Jsimla - Sept 2013

J-SIMLA
Vol. 5, No. 2, Sep 2013

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ISSN 0974-6196
Journal of South India Medicolegal Association
Official publication of South India Medicolegal Association
Volume 5 Number 2 September 2013
J-SIMLA
Vol. 5, No. 2, Sep 2013
Office bearers Of South India Medico-Legal Association 2012-13
PRESIDENT Dr. Devdass P.K

Bangalore
VICE-PRESIDENT Dr. Bhemappa Havanur

Bangalore
Dr. K.V. Satish

Bangalore
SECRETARY Dr. S.Venkata Raghava

Bangalore
TREASURER Dr. C.N. Sumangala

Bangalore
Executive Committee
Dr. Balaraj B.M (Mysore) Dr. Deepak DSouza (Mangalore) Dr. Uday Bhaskar Reddy (Rajahmundry) Dr. Taquddin Khan (Hyderabad)
Dr. Cyriac Job (Allapuzha) Dr. Sasikala (Thiruvanthapuram) Dr. Anand Reddy (Puducherry) Dr. Fremingston Marak (Puducherry)
EX-OFFICIO MEMBER Dr. Kusa Kumar Saha

Puducherry
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Vol 5, No 2, September 2013
Journal
of
South India Medicolegal Association

J-SIMLA is the official publication of the South India Medico-Legal Association. It provides a forum for publication of original communications, reviews, case reports, and brief communications in the fields of forensic science, forensic medicine, forensic pathology, forensic toxicology, forensic anthropology, forensic odontology, forensic radiology, medical ethics and the law related to medical practice, and forensic aspects of biological sciences. All manuscript submissions are subject to peer-review. The journal is indexed in Index Copernicus and scopus. Editor is the member of WAME.
Editor Dr. Pradeep Kumar M.V. Associate Editors Dr. Venkata Raghava S
Dr. Jagannatha S.R
Dr. Deepak H DSouza
National Editorial Advisory Board

Swapnil S. Agarwal, Gujarat M. Arun, Karnataka Binay K. Bastia, Gujarat Sreemantha K. Dash, Orissa Cyriac Job, Kerala Tanuj Kanchan, Karnataka Kewal Krishan, Chandigarh Adarsh Kumar, Delhi Manoj K. Mohanty, Pondicherry P. P. Mukhopadhyay, West Bengal Pankaj N. Murkey, Maharashtra Vikram Palimar, Karnataka V. V. Pillay, Kerala K. Ravindran, Tamil Nadu M. Narayana Reddy, Andhra Pradesh G. V. Nagi Reddy, Andhra Pradesh E. J. Rodrigues, Goa S. Senthilkumaran, Tamil Nadu Abhas K. Singh, Uttar Pradesh K. Thangaraj, Tamil Nadu
International Editorial Advisory Board

Mubarak A. Bidmos, South Africa Fabio De-Giorgio, Italy N. Anil Dolgun, Turkey Takaki Ishikawa, Japan Michal Kaliszan, Poland Dimos Karangelis, Greece Magdy A. Kharoshah, Egypt Sadip Pant, USA Jason Payne-James, UK Clifford Perera, Sri Lanka Selma Uysal Ramadan, Turkey Guy N. Rutty, UK Zhu Shaohua, China Klra Tr, Hungary Cyril H. Wecht, USA
2013 South India Medico-Legal Association. All rights reserved.
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Journal of South India Medicolegal Association

Volume 5, Number 2, September 2013
Contents
REVIEW ARTICLE Sexual Harassment Of Women At Work Place A Review
Edelweiss Rodrigues, Edlyn Rodrigues, Juliana Rodrigues, E. J. Rodrigues
36-42
ORIGINAL COMMUNICATIONS The Need for Flexibility in the upper limit of Gestational Age for Fetal Anomalies in the MTP Act: A Questionnaire Survey
Priya Ballal K,, Raina Chawla, Pralhad Kushtagi
43-49
A preventable death: suicidal patterns among women in metro-city Bangalore, India 50-57
Karthik S K, Balaji PA, Mohan VJ, Smitha R Varne, Poornima S, Syed Sadat Ali, Jayaprakash G
Incidence of Poisoning Reported At A Tertiary Care Hospital

K.Padmakumar, B.G.Maheshkrishna, J.Jaghadheeswararaj, A.Natarajan
58-62
Socio demographic profile of Cardiac deaths

Dayananda R, Harish S, Girish Chandra Y P, Sampath Kumar P
63-66
Prediction of Stature From Percutaneous Ulna Length
67-72
Dileep Kumar R, Nagesh Kuppast, Shradha Iddalgave, Raju G M, Sunil S Kadam, Hemanthraj M N
CASE REPORTS Fatal electrocution by Over Head Wire: A case report M. D. Nithin, Suraj S Shetty, Gopal B.K Sudden Death Due To Cardiac Tamponade Prateek Rastogi, Alok Atreya, Jenash Acharya 76-78 73-75
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REVIEW ARTICLE
SEXUAL HARASSMENT OF WOMEN AT WORK PLACE A REVIEW. Edelweiss Rodrigues 1, Edlyn Rodrigues 2, Juliana Rodrigues 3, E. J. Rodrigues 4.
1
Dept. of Physiology, Kannur Medical College, Anjarakandy, Kerala.

