreement with the study conducted by Sharma A et al :
samples for histo-pathological examination would be more
he noted redness from 10 min up to 7 hours[6]. It was observed
accurate, whereas gross changes are well appreciated in the fair
in another study that majority of cases on the first day were
skinned people to some extent. Future studies should include
dark red[4]. Reddish scab was usually noted between 12-24 hrs.
more number of cases comprising a) different age groups b)
Similar observation was made by Sharma A et al in their
each type of injury c) associated co-morbities d) different sites
study[6,8]. An author also quotes that reddish scab forms by 8-24
to get a more detailed survey. In examination by
h[7].Brownish scab was noted on the 3rd day. Dark brown scab
histopathology, the presence of artefacts in the form of sand,
was noted after 63 hrs. Black scab was observed after 5 days.
mud particles, grease, paint & glass pieces etc. are to be kept in
Sharma A et al found hard brown scab 27 h onwards[6]and an mind.
author also quotes that by 4th and 5th day the scab looks dark
Acknowledgement: Nil
brown[7]. However this was in disagreement with another
study, where they observed dark red scab instead of dark Conflict of Interest : None
brownish scab on 5th day[4]. The fall of scab was noted only after Limitations of Study : Samples studied were from
6 days. Scab was fallen off completely in an abrasion of more refrigerated bodies.
than 2weeks old. In a similar study by Sharma A et al found REFERENCES :
that, the black scab started separating 7 days onwards[6] and
1. Knight B. The Pathology of wounds. In: Saukko P
also the author quotes that by 6th day it is blackish and it starts
(ed.)Knight's Forensic Pathology .3 rd ed London: Arnold
falling off from the margins. A big scab takes a few more days
publishers; 2004. p. 136,166-69.
to fall off[7]. However, this was in disagreement with the study,
where they observed dark brown scab instead of black scab on 2. Pilling M.L, Vanezis P, Johnston A. Visual assessment of
the 9th day[4]. the timing of bruising by forensic experts. J Forensic Leg
Med. 2010;17(3): 143-49.
Microscopy revealed loss of epithelial layer in all abrasions.
Loss of rete ridges was a prominent feature in all the pressure 3. Vij K. Mechanical Injuries. In: Vij K (ed.) Textbook of
abrasions. Haemorrhage/congestion of vessels and early Forensic Medicine and Toxicology. New Delhi: Reed
inflammatory changes were noted in abrasions of age less than Elsevir India Private Limited; 2014. p. 203.
14 hours. Predominant neutrophilic infiltration was noted after 4. Aggrawal A. Mechanical Injuries. In: Aggrawal A (ed.)
14hrs. Mononuclear cell infiltration was first noted at 14h. In a Textbook of Forensic Medicine and Toxicology. New
similar study by Sharma A et al early mononuclear infiltration Delhi: Avichal Publishing Company; 2014. p. 232.
was observed at 13h[6].The earliest regenerative change of 5. Kumar L, Chaitanya B.V, Agarwal S.S, Bhastia B.K. Age
epithelium was noted at 24hrs.Granulation tissue was
61
Related Changes in Mechanical and thermal Injuries-A

P o s t M o r t e m S t u d y. J I n d i a n A c a d F o r e n s i c
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.
62
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.

Dr. Lovleen Received: 22 May 2018
Assistant Professor Received in revised form: 22 June 2018
Department of Zoology, School of Bioengineering and Available online: 1 July 2018
Biosciences, Lovely Professional University, Phagwara,
India
Contact : +91 94178-52950
Email : loveenmarwaha@gmail.com
KEYWORDS : Noon Tea, Reprotoxic Effects, Drosophila melanogaster
INTRODUCTION : that people suffering from anemia should avoid use of

Noon tea (Kashmiri tea or Gulabi chai) is a special traditional Kashmiri tea as it contains polyphenolics which prevents
beverage, of Kashmir area, in India. Noon chai is composed of absorption of iron. It had been reported that regularly
Camella Sinensis, salt and a pinch of baking soda. Limited use consumption of noon chai enhance the level of ethylamine,
of noon tea possess many health benefits as it is powerful methyamine and pyrolidine in body, which are ultimately are
antioxidant, inhibits formation of blood clots in intact blood responsible for gastric cancer. Furthermore, noon tea cause
vessels, chances of heart attack and stroke wards off. The inflammation and generates free radicals of nitrogen and
Kashmiri tea (noon chai) is refreshing in the heat and resists the oxygen which are carcinogenic[1].
cold in winters. The L-theanine, an amino acid component of MATERIALS AND METHODS :
the tea helps to reduce the anxiety and stress, gaseous As very limited data is available on reprotoxic consequences of
distension, and intestinal spasms. Use of baking soda in noon noon tea, therefore considering specific cognition, present
chai increases the alkalinity of the blood, which is useful in research work, had been executed, which deals with evaluation
muscle functionality. Major benefits of noon chai is, it of reprotoxic effects of noon tea on Drosophila melanogaster.
increases mental alertness, reduces headache and increase the Reprotoxic consequences mean drastic effects of suspected
fluid levels in the body[1]. Presence of oxalate in tea reduces the mutagen on reproductive potential of test organism.
kidney stone formation by 8% in females and 14% in males[2].
About Test Model And Colonization under Laboratory
But excessive use of noon chai is associated with induction of
Conditions: For present research exploration Oregon strain of
gastric cancer in human beings and excess amount of sodium
Drosophila melanogaster was used. It is an excellent model
bicarbonate can cause edema, alkalosis, heart failure,
organism as it has simple food requirements, completes its life
hypertension, hypervolemic hypernatremia and also cause
cycle within 9-12 days, small diploid number 2n=8, high
urinary alkalinisation. It has been reported that 40% of gastric
fecundity and easy adaptability to laboratory conditions.
cancer occur due to noon chai in Kashmir. It has been identified
63
Further more, eggs are opaque which can be counted easily. Figure 5 : Rearing of Drosophila Larvae Under
For experimental work, primary stock had been received from Laboratory Conditions
Drosophila laboratory, Department of Biotechnology, Punjab
Agricultural University, Ludhiana. Drosophila melanogaster
larvae had been maintained in BOD incubator at 25 ± 2 0C 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
propionic acid[3-5].
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 NaHCO3
and 1 gm green tea leaves was boiled in 100 ml of distilled RESULT :
water for making a stock solution of noon tea.
For the present research analysis, the reprotoxic impact of
Exposure to larvae and egg counting: Exposure was given to noon tea on the Drosophila melanogaster had been evaluated.
second instar larvae for 20 hrs. by mixing noon tea in culture Adult flies had been mated in two different experimental sets
medium, simultaneously control had been maintained with along with control. It had been reported that fecundity had been
experimental set. Second instar larvae had been treated for 24 severely affected in treated samples than natural population.
hours under controlled condition of laboratory. Subsequently, Furthermore, it had been analysed that fecundity is more
larvae had been reared upto adult stage, in normal culture predominantly affected if treatment was only male flies.
medium. Thereafter, imagos were allowed to crossmate in two Results had been analysed significant when scrutinized
different sets including first set: treated male and normal through Z-test (Table 1)
female, second set: treated female and normal male, along with
Table 1. Statistical analysis of consequences of noon on
control. Each experiment was repeated thrice. Subsequently, reproduction of Drosophila melanogaster, in
eggs obtained were counted under Bausch and Lomb, comparison to control stocks
dissection microscope, from each respective set. The data
obtained from each set, was scrutinized by Z-test (Figure1-5) Type Set-1 Set-2 Set-3 Mean Z value
Control 2379 2272 2052 2235 10.39
Figure 1 : Drosophila Figure 3: Eggs Laid by (egg count)
Melanogaster (Female) Natural Population
Unhatched
Treated male X 1811 1998 1410 1740

normal female
Eggs
(egg count )
Treated female 2150 2100 1543 1931 6.06

×normal male
(egg Count)
Figure 2 : Drosophila Figure 4: Eggs Laid

Melanogaster (Male) by Treated Individuals DISCUSSION :
Unhatched
Noon chai is a traditional pink coloured salted tea beverage

made in Kashmir. Limited research papers are available on
Eggs
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
consequences of tea on various test models, as in one study, it Sodium, Pinoxaden and Spinosad Pesticides on
had been concluded that tea-polyphenol are responsible for DrosoрhilаnMеlаnogаstеr. Toxicology International
cancer prevention[6] whereas, another study concluded that 2017;24(3):233-39.
that green tea decrease the life span of Drosophila[7]. But 5. Lovleen, Angurana R, Amin DS. Clastrogenic
according to one exploration the high concentrations of green Instrict of Sodium Bispyribacand Pinoxaden
tea water infusion showed toxic effect to Drosophila larvae[8]. Herbicides on Drosophila melanogaster. Toxicology
Some other reports, related with effect of various bio- International 2017; 24(2):178-84.
chemicals and synthetic chemicals on reproduction and
6. Sur S, Panda CK. Molecular aspects of cancer
development of fruit flies are available which includes: in one
chemopreventive and therapeutic efficacies of tea and
exploration, it had been reported that royal jelly enhance the
tea polyphenols. Nutrition 2017;43-44:8-15.
fecundity of Drosophila melongaster and increase the time
duration required for development [ 8 ] . According to 7. Lopez TE, Pham HM, Barbour J, Tran P, Nguyen BV,
Mukhopadhyay, et al., 2006 cypermethrin, a synthetic Hogan SP et al. The impact of green tea polyphenols
pyrethroid adversely affect the reproductive potential of on development and reproduction in Drosophila
Drosophila[9]. Furthermore, Lovleen, et al.,2017 reported, melanogaster. Journal of Functional Foods 2016;20:
negative effects of pesticides including , Bisрyribас Sodium, 556–66.
Pinoxaden and Spinosad Pesticides on the reproductive of 8. Morgan SL, Seggio JA, Nascimento NF, Huh DD,
Drosophila[4]. Similarly, during present study, noon tea had Hicks JA, Sharp KA et al. The phenotypic effects of
been reported to induce statistically significant reprotoxic Royal jelly on the wild type D. melanogaster.
consequences on Drosophila melanogaster. Plos,One 2016;11(8): e0159456.
CONCLUSION : 9. Mukhopadhyay I, Siddique HR, Bajpai VK and
It had been observed, after execution of research work which Saxena DK. Synthetic Pyrethroid Cypermethrin
dealt with reprotoxic consequences evaluation of noon tea, Induced Cellular Damage in Reproductive Tissues of
using Drosophila melanogaster. It had been concluded that Drosophila melanogaster: Hsp70 as a Marker of
noon tea induced statistically significant reprotoxicity in fruit Cellular Damage.Archives of Environmental
fly at 1% concentration. The specific tea induced more Contamination and Toxicology, 2006; 51(4): 673-
pronounced effects on exposed flies than untreated flies. 680.
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
65
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.
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.