2 3
Goa Dental College. Bambolim, Goa.
Dept. of Biochemistry, Goa Medical College, Bambolim-Goa.
Dept. of Forensic Medicine, Goa Medical College, Bambolim-Goa.
ABSTRACT: There have been a large number of cases of sexual harassment of women at workplace all over the country. The Constitution of India ensures and guarantees every individual the right to practice any profession, or to carry on any occupation, trade or business as enshrined under Article 19(1) (g). Every woman has a constitutional right to participate in public employment and this right is denied in the process of sexual harassment, which compels her to keep away from such employment. Sexual harassment of women at the place of work exposes her to a big risk and hazard which places her at an inequitable position vis-a-vis other employees and this adversely affects her ability to realize her constitutionally guaranteed right. Sexual harassment of women at workplace is also violation of the right to life and personal liberty as mentioned in Article 21, that no person shall be deprived of his life or personal liberty. Right to livelihood is an integral facet of the right to life. Since the Right to Work depends on the availability of a safe working environment and the right to life with dignity, the hazards posed by sexual harassment need to be removed for these rights to have a meaning.
KEY WORDS: Sexual, Harassment, Women, Workplace.
Introduction Sexual harassment can be summarised as, A well kept secret practiced by men, suffered by women, condoned by management, and spoken by no one. It is a manifestation of power relationswomen are victims of sexual harassment because they lack power, are vulnerable and insecure in position, lack self-confidence, or have been socially conditioned to suffer in silence.1 The term sexual harassment means a type of employment discrimination consisting in verbal or physical abuse of a sexual nature.2 The leading case pertaining to sexual harassment at workplace in India is Vishaka Vs State of Rajasthan. In this case a social activist, Bhanwari Devi was alleged to be brutally gang raped in the village of Rajasthan. The incident reveals the hazards to which a working woman may be exposed to sexual harassment and the urgency for safeguards in absence of legislative measures and the
Corresponding author: Dr Edelweis Rodrigues E-mail: ejrrod2003@yahoo.co.in
2013 South India Medico-Legal Association. All rights reserved. 36
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need to find an effective alternative mechanism to fulfil this urgent social need. In this case, the Supreme Court has categorically held that sexual harassment results in violation of fundamental rights of equality of sexes, of right to life and liberty, and of right to practice any profession or to carry on any trade or business. Gender equality includes protection from sexual harassment and right to work with dignity, which is a universally recognized basic human right. The court had to rely on international statutes and conventions due to lack of development of the Indian legislations. In the absence of the enacted law to provide for the enforcement of the basic human right of gender equality, a three judges bench of the Supreme Court chaired by Hon. Chief Justice Shri. J.S.Verma laid down guidelines and norms to be followed by the employers for tackling the incidents of sexual harassment at the workplaces and other institutions. This was done under article 32 of the Constitution of India for enforcement of the fundamental rights. These are to be treated as law under article 141 of the Constitution.3 It is found that more than 75% of departments had not set up a Complaints Committee and have failed to enact antisexual harassment policy. The Ministry of Women and Child Development had prepared a draft entitled `The Protection of Women against sexual harassment at Workplace Bill, 2007 ` to provide for the prevention and redressal of sexual harassment of women at workplace and for matters connected therewith. In Vishaka Vs State of Rajasthan, sexual harassment was defined as any unwelcome sexually determined behaviour, whether directly or by implication, as physical contact and advances, a demand or request for sexual
favours, sexually coloured remarks, showing pornography or any other unwelcome physical, verbal or non-verbal conduct of sexual nature. 4-5 The cases of sexual harassment of women at the workplace are increasing alarmingly because of several factors like poor status of women, increasing number of working women, poor knowledge of human relations and values, poor law and order position in the society and no adequate provisions of law to deal with the problem effectively. It is not just a women empowerment issue but an issue pertaining to human rights, human resource management and, safety and health of the workplace environment. Evidence suggests that although sexual harassment in the workplace continues to be a common occurrence, perpetrated by a person in authority, majority of women do not take action or lodge a complaint for fear of being dismissed, losing reputation or facing hostility or social stigma in the workplace.6-10 A study 11 by International NGO, Population council, has revealed that 77 out of 135 women employees [doctors and nurses] interviewed over a period of 11 months, working in four hospitals in Kolkota, admitted to sexual harassment. As many as 45 reported psychological harassment, 41 complained of verbal harassment, 21 unwanted touch and 16 sexual gestures and exhibitionism but none reported being raped. Although a large number of incidents of sexual harassment were experienced (77/135), very few women took any formal action (27/77), while others did not complain to supervisors or management. The study also found that the victim were reluctant to go public on this issue. Victims were sexually harassed by not only their coworkers but also by patients and their relatives.11 The study also revealed that
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just 20 out of 135 women were aware of the Supreme Court Guidelines on sexual harassment. None of them had heard of a Complaints Committee for redressal of their grievances. An article in TOI in 2006 also highlighted sexual abuse in hospitals 12. Few women seek redress and few have received swift action while others nonaction and even victimisation. For example, in one case a woman (Shenaj Sani) was dismissed from job on grounds of wilful negligence after she complained of sexual harassment 11. Doctors and nurses alike agree that sexual harassment is an occupational hazard for working women. A 30 year old government doctor said, We have accepted this and this is how things will continue. Another 35 years old nurse added, Saying bad things when they see a woman is natural. It doesn`t matter if the man is a doctor or non-medical staffer
11.
harassers. BEHAVIOUR CLASSES Dzeich et al described harassers into two classes, 13 as follows: a) Public Harassers are flagrant in their seductive or sexist attitudes towards colleagues, subordinates, students etc. b) Private Harassers carefully cultivate a restrained and respectable image on the surface, but when alone with their target, their demeanour changes. Langelan describes the following three different classes of harassers14: 1) Predatory Harassers are those who get sexual thrills from humiliating others. They become involved in sexual extortion and frequently harass just to see how targets respond. Those who do not resist may even be targets for rape. 2) Dominance Harassers are the most common type, who engages in harassing behaviour as an ego boost.
3) Strategic or Territorial Harassers
HISTORY Sexual harassment was earlier referred to as sexual intimidation, sexual coercion or sexual exploitation on the job. None of these names seemed quite right as the activists wanted something that embraced a whole range of subtle and un-subtle persistent behaviours. Finally during a brainstorming session somebody came up with harassment and then sexual harassment was instantly agreed. VARIED BEHAVIOURS The difficulties in understanding sexual harassment is that it involves a range of behaviour, often difficult for the recipients to describe to themselves, and to others, exactly what they are experiencing. Moreover, behaviour and motives vary between individual
are those who seek to maintain privilege in jobs or physical locations, for example men harassing female employees in a predominantly male occupation. SEXUAL HARASSMENT-THE LAW Sexual harassment in India is termed Eve teasing and is described as an unwelcome sexual gesture or behaviour whether direct or indirect including sexual coloured remarks, physical contact and advances, showing pornography, a demand or request for sexual favours, or any other unwelcome physical, verbal/non-verbal conduct being sexual in nature. The critical factor is the unwelcomeness of the behaviour, thereby making the impact of such actions on the recipient more relevant
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rather than intent of the perpetrator.15 According to the Constitution of India, sexual harassment infringes the fundamental right of a woman to gender equality under article 14 and right to life and live with dignity under article 21 of the Constitution of India. Although there is no specific law against sexual harassment at workplace in India but many provisions under IPC protect against sexual harassment at workplace, such as Sec.354 IPC which deals with assault or criminal force to a woman with intent to outrage her modesty, and Sec. 509.IPC which deals with word, gesture or act intended to insult the modesty of a woman.16 In India, the case of Vishaka Vs State of Rajasthan in 1997 has been credited with establishing sexual harassment as illegal. The Supreme Court of India recognised sexual harassment as human rights violation and gender based systemic discrimination that affects woman`s right to life and livelihood. The court defined sexual harassment very clearly as well as provided guidelines for employers to redress and prevent sexual harassment at workplace. While the Apex Court has given mandatory guidelines called Vishaka Guidelines, for resolution and prevention of sexual harassment enjoining employers by holding them responsible for providing safe work environment for women, the issue still remains under carpet for most women and employers. Vishaka guidelines apply to both organized and unorganized work sectors and to all women whether working part time, on contract or in voluntary / honorary capacity. The guidelines are a broad framework with lot of emphasis on prevention by adopting a sexual harassment policy, which expressly prohibits sexual harassment at
workplace and provides effective grievance procedure which has provisions clearly laid down for prevention and for training the personnel at all levels of employment. The Protection of Women from Sexual Harassment at the Workplace Bill was tabled in the Lok Sabha in December, 2010 and was thereafter referred to Parliamentary Committee on Human Resource Development. The Sexual Harassment at Workplace Bill was finally passed in May 2012 after being referred to Group of Ministers. The new amendment in the bill now proposes to bring domestic helps and workers under its ambit and expected to provide speedy redressal to about 47.5 lakhs women. The Bill provides protection not only to women who are employed but also who enter workplaces as clients, apprentices, daily wage workers or in ad-hoc capacity; students, research scholars in Colleges and Universities, and patients in hospitals have also been covered in the bill. However male workers have not been brought under its ambit. The bill makes it mandatory for all workplaces, including homes, universities, hospitals, government and non-government offices, factories, other formal and informal work places to constitute an internal committee for redress of complaints. The draft Bill defines workplace as offices in government, private sector and all places a woman visits by air, rail, land or sea during the course of her job. The Bill also does not put the burden of proof of innocence on the employer and gives the employer and the complainant of harassment equal chance to seek justice. The draft bill on Sexual Harassment at workplace is likely to become law, seems imminent and reality after almost one and a half decades.
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TYPES OF SEXUAL HARASSMENT 1) Quid-pro-quo: This is when the employer makes sex as a pre-requisite to getting something done in the workplace. eg. If you sleep with me, then your work will be done. These kind of conditions attached to one`s job jeopardize the career of the employee.
2) Hostile environment:
the opposite sex. The harasser may be completely unaware that his or her behaviour is offensive or constitutes sexual harassment or that his or her actions could be unlawful.
This is an environment where an employer (a superior or a colleague) does or says things that are uncomfortable and offensive to a woman as an individual. Sexual harassment does not need to include a demand for an exchange of sex for a job benefit. It is the creation of an uncomfortable environment. HARASSMENT SITUATIONS Sexual harassment can occur in a variety of circumstances. Often, but not always, the harasser is in a position of power or authority over the victim. Significant features relationships include: of harassment
It can result from a situation where one thinks that he or she are making themselves clear, but is not understood the way they intended. The misunderstanding can either be reasonable or unreasonable. An example of unreasonable intent is when a man holds a certain stereotypical view of a woman such that he did not understand the woman`s explicit message to stop.13
Sexual harassment takes place if a person:
Subjects another person to an unwelcome act of physical intimacy, like grabbing, brushing, touching, pinching, etc. Makes an unwelcome demand or request (whether directly or by implication) for sexual favour from another person, and further makes it a condition for employment/payment of wages/increment/promotion, etc Makes an unwelcome remark with sexual connotations, like sexually explicit compliments/cracking loud jokes with sexual connotations/making sexist remarks, etc. Shows a person any sexual explicit visual material in the form of pictures/cartoons/pinups/calendars/scr een savers on computers/any offensive written material/pornographic e-mails, etc. Engages in any other unwelcome conduct of a sexual nature, which could be verbal, or even non-verbal, like staring
The harasser can be anyone, such as client, a co-worker, a parent or legal guardian, a teacher or professor, a student, a friend, or a stranger. The victim need not be the person directly harassed but can be anyone who finds the behaviour offensive and is affected by it. Adverse effects on the target are common. The victim and harasser can be of any gender. The harasser does not have to be of