Dr. Sukhdeep Singh Received: 24 May 2018
Junior Resident Received in revised form: 19 June 2018
Department of Forensic Medicine, MMIMSR, Mullana, Accepted on: 19 June 2018
Ambala, Haryana, India. Available online: 1 July 2018
Contact : +91- 7357500006
Email: sukhdeep.sidhu00006@gmail.com
KEYWORDS : Skull Fractures, Head Injury, Intracranial Haemorrhages, Road Traffic Accidents
INTRODUCTION : April 2018 on 105 fatal RTA cases having head injury and
The majority of death are due to Road Traffic Accidents (RTA) brought for autopsy to the mortuary of Department of Forensic
in India as well as worldwide. The factors responsible for RTA Medicine of MMIMSR Mullana. Decomposed bodies,
are density of population, conditions of Roads, unawareness of Accident cases with no definite history and without head
safety measures of driving and rash driving etc. More life years injuries were excluded. Patterns of skull fractures along with
are lost due to traffic accidents than cardiovascular diseases in age, sex, type of vehicles, anatomical sites involved is noted.
individuals older than four years of age[1]. India accounts for RESULTS :
about 10% of road accident fatalities worldwide[2]. WHO Most of the victims were males (90.48%). Most of the victims
defined the accident as, “an unexpected, unplanned occurrence were in the 21-30 years age group (37.2%) followed by 31-40
that may involve injury”[3]. Head injury has been defined as, “a years age group (18.1%). (Table 1-2)
morbid state, resulting from gross or subtle structural changes
Table 1: Showing Distribution of Road Traffic Accident
in the scalp, skull, and/or the contents of the skull, produced by
Cases According to Age & Sex
mechanical forces”[4].
The extent and degree of injury to the skull and its content is Age (Yrs.) Male (%) Female (%) Total
not necessarily proportional to the quantum of force applied to 0-10 2 (1.9) 0 (0) 2 (1.9)
the head. According to Munro, any type of cranio-cerebral 11-20 8 (7.6) 0 (0) 8 (7.6)
injury is possible with any kind of blow on any sort of head[5]. 21-30 1 (0.9)
38 (36.2) 39 (37.2)
Severe head injury, with or without peripheral trauma, is the
31-40 16 (15.2) 3 (2.9) 19 (18.1)
commonest cause of death and/ or disability up to the age of 45
41-50 9 (8.6) 2 (1.9) 11(10.5)
years in developed countries[6]. The head being the most
vulnerable part of the body is involved frequently and leads to 51-60 12 (11.4) 2 (1.9) 14 (13.3)
morbidity and mortality in road traffic accidents. 61-70 9 (8.6) 2 (1.9) 11(10.5)
MATERIAL AND METHODS : >70 1 (0.9) 0 (0) 1 (0.9)
The present study was carried out from 1st May 2016 to 30th Total 95 (90.48) 10 (9.52) 105(100)
66
Table 2 : Showing Distribution of Road Traffic Accident observed in 64 (60.9%) followed by combination of extradural
Cases According to Type of Vehicle (EDH), subdural (SDH) and subarachnoid haemorrhage
(SAH) in 24 (22.9%) cases. Solitary intra-cerebral (ICH) and
Type of No. of % extradural haemorrhage was not observed. They were seen
Vehicle Cases only in combination with other haemorrhages. Subdural
Unknown 30 28.5 haemorrhage was the commonest solitary haemorrhage
Bicycle 3 2.9 observed in 6 (5.7%) of the total intracranial haemorrhages.
Bike (Motorcycle) 38 36.2 (Table 4)
Four Wheelers 20 19.1 Table 4 : Types of Intra Cranial Haemorrhages
Others( Heavy Vehicles) 8 7.6 Intracranial
Pedestrians 6 Haemorrhage No. of Cases %
5.7
Total 105 100 EDH ONLY 0 0
Victims in the age group 1-10 years constituted 1.9% only. SDH ONLY 6 5.7
Among the victims the lowest age was four years and highest SAH ONLY 3 2.9
was 72 years. More than 70 years age group was minimally ICH ONLY 0 0
affected. EDH+SDH 2 1.9
Majority of death occurred in bike riders (36.2%) followed by SDH+SAH 64 60.9
four wheeler occupants (19.1%). Heavy Vehicles like Truck SAH+ICH 2 1.9
occupants constituted eight cases (7.6%). (Table 2)
EDH+SDH+SAH 24 22.9
Parieto-Temporal region was involved predominately in 19 SDH+SAH+ICH 2 1.9
(18.1%) cases, followed by fronto-parietal region in 18 cases
EDH+SDH+SAH+ICH 2 1.9
(17.2%). Occipital bone was the most commonly fractured
TOTAL 105 100
single bone of vault of skull, comprising of 17 (16.3%) of total
skull vault fractures.(Table 3)
DISCUSSION :
Table 3: Distribution of Cases According to Anatomical
Location of Skull Fracture Current trends in population growth, industrialization and
urbanization are putting heavy pressure on transport networks
Location No. (%)
particularly on the road systems in the developing world.
Frontal 16 15.2 Because of this, deaths due to Road Traffic Accidents are
Parietal 15 14.3 steadily increasing in the developing countries[7].
Temporal 6 5.7 In the present study, males are largely involved in the accidents
Occipital 17 16.3 with male to female ratio of 9:1. This is in concurrence with
Frontal + Parietal 18 17.2 other studies[8-14]. This shows the male dominance in the
Frontal + Temporal 2 1.9 moving population especially on the roads and in vehicles.
Parietal + Temporal 19 18.1 In our study, 21-30 years was the most common and those
Temporal + Occipital 1 0.9 above 70 years was the least common age group involved in
accidents. This corresponds with other studies[8-13]. The young
Parietal + Occipital 3 2.9
and middle aged groups largely consist of students and
Frontal + Parietal + Occipital 1 0.9
working people in various jobs, who usually travel by either
Frontal + Temporal+ Occipital 1 0.9 own vehicles, buses or walk. This results in the involvement of
Frontal + Parietal + Temporal 5 4.8 young adults more commonly in road traffic accidents.
Frontal + Parietal + Temporal + Occipital 1 0.9 The motor-cyclists were the commonest group of victims,
Total 105 100 comprising 36.2% cases, followed by four wheelers occupants
comprising 19.1% cases. Similar trends were seen by Akhilesh
Intracranial Haemorrhages were noted in 105 cases. A
Pathak et al [15].
combination of subdural haemorrhage (S D H) with
subarachnoid haemorrhage (SAH) was most commonly Parieto-Temporal bone were the most commonly fractured
bones of vault of skull. Ranjit MT et al found the similar
67
findings[16]. 9. Chandra J, Dogra TD, Dikshit PC. Pattern of Cranio-

Subdural haemorrhage was the commonest single intracranial injuries in fatal vehicular accidents in Delhi
haemorrhage observed in 5.7% of the total intracranial 1966-76. Med. Sci. Law 1979; 19 (3): 186-94.
haemorrhages. The similar trends were seen by others[13,16,17]. 10. Akang EEU, Kuti MAO, Osunkoya AO. Pattern of fatal
CONCLUSION : head injuries in Ibadan - A 10 year review. Med. Sci. and
Law 2002; 42 (2): 160-6.
From the present study, following conclusions were derived
regarding road traffic accidents: 11. Gautam Biswas, Verma SK, Jag Jiv Sharma, Aggarwal
NK. Pattern of Road Traffic Accidents in North-East
Ÿ Males are more commonly involved in accidents.
Delhi. Journal of Forensic Medicine and Toxicology
Ÿ Young adults between 21 - 30 years are more vulnerable to 2003; 20 (1): 27-32.
accidents.
12. Nilambar Jha, Srinivasa DK, Gautam Roy, Jagdish S.
Ÿ Fatalities are more in two-wheeler riders than other Epidemiological study of Road traffic accident cases: A
vehicles. study from South India. Indian Journal of Community
Ÿ Fatal head injuries are commonly associated with skull Medicine 2004; 29 (1): 20-4.
fractures and Parieto- Temporal bone is most commonly 13. Anand Menon, Nagesh KR. Pattern of fatal head injuries
affected in RTA. due to vehicular accidents in Manipal. JIAFM 2005;
Ÿ Subdural haemorrhage was the commonest single 27(1): 19-22.
haemorrhage observed in RTA and a combination of 14. Swati Sonawane,Mahesh Jambure. Patterns of head
subdural haemorrhage with subarachnoid haemorrhage injuries in road traffic accidents-An autopsy study:
was most commonly noted in RTA. International Journal of Current Research 2015; 7 (12):
CONFLICT OF INTEREST : None Declared 23733-37
REFERENCES : 15. Pathak Akhilesh, Vyas PC, Gupta BM. Autopsy finding
1. Mohan D. Road traffic accidents and injuries in India: of pattern of skull fractures and intra-cranial hemorrhages
Time for action, Nat. Medical Journal of India, 2004; 17: in cases of head trauma: A prospective study. Journal of
63-6 Indian Academy of Forensic Medicine, 2006:28(4), 187-
90.
2. Arvind Kumar, Sanjeev Lalwani, Deepak Agrawal, Ravi
Rautji, TD Dogra. Fatal road traffic accidents and their 16. Ranjit MT, Keoliya AN. Patterns of head injuries in fatal
relationship with head injuries: An epidemiological road traffic accidents in a rural district of Maharashtra-
survey of five year.Indian Journal of Neurotrauma, 2008 : Autopsy based study. J Indian Acad Forensic Med. July-
5(2).63-67 September 2011: 33(3), 228-31.
3. Hogarth J. Glossary of Health care terminology, WHO, 17. Singh H, Dhattarwal SK. Pattern and distribution of
Copenhagen, 1978. injuries in fatal road traffic accidents in Rohtak (Haryana);
Journal of Indian Academy of Forensic Medicine, 2004;
4. Chavli KH, Sharma BR, Harish D, Sharma A. Head
26(1):20-23.
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.
68
Case Report
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
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
hypertrophy of 5th and 6th segments.There are some reports of hepato cellular tumours that develop in these accessory lobes.

Dr. Vijay Arora, Professor and Head, Dept. of Forensic Received: 15 March 2018
Medicine, Dr. R.P. Govt. Medical College, Kangra at Received in revised form: 13 April 2018
Tanda (H.P.) Available online: 1 July 2018
Contact : 94170-89939
Email : drvjarora@gmail.com
KEYWORDS : Accessory Liver lobes (ALL), Torsion,Malformation
INTRODUCTION : A Pin point atopic ALL with less than 10 gm weight and is most
The Malformations of liver include accessory lobes, agenesis often located at the margins of liver or even gall bladder wall.
of the lobes, absence of segments ,deformed lobes, decrease in CASE HISTORY :
lobe size, atrophy of the lobes and hypoplastic lobes Accessory An unmarried female body of moderate built, aged about 19
Lobe of Liver is congenital ectopic hepatic tissue mostly due to years with rural background was brought for medico legal
embryonic heteroplasia though in rare instances an ALL may autopsy with alleged history of intake of some poisonous
occur after trauma or surgery. There are two types of ALL: An substance .The body was examined externally and internally as
accessory lobe joined to normal hepatic tissue and a lobe that is done in all other cases for post mortem examination and the
completely separate[1]. An ALL and especially completely viscera and blood were preserved for chemical analysis.
separate ALL is rarely seen clinically and is difficult to There was no ante mortem injury appreciable over the
diagnose before surgery; so it is easily missed or body.
misdiagnosed. An abdominal ALL and especially a right
A rare congenital anomaly was found in the Liver. Four
abdominal ALL is reported relatively frequently.
accessory lobes were present in addition to normal Right and
ALL can be Classified in Two Ways : Left lobes. Left Lobe was also lying separate from the main
Ÿ One classification is based upon the fact that whether the organ i.e. the Right lobe of Liver. In addition to these four
accessory lobes are joined to Hepatic tissue or lying accessory lobes were present, two on the inferior surface and
completely separate. On this bases ALL can be classified as two lying anteriorly which were joined/attached to normal
Pedunculated or Sessile. Hepatic tissue. (Figure 1-3)
Ÿ The another classification is based upon volume and DISCUSSION :
weight: Patient with an ALL and no complications have no symptoms
Bulky ALL : Weight more than 31 gm, connected to Liver via or physical signs but may occasionally present with acute
a stalk of tissue or wide base in sub phrenic or peri Hepatic stomach aches/recurring stomach aches. Other complaints can
zone. be precordial pain, nausea and vomiting.
Small ALL : Weight category 11-30 gm,connected to Liver Clinical Manifestations of ALL Depend on Complications :
via a wide base on the surface of Liver or around the right 1. Torsion : Most patients visit the hospital complaining of
posterior lobe. frequent, severe stomachache due to vascular obstruction,
A completely separate ALL with no connection to normal liver ischaemia or even rupture or bleeding.
tissue i.e. most often seen in thorax or pelvic cavity.
69
2. During the seventh and eighth week of embryonic REFERENCES :

development : that is when mascular layer of abdominal wall 1. Wang C, Cheng L, Zhang Z. Accessory lobes of the
forms ,development of an ALL in embryo may obstruct Liver: A cse report of three cases and review of
closing the umbilical ring which is why most ALLs are literature; Intractable and rare diseases Research,
associated with acromphalus (i.e.Umbilical hernia). 2012, May 1 (2),86-91.
3. ALLs can also be associated with congenital biliary 2. Rao PPJ, MurliManju BV, Lobo SW, Menezes RG.
atresia : Hundal noted that from 1925 to 2006 there were 18 An unusual morphology of Human Liver: a case
cases of ALL diagnosed after Surgery or Biopsy. report with emphasis on its clinical implications;
Most reported cases of an ALL involve females ranging in age Journal of morphological sciences,2011,28(4):303-
from new born to 75 yearsof age however they might present in 304
any age group as an accidental finding. 3. Rao PPJ, Murli ManjuBV, MEnezes RG. Dumb bell
Wang et al[1] have reported three cases of accessory lobes of shaped morphology of liver: An autopsy case
Liver based upon CT scan and MRI and confirmed by Surgical report;Clin Ter,2013,164 (1):29-30
and Histilogical examination. Out of these three cases, one 4. GlenissonM,Salloum C. et al. Accessory Liver lobes:
case involved a pedunculatted ALL,another case involved a anatomical descriptions and clinical
true ectopic Liver and third case involved a sessile accessory i m p l i c a t i o n s ; J o u r n a l o f Vi s c e r a l s u rg e r y
lobe of Liver. (2014),151(6):451-455.
Rao et al[2-3] observed during routine autopsy ,that the Liver was 5. Joshi SD, Joshi SS, Athavale SA. some interesting
having some un usual morphology .There were two vertically observations on the surface features of Liver and their
placed furrows present on the anterior surface of the right lobe. clinical implications; Singapore Medical journal
The furrows were partially deep and measured 7cm and 4cm in 2009;50:715-19
length.
6. MacMohan HE. Congenital anomalies of the Liver.
Rao et al[2-3] have also reported acase with unusual shape of American Journal of Pathology1929;5:499-508.
Liver .The left lobe of Liver was bifid having dumb bell typed
7. Aktan ZA, Savas R et al: Lobe and segment
morphology.
anomalies of liver, Journal of Anatomical Society of
Acording to Joshi et al[5] the knowledge of morphological India2001;50:15-16
variations on the Liver surface is important to imaging
specialists and surgeons, in order to avoid possible errors in Fig. 1 Fig. 2
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. Fig. 3
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.
70
A Case Report
Pericardial Rupture without Cardiac Injury or Herniation
1. 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.
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 Received: 7 March 2018
Associate Professor, Department of Anatomy, Received in revised form: 25 March 2018
Kasturba Medical College, Manipal, Available online: 1 July 2018
Manipal Academy of Higher Education, Manipal, India.
Contact : 98867-38555
Email : chandnipalimar@gmail.com
KEYWORDS : Blunt Traumatic Pericardial Rupture, cardiac herniation.
INTRODUCTION: clot. But any tears beyond 8-12 cm may result in subluxation
Blunt traumatic pericardial rupture is rarely reported although /torsion of the heart and the deceased may die subsequently
the incidence of chest trauma accounts for 10 -15 % of all the due to cardiogenic shock[4].
traumatic cases and the mortality associated with it sums up to CASE REPORT:
25 %. The rare clinical presentation coupled with The deceased was a 46 years old adult male, with a history of
misdiagnosis, complications and rapid deterioration of the fall from height. He had sustained severe injuries over the back
patient are the contributory factors for high incidence of of his chest and was not able to speak. He was brought dead.
mortality.
On Autopsy : Left sided hemothorax was discovered with 800
Anatomically, pericardial sac is a pleuropericaridial fold, ml of frank blood in the pleural cavity. Retrosternal contusion
develops in the fifth month of intrauterine life as a fold of was noted. Fracture of left 1st to 12th ribs were present along the
mesenchyme[1]. The sac is composed of outer fibrous and the left side of the posterior chest wall along the left midscapular
inner doubled layered sac is serous pericardium. Anteriorly, it line. Left lung showed lacerations and contusions. Pericardial
is separated from the chest wall from the lungs and the pleura, tear measuring 3 x 0.5 cm x pericardial cavity deep was seen
except at a small region corresponding of posterior sternum over the left pleuopericardial region. (Figure 1)
corresponding to the 4th and 5th 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 Figure 1 :
diaphragm's central tendon[2]. Showing the
Pericardial tear
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
nerve[3]. Small lacerations may heal on its own by formation of
71
100ml of frank blood was present in the pericardial sac. No severity, however when encountered in triage requires
features of cardiac injury or any herniation was noted. immediate and prompt measures. The clinical picture should
Cause of Death : was opined as death due to multiple injuries warrant the clinician about the possible diagnosis. Diagnosis
to the chest as a result of blunt force trauma. is often missed but with availability of imaging modalities like
FAST which is 97 – 100 % sensitive and other modalities it can
DISCUSSION:
be diagnosed. Operative intervention is thoracotomy with
It is often said that blunt traumatic pericardial rupture is an surgical closure.
incidental finding intra operatively, or at autopsy. Such patients
REFERENCES:
hardly have any time, and sometimes the patient are lost even
before they arrive at the hospital. Also the tense and stressful (1) Larsen WJ. Human Embryology. 3. Philadelphia:
environment of triage system also possess some difficulty in Churchill Livingstone; 2001.
diagnosing the condition. Multiple abrasions, contusions with (2) Gray H. Gray's Anatomy. 38. Philadelphia: Churchill
underlying ribs fracture can be associated findings. History Livingstone; 1999.
may be of Blunt trauma sustained as a result of road traffic (3) Thomas P, Saux P, Lonjon T, Viggiano M, Denis JP,
accident, Sudden deceleration, Fall from height with vector of Giudicelli R et al. Diagnosis by video assisted
injury on the left side[5]. thoracoscopy of traumatic pericardial rupture with
Clinical Features which may rise suspicion of cardiac delayed luxation of the heart: case report. The Journal of
herniation includes [6] displaced and heaving apex beat, a Trauma Injury, Infection and Critical care. 1995;38: 967-
splashing murmur "bruit de Moulin" as a result of the heart 70.
moving in a haemopneumopericardium[7], hemodynamically (4) Carillo EH, Heniford BT, Dykes JR, McKenzie ED, Polk
unstable despite intravenous fluid administration and inotropic HC, Richardson JD. Cardiac Herniation Producing
support, signs similar to that of cardiac tamponade, pulsus Tamponade: The Critical Role of Early Diagnosis. The
paradoxus, raised jugular venous pressure (JVP), tachycardia Journal of Trauma Injury, Infection and Critical care.
and dysrhythmia. 1997;43 (1): 19-23.
Investigation: Various imaging modalities are available. (5) Clark DE, Wiles CS 3rd, Lim MK, Dunham CM,
Ÿ An ideal Triage usually have the facility of “FAST Rodriguez A. Traumatic rupture of the pericardium.
(Focused Assessment with Sonography in Trauma)”. Surgery. 1983; 93:495-503.
The sensitivity of FAST in detecting pericardial fluid is as (6) Sherre PB, Galloway R and Healy M. Blunt traumatic
high as 97 -100 %[8]. pericardial rupture and cardiac herniation with a
Ÿ CT (Computed Tomography) is useful in stable patients penetrating twist: two case reports. Scandinavian Journal
especially detecting the complications such as Cardiac of Trauma, Resuscitation and Emergency Medicine.
herniation. 2009;17:64
Ÿ MRI, Ultrasound, Chest X-ray, ECG can also provide (7) Wright MP, Nelson C, Johnson AM, Mcmillan IKR.
substantial information. Herniation of the heart. Thorax. 1970;25: 656-66.
Treatment: Once diagnosis is established the treatment is (8) Fulda G, Brathwaite CEM, Rodriquez A, Turney SZ,
based on the severity of injury[5]. Dunham CM, Cowley RA. Blunt traumatic rupture of the
(1) Video-assisted thoracoscopy especially in stable heart and pericardium: a ten-year experience
patient and where there is lack of diagnosis clarity. [1979–1989]. J Trauma. 1991; 31:167–73.
(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
72
A Case Report
Elongated Styloid Process (Eagle Syndrome) - A Rare Finding at Autopsy
1. 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
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.