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to make other person uncomfortable, making offensive gestures, kissing sounds, etc. Sexual harassment is intimidation, bullying or coercion of a sexual nature, or the unwelcome or inappropriate promise of rewards in exchange for sexual favours. In some contexts or circumstances, sexual harassment is illegal. It includes a range of behaviour from seemingly mild transgressions and annoyances to actual sexual abuse or sexual assault. The victim of sexual harassment can be a male or a female. It is not only between an employer but can also happen between colleagues.
GUIDELINES AND NORMS PRESCRIBED FOR SEXUAL HARASSMENT (3) 1) Duty of Employer or other responsible persons in work places and institutions. It
following steps. a) Express prohibition of sexual harassment at work place should be notified, published and circulated in appropriate ways. b) The Rules/Regulations of Government and Public Sector bodies relating to conduct and discipline should also include rules / regulations prohibiting sexual harassment and provide for appropriate penalties against the offenders.
4) Criminal proceedings: Where such
conduct amounts to specific offence under IPC or any other law, the employer shall initiate appropriate action in accordance with the law.
5) Disciplinary action: Where such
shall be the duty of employer or other responsible persons in work places or other institutions to prevent or deter the commission of acts of sexual harassment and to provide the procedures for the resolution, settlement or prosecutions of acts of sexual harassment by taking all steps required.
2) Definition- Sexual harassment
conduct amounts to mis-conduct in employment as defined by the relevant service rules, appropriate disciplinary action should be initiated by the employer in accordance with those rules.
6) Complaint mechanism: Whether or
not such conduct constitutes an offence under law or a breach of the service rules, an appropriate complaint mechanism should be created in the employer`s organization for redress of the complaint made by the victim.
includes such unwelcome sexually determined behaviour (whether directly or by implication) as : a) physical contact or advances; b) a demand or request for sexual favours; c) sexually coloured remarks; d) showing pornography; e) any other unwelcome physical, verbal or nonverbal conduct of sexual nature.
3) Preventive steps:
7) Complaints Committee: The
complaints committee should be headed by a woman and not less than half of its members should be women. Further to prevent undue pressure or influence from senior levels, it should involve a third party like NGO or other body familiar with issues of sexual harassment.
8) Worker`s initiative : Workers should
All employers or persons in charge of work place whether in public or private sector should take appropriate steps to prevent sexual harassment by taking
be allowed to raise issues of sexual harassment at worker`s meeting and other appropriate forum and it should be
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affirmatively discussed Employee Meetings.
at
Employer
References
1. 2. 3. 4. Sexual Harassment: Gender! A Partnership of Equals, ILO, 58 (2000). Black`s Law Dictionary 9th Ed., 2009. In Vishaka Vs State of Rajasthan (1997) SCC 241. Umadethan B. Sexual Offences. In: Principles and Practice of Forensic Medicine.1st ed. Swamy Law Publishers, Kochi. 2008.357-359. Reddy K S N. Sexual offences. In: The Essentials of Forensic Medicine and Toxicology.30th ed. K.Suguna devi, Hyderabad. 2011. 389. Kapoor,A. Women Worker`s Rights: A Reference Guide. ed.1999. International Labour Organisation. New Delhi. National Commission for Women (NCW).n.d. Study to access the Harassment of Women at Work in Organised and Unorganised Sectors. New Delhi, Report prepared by Santek Consultants Pvt. Ltd. Saheli. Another Occupational Hazard: Sexual harassment and the Working Woman. New Delhi. Saheli Women`s resource centre. 1998. Sakshi. Sexual Harassment at the workplace: A Guide to the Sexual harassment law in India. 1999. Sanhita. Politics of Silence. Kolkota: Sanhita. 2001. Paramita Chaudhuri. Sexual Harassment at Workplace: by Population Council, an International NGO. Kounteya Sinha. Sexual abuse in Hospitals exposed, The Times of India, Nov. 8, 2006:7. Dziech, Billie Wright, Weiner, Linda. The Lecherous Professor: Sexual Harassment on Campus. Chicago Illinois: University of Illinois Press, 1990. Langelan, Martha. Back Off: How to Confront and Stop Sexual Harassment and Harassers. Fireside, 1993. Sexual harassment and Rape Laws in India. (http://www.legalsserviceindia.com/articles/ra pe_laws.htm) Heyman R.. Why Didn`t You Say That in the First place? San Francisco: Jossey-Bass Publishers. 1994.
9) Awareness : Awareness of the rights
of female employees in this regard should be created in particular by prominently notifying the guidelines in a suitable manner.
10) Third party harassment : Where
5.
sexual harassment occurs as a result of an act or omission by any third party or outsider, the employer and person in charge will take all steps necessary and reasonable to assist the affected person in terms of support and preventive action.
11) The Central / State Governments
6.
7.
are requested to consider adopting suitable measures including legislation to ensure that guidelines laid down in this order may also be observed in the Private sector. Conclusions: Men and women are like two wheels of the chariot of life, yet sexual Harassment of women at workplace is a common occurrence. It was noted that notwithstanding the Vishaka judgement, sexual harassment continues to characterise the working conditions of many women in the health sector, and argues that while the judgement was a necessary condition, it is not sufficient to reduce sexual harassment of women in the workplace. What is required, at the same time, are appropriate implementation mechanisms that recognise the obstacles posed by power imbalances and gender norms in empowering women to make a formal complaint on the one hand and in receiving appropriate redress on the other.
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9.
10. 11.
12. 13.
14.
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ORIGINAL COMMUNICATION
THE NEED FOR FLEXIBILITY IN THE UPPER LIMIT OF GESTATIONAL AGE FOR FETAL ANOMALIES IN THE MTP ACT: A QUESTIONNAIRE SURVEY Priya Ballal K 1,Raina Chawla 2, Pralhad Kushtagi 3
1
Department of Obstetrics-Gynecology, Kasturba Medical College, Mangalore Department of Obstetrics-Gynecology, Kasturba Medical College, Mangalore Department of Obstetrics-Gynecology, Kasturba Medical College, Mangalore
Abstract To elicit opinion of practicing obstetricians regarding the change required in the existing MTP Act with regard to limit of gestational age for terminating pregnancies with fetal anomalies and to obtain suggestions about formation of a regulatory body, a questionnaire survey was carried out amongst the consultant obstetricians spread across the city. The questionnaire sought opinions on whether or not to terminate a pregnancy beyond 24 weeks based on the kind of fetal anomaly diagnosed, need or otherwise for increasing the gestational age limit for considering MTP, how would one react to the situation of managing a live baby following late pregnancy terminations and requirement of a regulatory body and consequences of such an amendment. The questions were a combination of multiple choice and open ended types with options of adding ones own suggestions. Responses were received from 41obstetricians and 90.2% expressed the need for amending the MTP Act to increase limit of gestational age with 24.3% suggesting delinking the age constraint. If the anomaly were to be of uncertain significance or that incompatible with survival, 12.2 to 19.5% responded in favor of refusal to terminate pregnancy if duration of pregnancy was beyond the legally permissible limit. Majority of respondents opted for terminating pregnancy citing maternal reasons (36.6 to 39%), recording lower legally permissible gestational age (24.3 to 36.6%) or recording it as preterm labor-delivery (9.7 to 73.2%). Mothers wish was the prime consideration by 41.5%. Opinion of 53.7% obstetricians was not to resuscitate if baby was born alive and 19.5% opted to ensure prior feticide. Necessity of ombudsman was felt by 68.3% It is concluded that delinking or at least raising the gestational age from the provisions of MTP Act for fetal anomalies is required. It is necessary to have a regulatory body to concur with decision made for termination of pregnancy. Key words: termination of pregnancy; MTP Act; anomalies; gestational age Introduction Termination of pregnancy (abortion) obtained a legal sanction in India in 1971 and the law was enacted. The Act
Corresponding author: Pralhad Kushtagi Email: pralhadkushtagi@hotmail.com
(Medical Termination of Pregnancy Act; MTP Act) allows terminations up to 20 weeks of pregnancy under circumstances when it is immediately necessary to save the life of the pregnant woman, the permission for MTP can be extended beyond 20 weeks of pregnancy.1 However,
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the law is silent about pregnancy termination for fetal reasons, for example in pregnancies detected to have a severe fetal anomaly. The targeted screening for fetal anomalies is recommended to be carried out routinely between 18 20 weeks of gestation.2 When a diagnosis of fetal anomaly is made in the 19 th week, the time available for counseling, decision making and intervention will probably be insufficient to act within the Act. There is no information available about the time taken by the pregnant woman after the advice for fetal anomaly detection scan (FADS) is given, the performance of the scan, and reporting for termination of pregnancy in the event of a severe fetal anomaly. Despite the availability of ultrasonography services, significant numbers of scans for detecting anomalies are carried out after 20 weeks of pregnancy. Analyzing the cases with fetal anomalies we have reported that 26.5% of women had their FADS only after 20 weeks of pregnancy. 3 Anomaly detection rate varies depending on factors like differences in operator skill, equipment used or the gestation at which the scan was performed.4 Even when the scan was carried out prior to 20 weeks of pregnancy in the women with anomalous fetus the detection rate was 53%.3 Many malformations become more evident only later in gestation and are thus missed on the initial FADS. In a small proportion of fetuses, congenital heart diseases become more evident as pregnancy progresses. Thus, the cardiac evaluation can be normal at 18 weeks although a significant malformation is found later. This occurs in cases such as aortic or pulmonary stenosis, cardiac tumors or 4 cardiomyopathies. In another large multi-center study, 38.5% of anomalies (24.8% being major structural
malformations) were detected only after 29 weeks.5 Under such circumstances it is not uncommon for the woman reporting after 20 weeks of gestation for termination of pregnancy because of major fetal anomaly. Laws regulating termination of pregnancy are different in different countries. The abortion law in United Kingdom allows terminations for fetal abnormality without any upper limit for gestational age.6 Most of the countries where abortion is legalized are 7 restrictive. A questionnaire survey was planned to obtain opinions of obstetricians and gynecologists on the need for flexibility in the upper limit of gestational age for fetal anomalies in the existing Medical Termination of Pregnancy Act of India (MTP Act). Methods The survey was conducted amongst 60 obstetricians and gynecologists using a pretested questionnaire. The obstetriciangynecologists receiving the questionnaire were either a faculty at local medical colleges and/ or members of a local obstetrics and gynecology society. The questionnaires were delivered personally with a request to return the filled questionnaire in seven days. The questionnaires were served and collected by a person not involved in the study (AS and RR). The questions were pretested with 10 resident postgraduates in obstetrics and gynecology to ascertain clarity, highlight ambiguity, and identify duplicity of the framed questions before finalizing the questionnaire for use in the survey. The letter accompanying questionnaire contained a brief note on the need for survey, objective of the survey, assurance
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that anonymity would be maintained and that results and conclusions of the survey will be communicated after analysis. Conduct of the survey had institutional ethics committee approval. Answering the questionnaire was taken as the consent to participate. The questionnaire consisted of 15 questions. The initial 4 enquiries were about background information of the respondent. This included sex, qualification, experience in clinical practice after specialization and the number of MTPs performed in their working area on a yearly average. The next 3 questions involved 3 scenarios, each seeking opinions on whether or not to terminate a pregnancy at 24 weeks based on the kind of fetal anomaly diagnosed, i.e. an anomaly compatible with survival after birth (e.g. cleft palate, limb anomalies), an anomaly of uncertain prognosis (e.g. tetralogy of Fallot, trisomy 21) and an anomaly incompatible with survival after birth (e.g. anencephaly, trisomy 18). The next 3 questions sought an opinion on whether the upper limit for MTP for fetal anomaly needs to be increased, if so, to what limit and by doing so, how would one react to the situation of managing a live baby following termination beyond 20 weeks. There was a question designed to seek an opinion on who they feel is the primary person involved in deciding the continuation or termination of pregnancy, i.e. the mother, her family, the obstetrician, the MTP Act or a combination thereof. An attempt was made to elicit responses through a series of four questions on the pros and cons of increasing permissible gestational age for MTP in the Act regarding fetal anomaly. The questions were a combination of multiple choice (with 4 possible alternatives with an option to choose to agree to one or more of them) and open