Dr. Anil Garg, Received: 6 March 2018
Associate Professor, Received in revised form: 31 March 2018
BPS Government Medical College for Women, Khanpur Available online: 1 July 2018
Kalan, Sonipat
Contact : 98724-02904
E-mail: anil9637@yahoo.com
KEYWORDS : Eagle Syndrome, Styloid Process, Autopsy
INTRODUCTION: process occurs[6].

Eagle syndrome is constellation of symptoms varrying form The elongated styloid process may present as one of cause of
recurrent neck pain on rotation, foreign body sensation in the sudden death due to pressure or constant irritation of jugular or
neck, hyper salivation, difficulty in swallowing, hypoacusis, carotid arteries and carotid body. A case of Hispanic male with
hyperacusis, earache, syncope and sudden death due to external carotid pseudoaneurysm with pointed elongated
elongation of the styloid process or ossification of stylohyoid styloid process was reported in emergency with neck
ligament[1]. This syndrome was first described by Watt W. oedema[7]. Forensic experts may come across these type of
Eagle, an Otorhinolaryngologist in 1937[2]. unnatural death reported to be syncope or heart attack which
Every human is unique anatomically, even identical twins are may get missed if they are unaware of elongated styloid
not alike. Stylos in greek means pillar which is a thin, process or ossified stylohyoid complex. Fractured elongated
cylindrical, sharp osseous process, deriving from the posterior styloid process may be present as important finding in
lower surface of the petrosal bone just anterior to stylomastoid unnatural deaths like Hanging and Manual strangulation[8].
foramen[3]. On the same side, the apex of the styloid process is OBSERVATIONS :
connected with the lesser cornu of hyoid bone by stylohyoid In routine autopsies, on dissection in the neck region many a
ligament. The ligament represents from embryological view times, styloid process is not visualized and not dissected out.
the continuation of the processes apex. The styloid process But in decomposed bodies as tissues are macerated and hence
originates from the Reichert cartilage of second branchial arch. it can be dissected out easily at the base of skull. We have also
Styloid process length mostly ranges from 20 mm to 30 mm [4]. encountered three cases at autopsy of decomposed body where
Stylomandibular ligament, Styloglossus, Stylohyoid, and we found elongated styloid process and details are given in
Stylopharyngeus muscles are attached at the styloid process [5]. Table No. 1.
In about 2 to 30% of general population an elongated styloid
73
Table No 1 : Details of Cases
Case No. Sex Stage of Decomposition Length of Styloid Age of individual
left Side Right Side
1 Male Adipocere 4.8 cm 3.8 cm (Fig. 1) 40-50 years
2 Male Adipocere 4.3 cm 4.8 cm (Fig. 2) 40-50 years
3 Male Mummified 5.1 cm 5.4 cm (Fig 3) 40-50 years
DISCUSSION AND CONCLUSION :

Figure 1
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
Figure 2
angiographic correlation. 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
Anatomical basis of clinical practice 39th 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 Figure 3
Forens Med 2006;13:268-70.
74
Review Paper
Role of Forensic Odontologists in Child Abuse Detection and Reporting : A Review
1. 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
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.

Dr. Pooja Puri, Received: 23 March 2018
Assistant Professor, Received in revised form: 28 March 2018
Amity Institute of Forensic Sciences, Amity University, Available online: 1 July 2018
Noida, U.P.
Contact : +91 98735-15547
Email : poojaforensics@gmail.com
KEYWORDS : Forensic, Child Abuse, Facial Injuries, Forensic Odontologist.
INTRODUCTION : may not have intended to hurt the child. It may however, be the
According to the convention on the rights of the child, Article 1 result of over discipline or physical punishment that is
defines, “the child as every human being below the age of 18 inappropriate to child's age.
years unless under the law applicable to the child, majority is 2. Sexual Abuse : Is an inappropriate sexual behavior with the
attained earlier”[1]. In Indian legal system, the child has been child by the person responsible for the care of the child. It
defined differently in various sections of the laws pertaining to includes fondling a child's genitals, making the child fondle
children. The Indian Immoral Traffic (Prevention) Act, 1956 adult genitals, intercourse, incest, rape, sodomy, exhibitionism
defines a child as a person who has not completed the age of 16 and sexual exploitation.
years[2] . The sections 82 and 83 of Indian Penal Code state that 3. Emotional Abuse : Also known as verbal abuse or mental
nothing is an offence done by child under 7 years and further abuse or psychological maltreatment. It includes acts or the
under 12 years, till he has attained sufficient maturity of failures to act by parents or caretakers that have caused or
understanding the nature of act and the consequences of his could cause, serious behavioral, cognitive, emotional or
conduct on that occasion[3. The World Health Organization mental trauma.
defines child abuse as: all forms of physical and/or emotional
4. Neglect : Failure to provide for the child's basic needs.
ill-treatment, sexual abuse, neglect or negligent treatment or
Neglect can be physical (failure to provide adequate food,
commercial or other exploitation, resulting in actual or
clothing, medical care etc.), educational (failure to provide
potential harm to the child's health, survival, development or
schooling etc.) or emotional (lack of emotional support/love
dignity in the context of a relationship of responsibility, trust or
etc.)
power[4].
It is worth mentioning that these types of abuse are interrelated
Child Abuse is a globally prevalent phenomenon and this term
and typically found in combination than alone. For instance, a
may have different connotations in different contexts. The
physically abused child is often emotionally abused and
four major categories of abuse are traditionally
sexually abused child may also be a neglected child[6-7].
recognized[5]:
Risk Factors For Child Abuse and Neglect: The child abuse
1. Physical Abuse : Inflicting of physical injury upon a child.
is a complex problem with no single attributable cause. Rather
This may include burning, hitting, punching, shaking, kicking,
it is the result of an interplay of multiple factors. Some of the
beating or otherwise harming a child. The parent/ caretaker
risk factors for child abuse and neglect are summarized in
75
Table 1[8-11]. child abuse on the oro-facial region may be a challenging task
Table 1 : Risk Factors for Child Abuse for the medico-legal expert and by collaborating with
odonotologists they can better diagnose and detect such
Ÿ Personality characteristics Homelessness
and psychological
Ÿ injuries. The signs of abuse may vary from case to case. Most
Ÿ Poverty and
well being unemployment of the victims will have injuries that are either unexplained,
Ÿ History of maltreatment Social Isolation/Social
Ÿ Substance Abuse
Ÿ inconsistent with the explanation given and of different
support
Ÿ Attitude and knowledge Ÿ Low Socio-economic durations. There may be presence of burns/scalds, broken
Ÿ Marital Conflict Status
Ÿ Domestic Violence
bones, human bite marks etc. Some of the physical signs of
abuse/neglect in oro-facial region as summarized below :
Parent/Care Social
giver Factors Factors
Oral/Facial Signs of Abuse/Neglect
Environmental Region
Factors Child
Factors
Teeth Fracture, Avulsion, Subluxation
Intraoral Labial/ lingual frenum tears, burns,