ended types with options of adding ones own suggestions. The study had the approval of Institute Ehics Committee. Results Out of the 60 questionnaires distributed, 41 were returned filled and women outnumbered men (70.7%). Most of them were (34 of 41; 83%) with postgraduate degree in Obstetrics and Gynecology, 4 (9.7%) with diploma and the remainder (7.3%) had either a degree/ diploma with additional qualifications. The respondents included 13 with less than 5 year experience (31.7%). Specialists with up to and beyond 10 year work experience were 11 (26.8%) and 17 (41.5%), respectively. Most answered (78%) that they performed more than 10 MTPs in a year. To the hypothetical situation where the anomaly was compatible with life, a large number (27.6%) chose to terminate the pregnancy even though it was 24 weeks. If the anomaly were to be of uncertain significance or that incompatible with survival, only 12.2 to 19.5% responded in favor of refusal to terminate pregnancy as duration of pregnancy was beyond the legally permissible limit. However, majority of respondents opted for terminating pregnancy citing maternal reasons (36.6 to 39%), recording lower legally permissible gestational age (24.3 to 36.6%) or recording it as preterm labordelivery (9.7 to 73.2%). (Table 1) Most obstetricians felt that the decision of continuing or terminating a pregnancy in the presence of a fetal anomaly should be based on wishes of the mother (41.5%)). Only 26.4% opined that the MTP Act should be the lone guiding factor. (Table 2) The need to increase limit for gestational age in the MTP Act for fetal
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anomalies was expressed by 37 of 41 (90.2%) respondents. Removal of gestational age limit was suggested by 24.3%, raising the permission up to 28 weeks by 27% and at least to 24 weeks of pregnancy by the remaining 46% obstetricians. (Table 3) When these responses were compared with options given for first set of questions, 2 obstetricians who refused to terminate pregnancy for fetal anomaly since there is no sanction beyond 20 weeks wanted the age bar to be raised. The other 2 respondents who in practice would not mind terminating pregnancy citing maternal reasons also wanted the permissible age under the Act to be increased. If the gestational age limit is raised beyond 20 weeks of pregnancy, 53.7% obstetricians opined that the fetus should not be resuscitated if born alive and 19.5% opted for feticide to be performed prior to termination. Only 14.6% felt resuscitation should be carried out if the baby is born alive. As a consequence of raising the gestational age limit for termination of pregnancy the anxiety that female feticide may increase was expressed by 31.3%, and 24.4% felt that it will result in increase in unwanted live births. The probability that such a change in the Act will deny the fetus its right to life was thought aloud by 14.6%, while 29.3% reasoned that it will be a move towards human race without handicap. The need for a regulatory body in the form of a certification board to verify that the anomaly would result in severe handicap or incompatible with life was expressed by 68.3%, and necessity of appending the case record with the autopsy to confirm and document the anomaly was suggested by 41.5% respondents. After the certification, ensuring fetal death as a prerequisite for
termination of pregnancy was insisted by 4.9% obstetricians. To the question regarding who all should constitute the certification board, 68.3% agreed to the suggestion that it can include an obstetrician, a geneticist, neonatologist/ paediatrician and a concerned specialist (e.g., cardiologist, pediatric surgeon etc. for the related anomaly). Some obstetricians opined that in rural areas it is not practically possible for patients to go to the board. There were other suggestions like: to include a member of the family in the board; to have a general practitioner; ultrasound documentation is sufficient to confirm presence of anomaly. In an effort to understand how obstetricians perceived the severity of an anomaly, the questionnaire asked the participants to provide a definition of severe anomaly. Majority defined it as incompatible with life. Other descriptions were that cause morbidity, which pose a financial or mental burden to the family and some gave examples of anomalies (renal, cardiac, cranial etc.). Discussion The study was designed to compile opinions expressed by obstetricians and bring the emerging common opinion before a concerned forum which could help to bring about changes in the provisos of the MTP Act in case of fetal anomalies. Through this survey the call for increasing the current upper limit of gestational age for terminating pregnancies with fetal anomalies in the Act was loud and certain with 90.2% expressing their assent. It gains further momentum when one finds that some structural abnormalities are convincingly picked up only after 20 weeks of pregnancy and significant number of scans for detecting anomalies is carried
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out thereafter.3 The reports such as that of Niketa Mehta where the Honorable Court had to step in to give directive bring to forefront the requirement for changes in provisions of the MTP Act in India. The case referred to sought permission to have the pregnancy terminated in the 26 week of pregnancy following antenatal fetal diagnosis of a serious congenital heart disease.8 Probably due to presence of constraints in the Act, the results of present survey have shown that majority of respondents indicated a practice of terminating pregnancy under the false pretext by citing maternal reasons (36.6 to 39%), recording lower legally permissible gestational age (24.3 to 36.6%) or recording it as preterm labor-delivery (9.7 to 73.2%). The abortion Act 1967 of United Kingdom was amended as Human Fertilization and Embryology Act 1990 introducing a time limit on most abortions of 24 weeks of gestation with the permission for termination of pregnancy at any gestation on the grounds of serious fetal anomaly.6 Even if the law is amended, the premise for considering termination of pregnancy in the event of fetal anomaly needs to have checks. Although most obstetricians opted for termination of pregnancy in the case of an anomaly of uncertain prognosis or that incompatible with life, what was surprising to note in the present survey was that 27.6% respondents opted to terminate pregnancy for an anomaly compatible with life. The examples provided for that class were cleft lip and limb defects. The results of a web based questionnaire survey by Aloouini et al 9 soliciting participation across 16 countries to help decision-making in mild congenital
abnormalities and to address its legal aspects, the physicians opinions varied from accepting termination of pregnancy under different conditions to refusal for the same pathologies. They concluded that type of abnormality, personal and ethical opinions and legal conditions for access to termination of pregnancy in each country accounted for the heterogeneity of answers. Other studies also found similar heterogeneity in decision-making for fetal anomaly of mild and those with uncertain prognosis.10-11 We feel that there should be an ombudsman comprising representatives from the specialties and humanities to certify that termination of pregnancy can be carried out for fetal reasons. Among the participated obstetricians 68.3% echoed the view. Raising the gestational age for termination of pregnancy brings another issue pertaining to care of a baby born alive after termination. It was opined by 53.7% obstetricians that a baby born alive should not be resuscitated and 19.5% opted for feticide to be performed prior to termination. The Royal College of Obstetricians and Gynaecologists also states that, for all terminations at gestational age of more than 21 weeks and 6 days, the method chosen should ensure that the fetus is born dead. Intracardiac potassium chloride is the recommended method and the dose chosen should ensure that fetal asystole has been achieved. It is mandatory to confirm asystole by an ultrasound scan 30-60 minutes after the procedure. Where the patient chooses not to have feticide in the presence of a lethal abnormality, discussion must take place within the appropriate team, and the patients wishes and agreement sought on the management of the fetus after birth.6
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This aspect as a prerequisite needs to be incorporated in the Act. Permitting termination of pregnancy for eugenic reasons does raise ethical concerns. In the present study, 14.6% did worry that it denies the fetus its right to life while 29.3% reasoned that it will be a move towards human race without handicap. Savulescu 11 voiced similarly and questioned the practice of late termination of pregnancy. He asserted, when a pervasive professional practice or law only allows termination of pregnancy when there is fetal abnormality, this discriminates against abnormal fetuses. Nearly a third of the respondents (13 of 41; 31.7%) did express concern that increasing upper limit of gestational age in the MTP Act even though for a specific reason, may provide an additional time space to exploit the favored sex altering the milieu of society. We feel that it may be wise to delink gestational age from the provisions of the MTP Act with respect to fetal anomalies. However, it is necessary to have a regulatory body to concur with decisions made by the caring obstetrician and the family, taking in to consideration the supporting investigations. It is time to rethink and amend the clauses of the existing MTP Act. Declaration The concept of the survey was presented at ICOG-FOGSI International Update: Ethics, Evidence, Efficiency; held in Goa: March 18-20, 2011 Acknowledgement Authors are thankful to Drs Archana Shenoy and Rituraj for helping in distribution and collection of questionnaires.
References
1. The Medical Termination of Pregnancy Act, 1971 no. 34 of 1971 (http://www.mp.gov.in/health/acts/mtp% 20Act.pdf; accessed on 28/03/2012) NICE Antenatal Care: Routine care for the healthy pregnant woman. 2008 (http://fetalanomaly.screening.nhs.uk/fet alanomalyresource/whats-in-thehexagons1/about-the-nhs-fetal-anomalyscreening-programme/screening-forstructural-fetal-anomalies-inengland/nice-antenatal-care-guidelines; accessed on 15/07/2012) R Chawla, PK Ballal, P Kushtagi. Timely Antenatal Diagnosis of Fetal Anomalies Still a Far Cry. J Biological Graphics and Computing 2012; 2(2, December): 64-71 DOI: 10.5430/jbgc.v2n2p64 Allan L. Antenatal diagnosis of heart disease. Heart 2000; 83: 367 - 368 Levi S. Mass screening for fetal malformations: the Eurofetus study. Ultrasound Obstet Gynecol. 2003; 22(6):555-8. Legal and ethical aspects of abortion. In: The Care of Women Requesting Induced Abortion Evidence-based Clinical Guideline Number 7, chapter 3. September 2011. RCOG Press. London ISBN 1-904752-06-3 Hessini L. Abortion and Islam: Policies and Practice in the Middle East and North Africa. Reproductive Health Matters 2007;15:75-84 http://www.rediff.com/news/2008/augus t/04abort.htm; accessed on 7/04/2011 Alouini S, Curis E, Prefumo F, Benazeth S, Herve C. Termination of Pregnancy for Mild Foetal Abnormalities: Opinions of Physicians. WebmedCentral Obstetrics and Gynaecology 2011; 2(3): WMC001770
2.
3.
4. 5.
6.
7.
8.
9.
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Table 1: Opinion on termination of pregnancy beyond 20 weeks for different fetal anomalies
Anomaly A. Refuse to terminate B. Terminate for maternal reason C. Record lower gestational age and terminate D. Document as preterm labor and terminate E. B or C above F. Not mentioned Total Compatible with survival N (%) 26 (63.4) 5 (12.3) Uncertain Prognosis N (%) 8 (19.5) 16 (39) Incompatible with survival N (%) 5 (12.2) 15 (36.6)
8 (19.5)
10 (24.3)
15 (36.6)
1 (2.4)
4 (9.7)
3 (73.2)
1 (2.4) 41
2 (4.9) 1 (2.4) 41
2 (4.9) 1 (2.4) 41
Table 2: Variable influencing the decision about pregnancy termination Variables influencing the decision Mothers wish Desire of immediate family Obstetricians decision The Act Total 14 53* 26.4 14 26.4 3 5.7 Number of responses 22 Percent
Table 3: Need to increase the gestational age for fetal anomaly Suggested limit for gestational age (weeks) 22 24 28 No limit No answer No need to change Responses (N = 41) Percent
41.5
0 17 10 9 1 4 46 27 24.3 2.7 9.8
* Percentage is calculated for the number of responses; 6 respondents marked 2 options; 3 respondents marked 3 options
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A PREVENTABLE DEATH: SUICIDAL PATTERNS AMONG WOMEN IN METROCITY BANGALORE, INDIA. 1 2 Karthik S K , Balaji PA , Mohan VJ 1, Smitha R Varne 3, Poornima S 2, Syed Sadat Ali2, Jayaprakash G 1, 1 Dept. of Forensic Medicine, Dr. B R Ambedkar Medical College, Bangalore - India 2 Dept of Physiology, Dr. B R Ambedkar Medical College, Bangalore - India 3 Healing touch yoga centre, Bangalore. Abstract:
Objectives: The objectives of the study are (i) To ascertain the frequency of suicidal deaths among females and (ii) To assess the various causes and contributory and precipitating factors for women to commit suicide. Methods: Data was collected from inquests, first information reports, statements made by the relatives, hospital records, panchanama at scene of offence through the Police and from the Postmortem examination reports from the Department of forensic medicine. Results: More number of females commits suicide, with the male: female suicide ratio 0.80:1. The peak age for committing suicides was 21-30 years wherein the percentage is 43.27%, followed by 11-20 years and 31-40 years wherein 27.40% and 15.38% deaths occurred respectively. Majority of victims were married (65.38%) hailing from urban areas (83.65%), living in nuclear family type (76.44%). Hanging (60.58%) was the most common method employed for committing suicide. Family problems(28.85%) followed by love failures(13.94%) were the major motives behind suicide and most of them committed suicide in isolated places with spot deaths(death occurring within 2-3 minutes ) occurring in 81.7% of victims. Conclusions: Suicidal deaths among women are increasing daily due to influence of multiple factors, which includes family problems, love failure, breach of marriages, dowry deaths, harassment, and, educational stress, poverty, and modernization of culture. Women choose different methods like hanging, drowning, burning, consuming poison to commit suicide.
Key words: Suicide, Female, Hanging.
Introduction: Suicide is an act with a fatal
Corresponding author: Balaji P A Email: drpaba@rediffmail.com
outcome, which the deceased, with the knowledge and expectation of a fatal outcome, had himself/herself planned and carried out with the object of bringing about the changes desired by [1]. the deceased