Ÿ Disabilities lacerations, contusions, abrasions
Ÿ Stressful Life Events Ÿ Age on labial/buccal mucosa, palate,
Ÿ Violent Communities Ÿ Developmental Delay or tongue, floor of mouth, poor oral
mental retardatation hygeine, delayed dental treatment
Lips Burns, lacerations, contusions,
abrasions
Some of the Alarming Statistics are:
l More than 200 million children are involved in child Cheeks Burns, lacerations, contusions,
labor, with more than 180 million working in abrasions, bite marks.
hazardous situations or conditions[12]. Jaw Bones Fractures of facial bones, maxilla or
l An estimated 1.2 million children are subjected to condyles/ramus/symphysis of mandible
trafficking every year; 5.7 million are working as
Nose Nasal fractures, lacerations. contusions
forced and bonded labourers. 1.8 million Children are
involved in the act of prostitution and pornography[13]. Orbital area Fractures of orbital bones, retinal
l About 140 million girls and women worldwide are hemorrhages, ptosis, periorbital
suffering the consequences of Female Genital bruising.
Mutilation (FGM). In Africa, about 92 million girls in Skull /Scalp/ Fractures, subdural hematomas,
the age group of 10 years and above are estimated to Hair traumatic alopecia
have undergone FGM[14].
Ears Bruising of the auricle, damage to
l Every year there are estimated 31000 homicide deaths
tympanic membrane
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 In addition other features of child abuse may include
maltreatment are incorrectly attributed to falls, burns, behavioral indicators such as withdrawn behavior, anger,
drowning and other causes[15]. hostility, depression, anxiety, loss of self confidence and
flinching when approached or touched[16-17]. The roles and
l The deaths are only the tip of the problem. Millions of
responsibilities of an Odontologist in such cases of child abuse
children are victims of non-fatal abuse and neglect. In
are quite crucial, especially when the victimized children
a study, between one-quarter and one-half of children
present symptoms of abuse in and around the areas of oral
report severe and frequent physical abuse, including
cavity only. Once the Forensic Odontologist is sure about his
being beaten, kicked or tied up by parents. A
diagnosis of a case of child abuse, it becomes his legal
substantial amount of harsh punishment in the form of
responsibility to report the matter to proper authorities.
hitting, punching, kicking or beating also occurs in
schools and other institutions[8]. Forensic odontologists and the pediatric dentists have a
mandated child abuse curriculum included in their formal
Role of Forensic Odontologists : Recognizing the signs of
training courses. This helps them towards sharing the valuable
76
information thus gathered and providing assistance to other 9. Leeb RT, Paulozzi L, Melanson C, Simon T, Arias I. Child
forensic examiners about oral and dental aspects of child abuse Maltreatment Surveillance: Uniform Definitions for
and neglect. The Prevent Abuse and Neglect through Dental Public Health and Recommended Data Elements, Version
Awareness (also known as PANDA) coalitions have trained 1.0. Atlanta (GA): Centers for Disease Control and
thousands of dentists and dental auxiliaries in United States[18]. Prevention, National Center for Injury Prevention and
CONCLUSION: Control. 2008. [Online]. [cited 2018, Feb20];
Av a i l a b l e f r o m : h t t p : / / w w w. c d c . g o v /
Child abuse is a vast multidisciplinary area involving experts
violenceprevention/ childmaltreatment/
from different walks of life including general physicians,
riskprotectivefactors. html.
pedodontists, forensic odontologists, psychologists,
councilors and other governmental and non-governmental 10. Emerging Practices in the Prevention of Child Abuse and
officials. Thus the formal formation of such task forces which Neglect U.S. Department of Health and Human Services,
include all experts is a need of the hour to address the issue of Administration for Children and Families, Administration
child abuse and neglect. All these teams should identify the on Children, Youth and Families, Children's Bureau,
core problematic areas and work collectively utilizing mutual Office on Child Abuse and Neglect. 2003.[Online].[Cited
resources towards eradication of such evils from the human 2 0 1 8 , F e b 2 0 ] ; a v a i l a b l e f r o m
society thereby enhancing our abilities of love care and URL:https://www.childwelfare.gov/preventing/program
protection for the children. s/whatworks/report/report.pdf
REFERENCES : 11. International Labour Organization: A Future without
Child Labour. Global Report, ILO, 2002.
1. Flukinger A. International Law and the Right to Adequate
Food [Internet]. 2010 [cited 20 February 2018]. Available 12. International Labour Organization: New Global
from: http://treaty.org/reports/WUCL_Hunger&Law- Estimates on Child Labour. ILO, 2002.
A_Flukinger.105.pdf. 13. Child trafficking [Internet]. UNICEF. 2011 [cited 20
2. The Indian Immoral Traffic (Prevention) Act, 1956. February 2018]. Available from:
https://www.unicef.org/protection/57929_58005.html.
3. Preventing child maltreatment: a guide to taking action
and generating evidence [Internet]. 2006 [cited 20 14. Female genital mutilation—new knowledge spurs
February 2018]. Available from: optimism: [Internet]. WHO.; 2006[cited 2018,Feb 20];
http://whqlibdoc.who.int/publications/2006/9241594365 Av a i l a b l e f r o m U R L : h t t p : / / w w w. w h o . i n t /
_eng.pdf. reproductivehealth/ topics/fgm/progress72_fgm.pdf
4. Report of the Consultation on child abuse prevention. 15. Child Maltreatment: [Internet]. 2016 [cited 20 February
[Internet]. [cited 20 February 2018]. Available from: 2018]. Available from http://www.who.int/news-
http://www.who.int/violence_injury_prevention/violenc room/fact-sheets/detail/child-maltreatment
e/globalcampaign/en/chapter3.pdf. 16. Hinchliffe J. Forensic odontology, part 5. Child abuse
5. Kenney JP, Spencer ED. Child Abuse and Neglect. issues. British Dental Journal. 2011;210(9):423-428.
Manual of Forensic Odontology, Saratoga Springs, NY: 17. Kumar N, Anuradha G. Child abuse: An orodental
American Society of Forensic Odontology; 1997, p. perspective. International Journal of Forensic
191–3. Odontology. 2016;1(2):43.
6. Vale GL. Dentistry's Role in detecting and preventing 18. Oral and Dental Aspects of Child Abuse and Neglect
child abuse. In: Stimson PG, Mertz CA, editors. Forensic [Internet]. Review Group American Academy of Pediatric
Dentistry. First, Boca Raton, New York: CRC Press; Dentistry, Council on Clinical Affairs.; 2017 [cited 20
1997, p. 176–8. February 2018]. Available from:
7. Child Abuse and Neglect [Internet] .2002 [cited 2018, http://www.aapd.org/media/Policies_Guidelines/BP_Ch
Feb20].Available from: ildAbuse.pdf.
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
77
Review Paper
Nanotechnology And Its Applications In Forensic Sciences- A Boon To Legal Justice
Jaskaran 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
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.

Dr. Jaskaran Singh, Received: 17 February 2018
Assistant Professor, Received in revised form: 14 April 2018
School of Bioengineering and Biosciences, Available online: 1 July 2018
Lovely Professional University, Phagwara, Punjab
Contact : 99105-41247
Email : jaskaransingh630@gmail.com
KEYWORDS : Nanomaterials, Forensics, Identification
INTRODUCTION: more accurate and quick in order to enable quick and reliable
Nanotechnology deals with the manipulation of articles at the delivery of justice.
Nano level. Nanoparticles, besides being strong and stable, APPLICATIONS OF NANOTECHNOLOGY IN
have a large surface area, and can exhibit quantum effects FORENSIC SCIENCES:
ranging less than 10 Nanometres. This size range makes it 1. Authentication of sound recording- an evidentiary clue
possible to control various physical and/or chemical (Figure 1-2) : The importance of tape integrity in civil criminal
properties. Nanotechnology is practically applied in hearing shows everlasting reliance that whether to disqualify
Electronic Engineering, Physical, Material Sciences, or qualify audio tape evidence. Since tape recordings can be
Biomedical Sciences and Forensic Sciences among many. subjective to misinterpretation and falsification by editing
In the field of Forensic Sciences Nanoparticles have been used digitally through computer technology[1]. These editing can be
as luminescent markers to detect gunshot residue, done by various methods like:
development of latent fingerprints, enzymatic processing of Obscuration: a method used to distort a recorded signal in
DNA, Forensic explosive detection, post blast explosive order to render selected portions of information unintelligible
residues analysis, Gold Particles to enhance PCR accuracy, the
Deletion : Deletion of unwanted material by erasing, recorded,
atomic force microscope (AFM), to scan evidence surfaces,
stop/ pause.
Scanning Tunnelling Microscope (STM), that work on the
concept of quantum tunnelling. This Paper portrays reviews of Transformation : Alteration in a portion of recording to alter
all and existing Nano techniques that aid Forensics in being its original content.
78
Synthesis: Generalisation of artificial text by incorporating it instance, separation of various dye components via TLC or
with either a background sound, or a conversation, to a taped HPLC)[3]. To add “pigment characterization”, Carbon and
copy. In order to detect these editing nano particles of carbon silver nanoparticles are included in the composition analysis of
Ag and ZnO coated onto tapes which will help to detect these the pigment (e.g., elemental profile) and for morphological
aural anomalies on tape. Any editing onto these nano coated characterization (e.g., shape and size)[4].
tapes will alter the shape and size of nano particles, which will Figure 3 : Luminous Carbon Nanoparticles for ink gel
be deciphered by AFM and wave form analysis. analysis
Figure 1 : Different Type of Editing Shown by AFM
Abc abc abc abc abc abc abc abc abc

Fluroscent luminious
abc abc abc abc cba abc abc abc abc carban nanoparticle
Distort Ink gel
Abc abc abc abc abc abc abc abc abc
This inculcation of nanoparticles in different types of inks will
abc abc abc abc cba abc abc abc abc give uniqueness to inks for identification purposes.
Delete abc 3. Nanoparticles as Security Tags (Figure 4-5) :
Abc abc abc abc abc abc abc abc abc There are numerous ideas for making documents secure.
Passports, credit card and banknotes are just a few that are
abc abc abc abc abc abc 123
abc abc abc
always being upgraded in their security features.[5]
Synthesis 123 there are generally 3 security features in a document of
importance: First, where counterfeit is detectable by the naked
123456789 123456789 123456789
eye; Second, where optical devices are used (like infrared
123456789 145678239 123456789 lighting etc); and Third, where the document has to be tested in
a laboratory. The use of nanoparticles to make documents more
Transformation of letter 23 from its Original Position secure by introducing them in their inks or paper is gaining
much popularity. For example, Q-dots can be made to
Figure 2 : Wave Form Analysis of Audiotapes. luminescence not only in the near infrared region (between 0.7
microns and 1 micron), but in the short-wave infrared region
(between 1 micron and 2 microns) as well. [6] 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
vary from their larger counterparts. [7] 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
Imbibing Nano Particles in writing and printing Ink Figure 4 : Luminous Q Dots in Passports
Analysis(Figure 3) : The most common ink types that contain
Nano particles (mainly those of Carbon and Silver) are gel inks uv light
and ink jet inks[2] . 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 Luminescence (this luminescence is
unique and found only in passports)
by conventional methods to set up analytical profiles (for
79
Figure 5 : Flowchart of Nanotechnology in Security Tags 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
morphology of ammonium perchlorate,
4. Nanotechnology & Trace Evidences : Before the onset of Cyclotrimethylenetrintramine (RDX), trinitrotoluene (TNT),
Nanotechnological applications in Forensic Sciences, and Triaminotrinitrobenzene (TATB) systems.
collection of critical trace evidence, found at the nan scale, was
5. Fingerprinting Analysis (Figure 7-8) : Fingerprint is as
not possible due to lack of proper instrumentation.
impression formed on a surface upon being in contact with the
Nanoparticles have novel properties, which come in trace
friction ridges present on the fingertips of a human being.
evidence collection and analysis[8]. Nanotechnology has made
These are formed on suitable surfaces due to sweat secreted by
a major impact on the analysis of micro surfaces through the
the eccrine glands present in the ridges of the epidermis. The
use of various probes that interact with the surface in question.
recovery of fingerprints from a crime scene is a very crucial
AFM has now become a crucial part of surface analysis of
method in Forensic Science[11]. Latent fingerprints are those
various pieces of evidence like in collection and analysis of
prints that are invisible to the naked eye and are required to be
latent foot print/ shoe print/ pugmark evidences.
“developed” (like in case of photographs from a negative) by
How does AFM work? (Figure 6) : physical, and/or chemical means. The technique applied for
Atomic Force Microscopy is a scanning probe microscopy that developing depends on various conditions present at the time
possesses resolution of the order of Nanometres, a 1000 time of collection. In most cases, latent fingerprints go undetected,
better than the optical diffraction limit. Desired information is thereby hindering investigations.
gathered by touching the surface against a magnetic probe. Silver Physical Developer (Ag-PD) (Figure 7) : Silver
Piezoelectric elements that facilitate tiny but accurate and Physical Developer (Ag-PD) is a reagent used in standard
precise movements on (electronic) command enable very procedures used to develop latent fingerprints on wet and
precise scanning.[9]. porous surfaces, like paper and cardboard. Silver particles
Figure 6 : Block Diagram of the Working of AFM present on the water insoluble components precipitates as a
black substance along the fingerprint ridges. This process is
based of the principle of Fe2+ 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
poor [12] . 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
latent fingerprint collection. [13] The Gold nanoparticles adhere
Also, the AFM helps with deciphering complex written to the fingerprint residue and catalyse the precipitation of
evidence. The device measures the force exerted between a Metallic Silver from the Ag-PD solution. The adherence
microscopic tip and the atoms of the writing surface, which happens due to the interaction of the negatively charged Gold
enables the nanoscale viewing of the surface. This could help colloid, and the positively charged fingerprint residue, at a low
with document evidence where overwriting has been done.[10] pH.
Using the AFM, one can determine how old a sample of blood Figure 7 : Working of Ag-PD and Au Nanoparticles
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
80
Figure 8 : Identification of Latent Fingerprints on Wet fingerprint pattern. This double imaging not only gives details
Paper 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
causes them to emit light. [14]
Figure 9 : Enzymatic DNA Processing with Gold
Nanoparticles
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
A novel bio-sensing methodology has been developed for
(SiO2), and Gold nanoparticles coated with a Carboxyl group.
extremely sensitive and selective detection of histone
A special dye was also prepared in order to best view the
modifying enzymes, along with their inhibitors. This
fingerprints. Development of the fingerprint became possible
methodology banks on the antibody-mediated organisation of
due to the interaction between the Carboxyl group in the
Gold Nanoparticles (AuNPs) decorated with substrate
solution, and certain Amine groups characteristic of fingerprint
peptides which undergo enzymatic modifications with the help
residue. This procedure, however, is still under further
of histone modifying enzymes. This design enables the
research and development.
enzyme activity to undergo a visual and homogenous assay
With the development of the above-mentioned methods, it can using antibodies, which offers a robust and convenient
be concluded that certain chemical interactions between platform for enzyme and inhibitor screening. [15]
nanoparticles and certain chemical groups present in
Figure 10 : Activity of Histone Proteins with Gold
fingerprint residue can be promoted. These interactions, on
Nanoparticles
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
81
7. Nanoparticles Used in Paint Material (Figure 11) : architecture to provide substantial advantages over current
Nanoparticles are used in many materials and Paint is one of technologies, Nanotechnology applications for the protection
them.In general terms, Paint depicts a liquid that is used to cost of the soldier in the field. Nano Armour: Method for creating
a solid surface in order to protect it, seal or colour it.[16] super strong materials uses tungsten, not carbon, for the basic
Nanoparticles are used in many materials, and paint is one of material. It is five times stronger than steel and at least twice as
them. Generally, paint is defined as a liquid used to coat the strong as any impact-resistant material currently in use as
upper surface of a solid substance to seal, protect, or impart protective gear. It has withstood the equivalent of dropping
colour o it. Paints used in indoor as well as outdoor work have four diesel locomotives onto an area the size of a fingernail.
added biocides, among other additives for protection against Possible applications for this new Nanomaterial are ballistic
chemical, physical, or biological deterioration. Of late, the protection personal body armour, bullet proof vests, vehicle
paint industry is not only focussing on upgrading their paint armour, shields, helmets, and protective enclosures.
formulation, but also consider the incorporation of Smart body Armour: Another new Nano-armour is called
Nanoparticles (Nano-Silver, Nano-Copper, Nano-Zinc oxides, "smart" body armour. It weaves thin pads or cloth from fibres
photo catalytic active Nano-Titanium, Nano-Silica etc) as that can sense the impact of a bullet or shrapnel and
additives for protection of material against spoilage. In the near automatically stiffen. This material would be even more
future, Nano materials should replace biodegradable additives resistant to penetration and less cumbersome than the ceramic-
to aid in improvement of paint quality and properties.[17] plate armour troops wear now.[19]
Figure 12 : Use of Nanoparticle Coated Paint 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
Bullet Gun
Layers of Nano-polymer of Teflon
9. Gunshot Residue Analysis : Microscopic particles of