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It can also be defined as a complex behavioral phenomenon in which cultural, social and psychological aspects play important roles. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in 2020[2, 3, 4]. Suicide is fast becoming one of the most important public health issues in India [5]. According to WHO, latest suicide rate estimates, India along with China hold the dubious distinction of having the highest suicide rates in the world. Saving lives, keeping nation healthier includes a target to reduce the death rate from suicides. Thoughts of suicide and feeling life is not worth living might be the first step in a pathway that can end in completed suicide [6, 7]. According to a study entitled Epidemiology of suicides in Bangalore, conducted by the NIMHANS, Bangalore showed that more women than men commit suicide in Bangalore (57 %) & the largest numbers of them (57%) were adolescents & young adults. The psychological autopsy of suicides during a six-month period showed most victims were skilled workers (47 %) and housewives (23%). More than half of those committing suicides have specific high-risk behavior. Suicides due to family problems were increasing during the last three years [8]. Another study conducted involving rural southern India, indicated that the suicide rate in the 15-19 age group living around Vellore, Tamilnadu, India was 148 per 100,000for women and58 per 100,000 for men [9]. Rates for young women were almost three times higher than rates for young men and were the opposite of global rates. Clearly, this disturbing data indicated an urgent need for suicide prevention program, better assessment and treatment of mental disorders, better social treatment of women in India. Further in addition to
the impact on individuals and their families, suicide also imposed a huge social, emotional and economic burden on society [3, 10]. Data including suicidal patterns comparing males and females are plenty but patterns mainly highlighting females are limited and hence a prospective study was carried out to ascertain the frequency of suicidal deaths among females, and to study various contributory and precipitating factors for women to commit suicide and to have a better understanding of patterns of suicide in order to assist in adopting the most appropriate preventive plan. Legal aspects of suicide: In India according to section 309 I.P.C, whoever attempts to Commit Suicide or any act towards the commission of such offence shall be punished with simple imprisonment for a term which may extend to one year or a fine or both. Section 309 is reinforced by sections 306 & 304B, the former dealing with the abatement of commission of suicide, while the latter deals with dowry deaths. The Law Commission of India in its 210th report has recommended Humanization and Decriminalization of Attempt to Suicide [11] . Materials and methods: The present prospective study was carried out on female dead bodies which were subjected to post mortem examination in the morgue of Department of Forensic Medicine DR.B.R.AMC, Bangalore during the period from Nov 2009 to Oct 2011. Out of 942medico legal autopsies done in this period, 208 cases were determined to be of female suicidal
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deaths on the basis of police inquest and autopsy. These cases were examined regarding their socio-demographic characters, part of body involved, time of death, reasons for suicide and manner of death. The information with regard to the above aspects, such as inquests, first information reports, statements made by the relatives, hospital records, panchanamas of scene of offence were collected from the Police, apart from the Postmortem examination reports from the Forensic Department. Relevant information was also collected in person from the relatives, who attended the Mortuary at the time of Postmortem examination, where ever it is possible. Visit to the scene of offence were made whenever felt necessary. Statistical analysis: The data was entered in master chart and was analyzed using measures of central tendency like mean, median, range, percentage. The study was approved by Institutional Ethical Committee for human research and has followed guidelines according to the Helsinki Declaration of 1975, as revised in 2000. Results: In the present study out of the total 942 postmortems, 379 were suicidal and out of this 208(54.88%)cases of suicides were among females and 171(45.12%) were males. Females from urban areas were committing suicides more frequently 74(83.65%) than rural counterparts were 34(16.35%).
Chart 1: Age group of suicide victims
Chart 2: Education status of suicide victims
The number of Hindu females 163(78.37%) committing suicides were more when compared to Christians 23 (10.58%) & Muslims 22(11.06%).Victims among nuclear family159 (76.44%) outnumbered those among non-nuclear family 49(23.56%). Professionally majority of them were house wives 108(51.92%), next to them were the students 40(19.23%) who committed suicide.
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Table 1: Demographic pattern of suicide victims
40(19.23%) of women committed suicide during afternoon. Chart 3: Distribution of Suicide victims according to Motive
Demographic Numbe profile r Marital status Single Married 72 136
Percenta ge
34.62 65.38
Socio economic status
Upper Class Middle Class Lower Class
18 119 71
8.65 57.21 34.13
Family patterns
Nuclear Non-Nuclear (Joint)
159 49
76.44 23.56
Majority of deaths occurred at residence of the victims 178(85.57%). Few deaths occurred at remote areas 19(9.13%), while very few committed suicide at work place 5 (2.4%).Spot deaths occurred in majority of the cases 170(81.7%). 8(3.85%) of women survived for 6 hours after the act. 4(1.92%) of women survived for 12 hours after the act. 7(3.37%) of women survived for 24 hours after the act. 6(1.92%) of women survived for 3 days after the act. 5(2.40%) of women survived for 4-7days. Another 8(3.85%) of women survived for more than 7 days after the act.60(28.85%) of suicides took place during morning hours (6am-noon), 56(25%) during the evening hours, 52(26.92%) of women adopted the procedure to die in night, while another
Chart 4: Distribution of Suicide victims according to the Cause of Death
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Discussion: The present prospective study was carried on female suicide deaths registered from November 2009 to October 2011. Age group and (male: female) suicide ratio: The male: female suicide ratio was 0.80:1.The peak age for committing suicides was 21-30 years wherein the percentage is 43.27%, followed by 11-20 years and 31-40 years wherein 27.40% and 15.38% deaths occurred respectively. The percentage of females committing suicide was quite significant indicating that probably the young females are more emotional, sensitive and vulnerable to commit suicide. The youngest person to commit suicide was a 12 years old female, the oldest person to commit suicide was a 90 year old female. Suicide rate in the 15-19 years age group living around Vellore, Tamilnadu, India was 148 per 100,000 for women & 58 per 100,000 for men [9]. Yip & Liuin a demographic perspective study of female suicide in China, showed that the suicide rate was higher among women than men with a male: female suicide ratio of 0.77:1 [1, 12]. Concordantly suicide rates for Canadian girls aged 10-14 years increased from 0.6 per 100 000 in 1980 to 0.9 per 100 000 in 2008. Rates for female adolescents increased from 3.7 to 6.2 per 100 000 during the same period [13]. Similarly majority(67%) of those who commit suicide in Iran(lorestan) were women [14]. Suicide data were the endproduct of a chain of informants, including family members, police, doctors and coroners, and any of them, for a variety of reasons, may be unwilling to record the death as suicide. Therefore, there was possibility of underestimation of true suicide rates in the population,
especially in places where cultural and/or religious attitudes condemn suicide [15]. Motive or risk factors for committing suicide: In the present study, family problems have taken28.85%of female lives followed by other factors like love affairs, marital disharmony, physical illness, dowry deaths etc. and psychological problems accounted to 8.25 % of suicides. One of the strongest risk factors for suicide is mental disorders, and in a meta-analysis it has been shown that most types of mental disorder increase the suicide risk between 5-fold and 15-fold. For instance, depression is the most important mood disorder that is strongly associated with suicide, especially for young women and elderly people; in a recent study the prevalence of major depressive episodes in the year 2000 for the Eastern Mediterranean region were estimated to be 1872 and 2748 per 100 000 males and females, respectively; clearly both figures are higher than the world average [16, 17, 18, 19]. More females than males seek help from general practitioners for mental health problems. Consequently more females were treated for depression. Among females, increased sales of antidepressants were associated with a decline in suicide mortality (adjusted p = 0.03) [20]. In the present study, married women were major victims (65.38%) of the total number of suicides in the study population when compared to unmarried woman (34.62%).Stress associated with marriage, dependency, dowry related problems, interpersonal differences with spouse and relatives were the major factors in Indian women [21]. Marriage usually has a protective effect against suicide, which might illustrate the fact that those people who may be prone to suicide are more likely to be single or to
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have been divorced or widowed. However, marriage might not be protective in all cultures, especially for young women. For instance, higher rates of suicide and deliberate self-harm have been reported among married women in Pakistan in comparison to both married men and single women. This may be because social, economic and legal discrimination creates psychological stress that leads these women to commit suicide or deliberately harm themselves [22, 23, 24, 25]. The high female suicide rate in Hong Kong could be related to workload, responsibility, and expectations [26]. Method of committing suicide: In the present study, Deaths due to Hanging (60.58%)was the most common method of committing suicide among females than other modes of violent deaths and next in line was deaths due to burns (12.98%), followed by poisoning (11.06%), drowning(8.17%) and others. In a study involving Eastern Mediterranean Region, the rates of suicide as a proportion of all deaths by injury were the highest [27]. In European population, hanging was the most prevalent suicide method among females (35.6%) followed by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three [28]. The most common method among females in Japan and United States was hanging, followed by jumping from a high place [29]. Deaths by suffocation among Canadian females increased by an annual average of 8% in both females aged 10-14 years and adolescent [30].
Recommendations: 1. Health education, counseling, timely crisis intervention either by medical or psycho social methods certainly reduce the number of suicide victims. 2. Psychological counseling must be provided to all the people in need to tackle various kinds of stresses like education, unemployment, poverty, financial problems, physical illness, marital problems, social problems, emotional problems, personal problems, dowry related issues etc. 3. Yoga with meditation classes and camps which can benefit all areas of an individual's life: mind, body, behavior, health, disease and environment, should be organized by NGOs and Government health authorities and enroll particularly the high risk population. 4. The rampant dowry system in our country in our society should be eradicated. 5. Reducing the availability of and access to pesticide, reducing alcohol availability and consumption. 6. Promoting responsible media reporting of suicide and related issues, promoting and supporting NGOs, improving the capacity of primary care workers and specialist mental health services and providing support to those bereaved by suicide and training gatekeepers like teachers, police officers and practitioners of alternative system of medicine and faith healers. Above all, decriminalizing attempted suicide is an urgent need if any suicide prevention strategy is to succeed in the prevailing system in India. 7. Research studies regarding female suicide bombers, suicide pact among females are pertinent to the present era.
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Conclusion: Suicidal deaths among women are increasing daily due to influence of multiple factors, which includes family problems, love failure, breach of marriages, dowry deaths, harassment, and, educational stress, poverty, and modernization of culture. Women choose different methods like hanging, drowning, burning, consuming poison etc, to commit suicide. All these aspects imply an urgent need of implementation of preventive strategy by government and non government organisations (NGOs). Acknowledgement: We acknowledge Dr. Stanley John, Principal, Dr. B R Ambedkar Medical College for his support throughout the study. References:
1. Tadros G.Reverse gender pattern for suicide in Asian population? A perspective from UK. (Editorial Article), Jr of Pakistan Psych Soc 2008; 5(1):3. 2. Nordentoft M. Prevention of suicide and attempted suicide in Denmark. Epidemiological studies of suicide and intervention studies in selected risk groups.Dan Med Bull 2007; 54:306-69. 3. De-Leo D. Struggling against suicide: the need for an integrative approach.Crisis 2002; 23:2331. 4. Mental health.WHO,Suicide prevention (SUPRE). [Cited and updated date: 7th May 2012.] Available at: www.who.int/entity/mental_health/prevention /suicide/suicideprevent/en/ 5. Mohanty S, Sagu H, Mohanty MK, Patnaik M. Suicide in India: A four year retrospective study. J Forensic Leg Med 2007; 14(2):185-89. 6. India, China have highest suicide rates in the world. Available at: [cited and updated: 7th June2012] http://articles.timesofindia.indiatimes.com/20 08-10 11/india/27901743_1_suicide-ratesmental-health-world-suicide-prevention-day. 7. Thomas HV, Crawford M, Meltzer H, Lewis G. Thinking life is not worth living. A population survey of Great Britain.Soc Psychiatry,PsychiatrEpidemiol. 2002; 37(8):351-56.
8. Gururaj G and Isaac MK: Epidemiology of Suicides in Bangalore. NIMHANS Publication 44, 2001.Available at[cited and updated: 7th June 2012] http://www.nimhans.kar.nic.in/epidemiology/ epidem_p5.htm 9. Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad J, et al. Suicides in young people in rural southern India. The Lancet 2004; 363(9415):1117-18. 10. Silverman MM, Berman AL, Sanddal ND, O'carroll PW, Joiner TE. Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology.Suicide Life Threat Behav 2007; 37:248-63. 11. Law Commission recommends Humanization and Decriminalization of attempt to suicide. Available at:[cited and updated: 7th June 2012] http://www.indlaw.com/search/news. 12. Yip, P.S.F, Liu. KY. The ecological fallacy and the gender ratio of suicides in china. British journal of Psychiatry 2006; 189:465-66. Available at: [cited and updated: 7th June 2012] http://bjp.rcpsych.org/content/189/5/465.sh ort 13. Suicide rates among girls going up, but decreasing for boys: CMAJ study. Available at: [cited and updated: 7th June 2012]http://www.thestar.com/living/article/1 155285. 14. Women, Main Victims of Suicide in Iran. Available at: http://www.parstimes.com/women/womens_s uicide.html 15. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R.World report on violence and health. Geneva, World Health Organization, 2002. Available at: [cited and updated: 7th June 2012]http://whqlibdoc.who.int/publications/2 002/9241545615_eng.pdf 16. Amos T, Appleby L. Suicide and deliberate selfharm. In: Chief Editor: Appleby L, 1st ed. Postgraduate psychiatry: clinical and scientific foundations. London, 2001:34757. 17. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A metaanalysis. British journal of psychiatry, 1997; 170:20528. 18. Roy AL. Suicide. In: Sadock BJ, Sadock VA. Kaplan and Sadocks comprehensive textbook of psychiatry, 7thed. Philadelphia, Lippincott Williams & Wilkins, 2000:2031 40.
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19. Ustun TB et al. Global burden of depressive disorder in the year 2000. British journal of psychiatry, 2004; 184:38692. 20. Johannessen HA, Dieserud G, Claussen B,Zahl P.Changes in mental health services and suicide mortality in Norway: an ecological study. BMC Health Services Research2011; 11:68. Available at:[cited and updated: 7th June 2012] http://www.biomedcentral.com/14726963/11/68 21. Lalwani S, SharmaGASK, Rautji R, T Millo. Study of suicide among young and middle age adults in South Delhi.Indian J. Prev. Soc. Med. 2004; 35:173-78. 22. Charlton J. Trends and patterns in suicide in England and Wales. International journal of epidemiology, 1995; 24:S4552. 23. Charlton J et al. Trends in suicide deaths in England and Wales. Population trends, 1993; 69:106. 24. Khan MM, Reza H. Gender differences in nonfatal suicidal behaviour in Pakistan: significance of sociocultural factors. Suicide and life-threatening behavior, 1998; 28:628.
25. Khan MM, Reza H. The pattern of suicide in Pakistan. Crisis, 2000; 21:315. 26. Yip PS. Suicides in Hong Kong and Australia. Crisis. 1998; 19(1):24-34. 27. Rezaeian M. Age and sex suicide rates in the Eastern Mediterranean Region based on global burden of disease estimates for 2000. East Mediterr Health J. 2007; 13(4):953-60. 28. Vrnik A, Klves K, FeltzCornelisVCM, Marusic A, Oskarsson H, Palmer A, et al.Suicide methods in Europe: a genderspecific analysis of countries participating in the "European Alliance Against Depression".J Epidemiol Community Health. 2008; 62(6):545-51. 29. Ojima T, Nakamura Y, Detels R. Comparative study about methods of suicide between Japan and the United States. J Epidemiol. 2004 Nov;14(6):187-92. 30. Suicide rates in Canada increasing in girls aged 10-19 years.Available at: [cited and updated 7th June 2012] http://medicalxpress.com/news/2012-04suicide-canada-girls-aged-.html
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INCIDENCE OF POISONING REPORTED AT A TERTIARY CARE HOSPITAL K.Padmakumar 1, B.G.Maheshkrishna 2, J.Jaghadheeswararaj 2, A.Natarajan 2
2
Department of Forensic Medicine and Toxicology, Jubilee Mission Medical College, Thrissur. Department of Forensic Medicine and Toxicology, PSG Institute of Medical Sciences & Research, Coimbatore.
Abstract:
Throughout human history, intentional application of poison has been used as a method of suicide, pest-control, murder, and execution. In addition to this accidental poisoning also occur. Whatever be the manner poisoning is an important medical emergency and one of the leading causes of mortality and morbidity among the population. A detailed review of pattern of incidence and risk factors involved helps medical personals and policy makers to reduce the incidence and mortality. With this view a retrospective study based on medical records was conducted among 119 poisoning cases admitted at PSG hospital, Coimbatore, Tamilnadu from July 2010 to June 2012. Out of this, 56 cases (47%) were males and 63 cases (53%) were females. The most commonly affected age group was 21-30 years (40%) followed by 11-20 years (19%). Among the cases 63 cases (53%) were married and 56 cases (47%) were unmarried. More than two thirds belonged to low socio-economic group. The incidence of poisoning was higher during the month of July and majority of victims consumed poison during night. Incidences of suicidal cases (79.83%) were highest in the present study followed by accidental (11.77%) poisoning. One case was reported as homicidal (0.84%). Mode of administration of poison in all the cases is oral. Poisons included artificial cow-dung powder (40.34%), insecticides and pesticides (17.65%), drugs including alprozolam and phenytoin (27.73%).Among insecticides organophosphorus compound was the commonest. Key-words: Poisoning, Suicide, Cow dung powder.
Introduction: In recent years, the incidence of poisoning has increased considerably. Most of the cases of poisoning are due to intentional self administration. Pesticides, corrosives and vegetable irritants are commonly ingested for suicidal purpose as they are freely available [1]. Corresponding author: K.Padmakumar
Email: pkkidangoor@yahoo.com
Occupational poisoning is also common in our country because of ignorance, illiteracy, unsafe practices and lack of personal protection measures. It is estimated that more than 50,000 people die every year from toxic exposure in India [2]. But the nature and profile of different modes of poisoning varied significantly in different parts. Hence a pattern and trends of poisoning in a particular area is essential for early diagnosis, treatment and also for the
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government authorities to formulate policy regarding preventive and protective measures. Objective of this study is to determine the type of poison consumed, manner of consumption, demographic data, diurnal and seasonal variation. Up keeping of statistics always helps policy makers and scientists to solve the problems faced by the society from time to time. Gathering of information by this study can also be used in formulating recommendations which can help society from the hazardous effects of poisoning Materials and Methods: The study consisted of 119 cases admitted at PSG hospital, Coimbatore, Tamilnadu from July 2010 to June 2012 and was studied retrospectively based on medical records. Poisoning was diagnosed by history given by patient and relatives, clinical features, investigations and response to treatment. To evaluate the trends of poisoning criteria like age, sex, region (rural/urban), manner of poisoning and socio economic status were studied. Chronological factors like time of consumption and seasonal incidence were also studied. All the data was collected and critically analyzed, tabulated and compared with other various studies to analyze the aims and objectives of present study. Snake bite cases were excluded from the study Results: The study population consisted of 119 poisoning cases, out of which 56 cases (47%) were males and 63 cases (53%) were females as shown in figure No.1. The most commonly affected age group was 21-30 years (40%) followed by 11-20 years (19%). Distribution of poisoning cases in relation to age is shown in Figure-2. Out of the 119 cases of poisoning 63 cases (53%) were married
and 56 cases (47%) were unmarried. More than two thirds belonged to low socio-economic group. The incidence of poisoning was highest during the month of July, followed by June and May. Month wise distribution of cases is shown in Table-I. Considering the time of poisoning, majority of cases-46 (39%) were observed during night. Incidence of day time poisoning were 40 cases (34%) and in 33 cases (27%) exact time was not known. Distribution of manner of poisoning is shown in Table-II. Incidence of suicidal cases (79.83%) was highest in the present study followed by accidental (11.77%) poisoning. One case was reported as homicidal (0.84%) and 9 cases (7356%) were of undetermined origin. This inference is based on history. Mode of administration of poison in all the cases is oral. Poisons included artificial cow-dung powder (40.34%), insecticides and pesticides (17.65%), drugs including alprozolam and phenytoin (27.73%). Among insecticides organophosphorus compound was the commonest. Distribution of poisoning cases according to type of poison is shown in Table-III. Discussion: The incidence of poisoning as per this study is high in third decade of life which is similar to most of the studies by various authors [3, 4, 5, 6]. It is obvious that this age group is more prone to mental stress compared to extremes of age because of factors like education, unemployment, beginning of employment, marriage, settlement factors etc. are the important causes of death in married people. Regarding the socio economic status of victims, 52% cases belonged to low socio-economic status. In majority of the studies conducted in India more than
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two third of the victims belonged to low socio economic category [4, 7, 8]. A season wise variation was also noted in the incidence in this study. The incidence of poisoning was highest during the month of July, followed by June and May. Many studies showed maximum incidence during summer [3, 4, 6] while other studies [7, 9] showed more occurrence during rainy season. Considering the time of poisoning, majority of cases-46 (39%) were observed during night. Incidence of day time poisoning were 40 cases (34%) and in 33 cases (27%) exact time was not known. A study conducted in Khammam [3] and Orissa [4] says that most of the victims consumed poisons day time, while other studies says that maximum intentional consumption occurs during evening hours [9]. In the present study out of the 119 cases, 48 cases (40.34%) were due to artificial cow dung powder. This is in contrast to most of the studies conducted in various parts of India which shows pesticides as the commonest type of poison [3, 4, 6, 7, 8, 10]. Cow dung is used in south India as a household cleansing powder and also for religious purposes. Due to scarcity of natural cow dung chemical substitute for it is available in Tamilnadu in two powder forms: a green powder that contains malachite green and a yellow powder which contains Auramine O [12]. The packet containing powder is available in shops in this region, though the government has banned of-the-counter sales. That the powder is cheap and is easily available makes it the preferred poison for those wanting to end their lives. Gargi et al in their study in Punjab reported that aluminium phosphide is the leader of all the poisons, next commonest poisoning is organophosphorus and remaining poisons are very rarely consumed for
committing suicide [7]. A 25 years autopsy based study reported that since 1992 when aluminium phosphide is freely available in the market, it has reportedly overtaken all other forms of deliberate poisoning [10]. Another observation in this study is consumption of household poisons like detergent solutions and pyrethrins are on the rise. In the present study 79.83% cases were suicidal in nature. Majority of the studies in this regard also showed that most of the poisoning cases were suicidal [3,4,5,6,7,8]. This inference is based on the history. When such a history is given by the victim, we tend to believe it on the assumption that he has nothing to hide. Fourteen cases were accidental in nature, which occurred in both extremes of age. Out of the six cases in the age group below 11 years, 4 cases were of accidental ingestion of poisons and in 2 cases neem oil was given by the parents as a mode of treatment for worms which produced toxic symptoms. Conclusion: In the present study females are affected more than males with highest incidence of poisoning in the age group of 21 to 30 years. Most of the victims belong to low socio-economic group with married people outnumbering the unmarried. The incidence of poisoning was highest during the month of July, followed by June and May. Majority of cases occurred during night. Incidence of suicidal cases was highest in the present study. In contrast to many of the similar studies the most common type of poison used as per this study is artificial cow dung powder. This chemical substance, used in the dyeing industry, has emerged as the favourite substance for many in this region, when they wish to take their lives. A crackdown on the sale of a chemical substance,
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known as cow dung powder in common parlance, is imminent. Drugs like alprazolam should not be sold at counters without proper prescriptions. Extending the services of psychiatrist or psychologist to the community may help in identifying the high risk individuals who are likely to commit suicide. It is also suggested to conduct periodic study on trends of poisoning to formulate appropriate health education programmes for the prevention of accidental and suicidal poisoning. References:
Umadethan B, Forensic Medicine, First edition, CBS Publishers & Distributors, New Delhi: 2011; pp323. 2. Pillai VV, Textbook of Forensic Medicine and Toxicology, Paras Publishers, Hyderbad, 15th edition2010; pp 426. 3. Bharath K Guntheti, Uday Pal Singh. The pattern of poisoning in Khammam; Journal of Indian Academy of Forensic Medicine 2011: Vol: 33(4) pp 145-148. 4. Shreemanat Kumar Dash: Socio demographic profile of poisoning cases; Journal of Indian Academy of Forensic Medicine 2005:27(3) pp 133-138. 5. B.D Gupta, P C Vagehela. Profile of fatal poisoning in and around Jamnagar; Journal of Indian Academy of Forensic Medicine 2005:27(3) pp 145-148. 6. Vikram Palimar, G Pradeep Kumar. Poisoning Deaths in children. Journal of Indian Academy of Forensic Medicine 2009: Vol: 31(3) pp 218-221. 7. Gargi J, Rai H, Chanana A, Raj G, Sharma G, Bagga IJS. Current trends in PoisoningA hospital profile, Journal of Punjab Academy of Forensic Medicine and Toxicology -2005:27(3) pp 145-148. 8. Sanjeev Kumar, Akhilesh Pathak, HM Mangal. Trends of Fatal poisoning in Saurastra region of Gujarat, Journal of Indian Academy of Forensic Medicine 2011: Vol: 33(3) pp 197-199. 9. Srinivasulu, M K Mohanty. Study of Poisoning cases in a tertiary care Hospital. Journal of South India Medico legal Association 2011: Vol: 3(1) pp14-18. 10. Singh Dalbir MD, Jit MS, Tyagi Seema. Changing trends in acute poisoning in Chandigarch Zone-A 25 years autopsy 1.
experience from a tertiary care hospital in northern India. The American Journal of Forensic Medicine and Pathology 1999 June; 20(2): pp: 203-210. 11. Navinkumar M Sharma, S D Kalele. Study of profile of Deaths due to Poisoning in Bhavnagar Region, Journal of Indian Academy of Forensic Medicine 2011: Vol: 33(4) pp 311-316. 12. Utpal Kant Singh, F C Layland, Rajniti Prasad, Shivani Singh Ch: 23Miscellaneous Poisoning In Children by Jaypee Brothers, Medical Publishers. PP: 213-215
Fig I Sex-wise distribution of cases
53 %
47 %
Male Female
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Table: I Month wise distribution of poisoning cases.