gunshot residues are often present on the hands of a shooter,
8. Nanotechnology for Defence (Figure 12) : Protection following discharge of a firearm. These GSR are partially
represents an important industry, both economically and composed of nanoparticles of lead oxides crystalline
socially. The Nano products includes from simple plastic especially PbSb and Barium (Ba). Instead of analysing GSR
gloves to sophisticated and confidential military armour. chemically from the shooters hand, the GSR can also be
Today's generation of body-armour systems can provide characterized for identification by using SEM and AFM on the
protection at various levels. Like the way of using the elasticity basis of these nanoparticles present on it.
of carbon nanotubes to not only stop bullets penetrating
SUMMARY & CONCLUSION:
material but actually rebound their force without any trace of
damage.[18] Some of the examples are listed below: The insistence of nanotechnology designed materials is
rapidly increasing all around world. Its applications are giving
Develop covert nanomaterials for the tracking, labelling, and
impact on various field of agriculture, food, industry,
authentication of high value items, Nano-sensors with the
biomedical science. Due to its sensitivity site targeting
ability to detect toxins or other harmful threats at the molecular
properties and specificity, the nanoparticles senses as a boon
or even atomic level, Nanoelectronics and nanocomputing to
for identification, detection, determination of various
integrate transistor-like nanoscale devices into system
82
evidences in forensic sciences. Here, in arena of forensic Microscope. Physical Review Letters1986; 56: 930-
science where sensitivity and specificity is crucial important 933.
characteristic feature to identify sample. Without using any 10. R. Arvind. Nanoscale Characterization of Mock
distinctive method of analysis, such designed techniques lead Explosive Materials Using Advanced Atomic Force
to one of the most compliance reliable method for Microscopy Methods. Journal of Nano-sciences
identification of forensic evidence. As nanoparticles are 2015; 1: 1671-76.
known for their diverse properties like permeability, solubility, 11. M. Berger. Nanotechnology- The Future is Tiny.
adsorption, etc. It helps in collection, preservation and analysis Journal of Nano-optics chemical 2009; 3: 45-50.
of forensic evidence. Furthermore this application will not
12. M. Samet,I.Shweky,U. Banin,D. Mandler, J. Almog.
only improve the sensitivity analysis but will also aid in fast,
Application of nanoparticles for the enhancement of
accurate less time consuming activities. Nevertheless several
latent fingerprints. AdvanceArticle of Nano-Sciences
types of issues and concerns are being raised for such
2007; 5:113-116
application of nanoparticles but, then role in forensic science is
marvellous which gives aid in investigation and criminal 13. O. Hofstetter, A. M. McDonagh, C. Roux, C.
justice system without ambiguity. Lennard. Enhancement of latent finger-marks on
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glasses. Anal Chem 2009; 20(6): 293–300. Characterization of Nanofibers: Methods and
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83
Correspondence
Suggestion for MPT act, “abortion on demand”?
1. Lalit Kumar, Associate Professor, Forensic Medicine, Sri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun
There is so much ambiguity in the MTP act 1971 for the some Are they all saving the life of pregnant Women
points. By taking benefits of these ambiguities in MTP act (unmarried, widows, divorced and recently married
1971; so many doctors getting unreasonable monetary benefits females)?
while doing MTPs and patients are satisfying their demands. Is this not “abortion on demand”?
Suggestions/Definite answer of the following matters :
Then what's about The Indian Penal Code (Act No. 45
1. “Abortion on demand” is Legal whether it is demanded by of 1860) permitted abortion only when it was justified for
married or unmarried /widows/ divorced female result of the good faith purpose of saving the life of the woman.
contraceptive failure. (As 3.(2) in MTP act 1971,
One thing left is equal right of human beings as Article 2 of the
explanation
Universal Declaration of Human Rights states that “Everyone
2. Section 312 to 316 of the Penal Code provided that any is entitled to all the rights and freedoms set forth in this
person performing an illegal abortion was subject to Declaration, without distinction of any kind, such as race,
imprisonment for three years and/or payment of a fine; if colour, sex, language, religion, political or other opinion,
the woman was “quick with child”, the punishment was national or social origin, property, birth or other status.
imprisonment for up to seven years and payment of a fine.
Then, how can we differentiate between the fundamental rights
The same penalty applied to a woman who induced her of females being –married/ unmarried/ widows/ divorcees.
own miscarriage. In India, some statute provides certain
Copy To :
benefits to unborn child. For example: section.13 of
Transfer of Property Act. Ÿ PMO, New Delhi email: connect@mygov.nic.in,
indiaportal@gov.in
Ref: Sec 312 IPC. Causing miscarriage.—whoever
Ÿ Member-Secretary, Law Commission of India New
voluntarily causes a woman with child to miscarry, shall,
Delhi E-mail: lci-dla@nic.in
if such miscarriage be not caused in good faith for the
Ÿ Member-Secretary, National commission for Women,
purpose of saving the life of the woman.
Delhi Email: ncw@nic.in, sro-ncw@nic.in,lo-
2. What's about the pregnancies followed by consensual ncw@nic.in
sexual intercourse in unmarried females (Age >18 Years), Ÿ CEO (NITI Aayog ), Department of Health and
widows, divorced and recently married females not Family Welfare New Delhi Email: CEO - niti@gov.in
willing/ prepared for kid? Ÿ Secretary, Department of Medical, health and family
They can demand for abortion or not? welfare, Uttarakhand state.
If they can demand then what is the meaning for Section Email: secynkjha@gmail.com
312 to 316 of the Penal Code. Ÿ Secretary General, IMA Head Quarter. Email:
hsg@ima-india.org
as 3.(2) in MTP act 1971, explanation 2, only married
Ÿ Secretary General, The Federation of Obstetric and
word is used. There was no comment on unmarried above
Gynecological Societies of India Email:
18 years, widows and divorced.
fogsi2007@gmail.com
3. As per law 3.(2) in MTP act 1971, explanation 1, only rape Ÿ State secretary, IMA Uttaranchal state branch, Email:
word is used for grave injury to mental health, if drdipakdhar@gmail.com
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.
84
Correspondence
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
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.

Dr. Priti Chaudhary, Received: 16 May 2018
Professor and Head, Received in revised form: 16 June 2018
Department of Anatomy, Guru Gobind Singh Medical Available online: 1 July 2018
College, Faridkot Contact : 94440-47907
Contact : +91 98559-52965
Email : drpritiarora@gmail.com
Issue Present Provision in the Act Suggested recommendation Reason :
1 . Vo l u n t a r y b o d y The act is silent on this issue This clause should be added in In 1963 when the act was
donation by the general the act. The authorized officer enacted there was no such
public for dissection by should be empowered to accept awareness in general public
s t u d e n t s o f the pledge forms from general for voluntary donation of
M B B S/B D S/M S for public. Later on as the person body for study and
research purpose. (who has pledged to donate research purpose. Now many
his/her body) dies, his/her kins/ NGO's are working on it,
legal representatives should Even organ donation is in
handover the body to vogue. Moreover many new
the authorized officer. Medical & dental
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.
85
2. Certificate of Cause of Death Present Provision in the Act Suggested recommendation Reason :
(a) Unclaimed body when Death certificate is given by No Problem -----------
death occurs in hospital. attending physician.
(b) Unclaimed body The attended physician can't A provision is requested to be This will provide an ample no.
when death occurs give death certificate. As per made in the act that when ever of unclaimed bodies to the
outside hospital and law any dead body found in an unclaimed body is found medical students for research
body is brought to public place has to undergo where death has occur in public & study purpose. Presently
hospital as “brought postmortem to ascertain place & apparently there seems their number is very less but
dead." cause of death and to rule out t o b e n o f o u l p l a y, t h e so many new medical and
any foul play. Many a times, a police should be directed to dental colleges have come up
person dies due to excessive
take permission from executive so more bodies are required.
cold/heat or due to any other
cause and the body is
magistrate for not doing At present in GMC Patiala,
unclaimed. If such bodies are postmortem of such cases & the Police deptt. is giving
subjected to postmortem body be handed over to the unclaimed bodies but without
examination, usually nothing anatomy department for taking any permission from
comes out and they are not research & study purpose. The executive magistrate . It
useful for dissection in executive magistrate may be should be included in the Act
anatomy department after given clear cut instruction in to make this procedure legally
postmortem. As Per Mr. the Act for this purpose. safe. OR
Rajneesh Garg Advocate (
One of the panelist) only The police deptt. itself can be
executive magistrate of that given powers to handover the
area is empowered to body directly to Medical
abandon postmortem of such College /dental college
body without seeking permission
from executive magistrate.
(c) When death occurs at It happens so often that When ever a donated body is 1. To avoid the situation of
home & no physician relatives come without brought to Anatomy department foul play by relative and send
has attended the person. death certificate. The act is where death has occurred at body silently to Anatomy
The deceased has silent about it. The fear of home, it should be accompanied department.
pledged to donate Anatomy department in by a letter/ undertaking from 2. To save the Doctors in
his/her body / or the such cases is the fear of foul relatives that the person has died Anatomy department (who
relatives want to play. Somebody might have a natural death, so body is being accept the body) from any
donate body. murdered the old person and handed over to anatomy untoward litigations later on.
department. It should be attested
handover the body to the
by minimum 2 persons of the
Anatomy department. How
village (or city) comprising of
can Anatomists save Sarpanch and the NGO through
themselves from such which the body is being brought.
situations? 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
the matter to police for
postmortem.
(d) When death occurs at Act is silent In such cases also the body When death occurs in a village
home & death certificate should be examined by a the attending physician
is given by physician committee of Anatomist & (usually RMP) gives
Forensic expert as in (2 C) certificate that patient
above. declared dead giving no
cause of death. So again to
rule out any foul play the body
should be examined by
committee.
86
Issue Present Provision in the Act Suggested recommendation Reason :