Sl.No Month 1 2 3 4 5 6 7 8 9 10 11 12 January February March April May June July August September October November December Total No. of cases 9 11 7 6 14 16 20 7 4 7 9 9 119 % 7.56 9.25 5.88 5.05 11.76 13.45 16.81 5.88 3.36 5.88 7.56 7.56 100.00
Table: I I Sl.No: 1. 2. 3. 4. Manner Suicidal Accidenatl Homicidal Not Known
Manner of Poisoning No. of cases 95 14 01 09 % 79.83 11.77 00.84 07.56
Table: III Type of Poison Sl.No Name of Poison 1 2 3 4 5 6 7 8 9 10 11 12 Cow dung poison Insecticides & Herbicide Pyrethrins Detergents Alprozolam Phenytoin Alternate Medicine Neem oil Hair dye Alkali Aluminium phosphide Other drugs Total No. of cases 48 21 5 3 5 5 4 2 1 1 1 23 119 % 40.34 17.65 4.20 2.52 4.20 4.20 3.36 1.68 0.84 0.84 0.84 19.33 100.00
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SOCIODEMOGRAPHIC PROFILE OF CARDIAC DEATHS Dayananda R 1, Harish S 2, Girish Chandra Y P 2, Sampath Kumar P 3
1
Department of Forensic Medicine, Mysore Medical College and Research Institute, Mysore. 2 Department of Forensic Medicine, M S Ramaiah Medical College, Bangalore. 3 Department of Forensic Medicine, Sri Ramamchandra Medical College and Research institute, Chennai.
Abstract:
Autopsy surgeon comes across a lot of natural deaths in which cardiac deaths predominate. To determine the socio demographic profile of cardiac deaths a prospective study was conducted at M S Ramaiah medical college, Bangalore. Details of the deceased were collected from autopsy records, relatives and analysed. Of the 76 cardiac deaths majority were males and in the age group 31 40 years. The habits like smoking and alcohol consumption was significantly high in deaths of cardiac origin. Majority of cardiac deaths were in Class II followed by Class III socio economic group. Majority of cardiac deaths occurred between 6.01 am to 12 pm, within an hour of onset of symptoms.
Key words Cardiac death, Smoking, Alcohol and Socioeconomic status
Introduction
A large number of victims who died unexpectedly, when subjected to autopsy were found to be natural deaths among which diseases of heart account for approximately 90 percent.1 The role of the autopsy surgeon in the investigation of sudden death is enormous. In some instances, there will be a welldocumented medical history and autopsy findings allowing a straightforward cause of death determination. Unfortunately, majority of cases present without any ante mortem documentation of significant clinical history.2 This investigation requires the collection of data from the family members of the deceased regarding the recent symptomatology before death, past medical history and history of cardiac deaths in the family. The practice of forensic medicine is quite different from other branches of medicine, the autopsy surgeon should not accept the mere association of a cardiac disease with unexpected deaths unless the history, gross pathological findings, histopathological findings, relevant investigations like microbiological, bio chemical markers, cardiac markers etc confirm it. Hence socio demographic profile of cardiac deaths will help to prevent the same in future. Materials and methods The present prospective study was conducted in the department of Forensic medicine M.S Ramaiah Medical College Bangalore from Oct 2009 to March 2011, for a period of 18 months, with prior ethical clearance. The study included all cases of natural death which had occurred within 24 hours from onset of complaint.
Corresponding author: Dayananda R Email: drdaya.r@gmail.com
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At the time of autopsy, information of the deceased was collected regarding the stress, habits, past medical history like hypertension, DM, heart disease and the symptoms that immediately preceded death was obtained from the relatives with prior consent. The hospital case sheets were studied in detail in admitted cases. The cases with congenital heart disease, decomposed bodies, excessively mutilated bodies, deaths due to non cardiac and unnatural causes were excluded from the study. Results and discussion In the study period, out of 76 cardiac deaths 62 were males and 14 were females. Estrogen has been suggested to play a cardioprotective role in women and could contribute to gender differences. Similar results were obtained by Monika Garg3 and Murthy 4. Maximum incidence of cardiac deaths was among 31- 40 years followed by 41 -50 years (Table 1). The cardiac fatalities increased upto the age of 40 and decreased after 40 years in both the sexes. The reason could be as a person ages, the cardiac vessels experience gradual changes. The walls of the arteries lose their elasticity and stiffen with progression of atherosclerosis. The muscles of the aged heart may relax less between beats as a result the ventricles become stiffer and may work less efficiently. The decreased number of deaths in victims aged above 40 years can be explained by well documented medical history and records from which cause of death could be given without autopsy. Socioeconomic profile of cases were studied based on Kuppuswamys classification. There were 8 cardiac deaths in Class I, 50 in Class II and 18 in Class III while class IV and V recorded no cardiac deaths in our study. The high
incidence in class II and III could be due more stress in work places, high ambitions, inability to afford for rich healthy foods, increasing health care expenses, high preference for junk and fast foods. The habit of smoking, chronic alcoholism, non vegetarian diet was present in 51, 46 and 63 cases respectively (Fig 1). Direct and additive effect of smoking on heart may be attributed to carbon monoxide and nicotine as suggested by Leone et al.5 This is in accordance with the findings of Leone et al5 and Auerbach et al.6 Acute excessive alcohol intake was known to cause direct toxic effect on the heart, whereas chronic heavy drinking may cause alcoholic cardiomyopathy.7 The high incidence in non vegetarians could be due to the high fat content and low fibre content as compared to vegetarians. In our study 25, 23, 8, 52 cases had a previous history of hypertension, dibetes mellitus, cardiac disease, stress (loss of spouse, job, financial problems etc) respectively (Fig 2). Hypertension, Diabetes mellitus and cardiac diseases are known risk factors in our study which are in agreement with the study done by Enas et al.8 When a person is subjected to stress, sympathetic activity is increased and parasympathetic activity is inhibited and initiates the fright, fight and flight response. Acute stress causes the atherosclerotic plaque to rupture, this activates the platelets and coagulation pathway leading to coronary thrombosis. In sympathetic overactivity, coronary spasm which could have contributed to the death could not be ruled out. Out of 76 cardiac deaths 42 deaths occurred between 6.01 am to 12 pm (Table 2). The circadian variation with a peak incidence in the morning hours can be explained by increased stress at morning either in a hurry to reach work
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place on time or at work as compared to free hours9. Which correlates with the findings of Willich et al.10 Among the 76 cardiac deaths 63 died within one hour of the onset of symptoms, others (13) died within 12 hours this may be due to severity of disease, unawareness of symptomatology by patients, lack of screening measures, lack of ambulance services etc. This stresses the importance of golden hour Conclusion Males are more vulnerable to cardiac deaths. Majority of deaths (44.74%) occurred in the age group 31- 40 years. Smoking, alcohol, stress and non vegetarian were significant risk factors in our study. Middle socio economic status people are more predisposed to cardiac deaths. Most of the cardiac deaths occurred between 6.01 am 12 pm. Majority of the deaths (82.89%) occurred within an hour of onset of symptoms. Suggestions and preventive measures: Periodic health check up from young adulthood. Providing ambulance services, doctors, infrastructure for all primary, secondary and tertiary centres. Modification in life style, diet etc. Prompt treatment at the earliest stage. Education of the masses regarding etiology, symptoms, investigations and treatment of the cardiac diseases. References
1) Pekka Saukko, Bernard knight. Knights forensic pathology. 3rd ed. New York: Oxford University press Inc; 2004.p.492-5.
2)
David Dolinak, Evan W Matshes, Emma O Lew. Forensic pathology principles and practice. 1st ed. London: Elsevier Academic Press; 2005.p.72-6. 3) Monika Garg, Akash Deep Aggarwal, Sant Prakash Kataria. Coronary Atherosclerosis and Myocardial Infarction-An Autopsy Study. J Indian Acad Forensic Med 2011 Jan-Mar; 33(1):39-42. 4) Murthy MSN, Dutta BN, Ramalingaswami V. Coronary atherosclerosis in North India (Delhi Area). J Pathol Bacteriol 1963; 85:93-101. 5) Leone A, Lopez M, Picerno G.Cigarette smoking in relation to coronary disease:hypothesis on the mechanism of myocardial damage.5th World Conference on Smoking and Health,Winnipeg, Canada 1983.Abstracts 1983:97-8. 6) Auerbach O,Carter HW,Garfinkel L, Hammond EC. Cigarette Smoking and coronary heart disease,a macroscopic and microscopic study. Chest 1976:70:697705. 7) Vinay Kumar,Abul K Abbas,Nelson Fausto.Robbins and cotran. Pathologic basis of disease.7th ed Elsevier Inc ;2008.p.555-608 8) Enas EA. The essence and nonsense of stress:The straw that breaks the camel's back. AAPI Journal 1996;8:47-48. 9) Vincent J DiMaio, Dominick J DiMaio. Forensic pathology. 2nd ed. Boca Raton: CRC Press; 2001. p.43-57. 10) Willich SN, Levy D, Rocco MB, et al.: Circadian variation in the incidence of sudden cardiac death in the Framingham heart study population. Am Cardiol 1987; 60:801-806.
Table 1- Age and sex distribution of cardiac deaths. Age 21-30 years 31-40 years 41-50 years >50 years Male Female Male Female Male Female Male Female No of deaths 9 0 31 3 15 9 7 2 Total 9 34 24 9
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Table 2: Distribution of cases according to the time of death. Time 12.01 am to 6 am 6.01 am 12 pm 12.01pm 6 pm 6.01pm 12 am No of cases 18 42 6 10
Figure 1 - Predisposing habits for cardiac deaths.