3. Authorized officers to Principal of Govt. Medical May be extended to Principals In 1963 only 3 state Govt.
receive unclaimed Colleges Patiala & Amritsar of all Private Medical & Dental Medical Colleges were there
bodies. and Faridkot i.e. Govt. Colleges as well. but now many new private
Institutes. 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
the same procedure for
accepting such bodies as is
suggested above for Govt.
Institutes in Para 2 (c) above.
4. Whether body should Act is silent. But practice is 1. If no foul play is found and Currently original human's
be accepted in Anatomy that such bodies are not death is declared by forensic skeletons are almost not
department after accepted as these are not fit expert to have occurred by available. These are an
autopsy or not. for dissection. natural way, there is no harm in important aspect of teaching
accepting the body by anatomy & research in Medical
department for preparation field. Students are buying
of bones which may be used by skeletons made of fiber but
students for study purpose & these are no where close to
research. original ones. So provision
2. Virtual autopsy is another should be made in
alternative in such cases the Act to allow handing over
(unclaimed bodies) so that unclaimed bodies after
body can be saved for autopsy to anatomy
dissection by students. department for preparing
skeletons. But it should be at
the liberty of Anatomy
department whether they need
such bodies for skeletons or
not.
5. Whether a donated Act is silent should not be allowed As embalming is done
body can be returned immediately after receiving of
after it is received in body in Anatomy department.
Anatomy department for Moreover relatives donate
dissection. body by their own will.
6. Whether relatives can Act is silent should not be allowed 1.It may wake up the motions
be allowed to see the of the relatives to take body
body after it is donated back.
& received in the 2.They visit mortuary where
Anatomy department. so many other bodies are
lying. It may weaken them
emotionally
87
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:
drparmodgoyal@gmail.com
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
formatted differently. Electronic formats have created opportunities for adding details or whole sections, layering information,
cross linking or extracting portions of articles, and the like only in the electronic version. Double spacing all portions of the
manuscript— including the title page, abstract, text, acknowledgments, references, individual tables, and legends—and generous
margins make it possible for editors and reviewers to edit the text line by line and add comments and queries directly on the paper
copy. If manuscripts are submitted electronically, the files should be double-spaced to facilitate printing for reviewing and editing.
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
Draft with No________________ of _______________________________________Bank, in the name of PAFMAT along with
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PARTICULARS
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8. Phone No. & Email
Place Yours Sincerely
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(Signature)
FOR USE OF PAFMAT
Membership Accepted with Life / Annual membership No. / PAFMAT / /
Dated
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89
90
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91
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LM/PAFMAT/108/2014 Dr Mini LM/PAFMAT/150/2018 Dr. Prem Chandra Srivastava
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LM/PAFMAT/116/2014 Dr Maninder Singh LM/PAFMAT/158/2018 Dr. Nidhi Sachdeva Agarwal
LM/PAFMAT/117/2014 Dr Akhilesh Agarwal LM/PAFMAT/159/2018 Dr. Rajeev Varma
LM/PAFMAT/118/2014 Dr Guneet LM/PAFMAT/160/2018 Dr. Pragnesh Bharatkumar
LM/PAFMAT/119/2014 Dr Hitesh Bhatia Parmar
LM/PAFMAT/120/2015 Dr. Deep Rattan Mittal LM/PAFMAT/161/2018 Dr. Yatiraj Singi
LM/PAFMAT/121/2015 Dr. Arun Kumar Maria LM/PAFMAT/162/2018 Dr. Navpreet Kaur
LM/PAFMAT/122/2015 Dr. S Valliappan LM/PAFMAT/163/2018 Dr. Kunal Khanna
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LM/PAFMAT/124/2015 Dr. Harvinder Singh Chhabra LM/PAFMAT/165/2018 Dr. Vivekanshu Verma
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LM/PAFMAT/126/2016 Dr. Amarnath Mishra
92
Glimpse of Mid Term CME on Medical Negligence &

Assault on doctors
Organized by:
DEPARTMENT OF FORENSIC MEDICINE
PUNJAB INSTITUTE OF MEDICAL SCIENCES, JALANDHAR
On Saturday, 12th May, 2018
Editorial Board
Editor-in-Chief Joint Editor Assistant Editor Web Master

Dr Parmod Kumar Goyal Dr Amandeep Singh Dr Satinder Pal Singh Dr Dildar Singh
National Advisory Editorial Committee: Manuscript Review Committee

Board Dr S. S. Oberoi Dr OP Murti Dr. Vivek Srivastava
Dr T.D. Dogra Dr Sangeet Dhillon Dr V. V. Pillay Dr. Sanjoy Das
Dr J.S. Dalal Dr Ishwar Tayal Dr Shiv Kochhar Dr. Pardeep Singh
Dr R.K. Gorea Dr Kuldeep Singh Dr R.K. Sharma Dr. Monika Gupta
Dr O P Aggarwal Dr Harjinder Singh Dr N K Aggarwal Dr. Navita Aggarwal
Dr K K Aggarwal Dr Harpreet Singh Dr Amitabh Shrivastva Dr. Tanvir Kaur Sidhu
Dr Balbir Kaur Dr Parul Kher Dr Shankar M. Bakkannavar Dr. Sandeep Kaur
Dr K. Vij Dr Antara DebBarman Dr Mukesh Yadav Dr. Priti Chaudhary
Dr Dalbir Singh Dr Gurpreet S. Sandhu Dr C.B. Jani Dr. Vijay Suri
Dr Sanjoy Dass Dr. Vijal Pal Khanagwal Dr. Saranpal Singh
Dr E.J. Rodrigeus Dr. Samita Sinha Dr. Lovleen Marwaha
Dr Gurudatta Pawar Dr. Manjot Kaur Dr. Tanuj Kanchan
Dr D.S. Badkur Dr. Karan Maheshwari Dr. Raghuvendra K. Vidua
Dr Jagadeesh. N. Mrs. Ritika Gupta, FSL Bathinda
Subscription Information Claims for Missing Issue

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Abroad : Postal Charges Extra publication of the issue and Rs.
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l Payments be made in Bank Account of Journal of Punjab
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JOURNAL OF

Punjab Academy of Forensic Medicine & Toxicology

A Peer Reviewed Journal on

Place of Publication: Bathinda (Punjab) India

PUNJAB ACADEMY OF FORENSIC MEDICINE AND TOXICOLOGY

GOVERNING COUNCIL (2017 - 2019)

Finance Secretary Vice President Web Master

Editor-in-Chief Joint Editor Assistant Editor

Dr. Adish Goyal Dr. Mukul Chopra

FOUNDER GOVERNING COUNCIL OF PAFMAT

From the Desk of Editor-in-Chief

ISSN Numbers: that it is not being considered for publication elsewhere.

Funding Bodies: Punjab Academy of Forensic Medicine &

Address for submission of articles Online (Soft Copy):

Volume: 18, Number: 01 January to June Publication: Half Yearly

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

Volume: 18, Number: 01 January to June Publication: Half Yearly

*Life Membership Form 89

*Life Members PAFMAT 91-92

Corresponding Author Article History:

KEYWORDS : Justice, Relative Justice,Theory

INTRODUCTION : Utilitarianism has been debatable as legal understanding may

Corresponding Author Article History:

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

INTRODUCTION : various comparative data techniques listed above, Personal

RESULTS : past [5-7].

values. In, Principles of Forensic Medicine including 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

Corresponding Author Article History:

INTRODUCTION: amphetamines and methamphetamines[1]. Ephedrine increases

S. No. Solvent Systems Phenypropan Ephedrine Pseudo

Corresponding Author Article History:

INTRODUCTION : Earth. Statistical analysis to the data collected by OTD

Corresponding Author Article History:

KEYWORDS : Informed Consent, Awareness, Medico-legal.

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

chart, results were interpreted using SPSS IBM 20 software. % %

In which languages do Have you attend any

Age <35 14 100.0 0 0.0 14 Age <35 4 28.6 10 71.4 14

Do you know the Do you know what is the

Age <35 13 92.9 1 7.1 14 Age <35 3 21.4 11 78.6 14

Do you know that: any

Age <35 11 79 3 21 14 Age <35 13 92.9 1 7.1 14

Who will give consent Is consent thought

Age <35 13 92.9 1 7.1 14 Age <35 6 42.9 8 57.1 14

Who will give consent Do you explain youself,

Age <35 2 14.3 12 85.7 14 Age <35 8 57.1 6 42.9 14

Do you take informed consent Have you faced any

% % Age <35 1 7.1 13 92.9 14

How do you take consent While examining the

Do you think format Total P Value While examining the

Age <35 10 71.4 4 28.6 14 Age <35 8 57.1 6 42.9 14

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KEYWORDS : Medico Legal Case, Casualty, Proﬁle

INTRODUCTION : emergency department of NSCB Medical College and

Table 1 : Age Wise Distribution of Medical Legal Cases

51 149 301 196 109 60 37 07 02

Homicidal 153 (57.73%)

Type of Case No. of Cases Homicidal 18 (69.23%)

Road Traﬃc Accident 323 (35.41%) Accidental 7 (26.92%)

Fall From Height 100 (10.96%) Suicidal 1 (03.84%)

Poisoning 56 (06.14%) department i.e.492 (53.94%) followed by orthopedics

Human Bite 03 (00.33%) Medicine 189(20.72%)

Unconscious 3 (00.33%) ENT 68(07.45%)

Drowning 2 (00.22%) Ophthalmology 19(02.10%)

‘1' indicates positive answer or Yes '0' indicates negative answer or No