70 60 51 50 40 30 20 10 0 SMOKING PRESENT ALCOHOL ABSENT Non vegetarian 30 25 13 46 63
Figure 2 Predisposing diseases for cardiac deaths.
Present
Absent 68
51 25 23
53
52 24 8
HTN
DM
H/O cardiac disease
Stress
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PREDICTION OF STATURE FROM PERCUTANEOUS ULNA LENGTH Dileep Kumar R 1, Nagesh Kuppast 1, Shradha Iddalgave 2, Raju G M 1, Sunil S Kadam 1, Hemanthraj M N 1 1 Dept. of Forensic Medicine, S. S. Institute of Medical Sciences and Research Center, Davangere, 2 Dept. of Anatomy, J. J. M. Medical College, Davangere. Abstract The anthropometric study of bones provides information regarding individuals age, sex, race and height. Many a times Forensic Experts are asked to identify the person from dismembered part of the body and skeletal remains by the Investigating Officer. If the whole skeleton is available it becomes easy for identification, but the problem arises when only dismembered part of the body, few bones or single bone is available. In identification stature is primary characteristic along with age and sex. The present study is carried out in S. S. Institute of Medical Sciences and Research Center, Davangere, Karnataka. Total 100 students (50 males and 50 females) are randomly selected. The height of the students and length of both right and left ulna of each student is measured by the same observer and with the same instrument. Regression Equation for estimation of stature from percutaneous length of right and left ulna for males and females is calculated separately. Co-efficient correlation of height with percutaneous ulna length is also calculated. The results of the present study would be useful for Anthropologists and Forensic Medicine Experts. Key Words: Stature, Percutaneous Ulna length, Regression Equation, Co-efficient correlation
Introduction Stature estimation is one of the important criteria for establishing the identity of an individual. Many a times Forensic Experts are asked to identify the person from dismembered part of the body and skeletal remains by the Investigating Officer. If the whole skeleton is available it becomes easy for identification, but the problem arises when only dismembered part of the body, few bones or single bone is available as it is a tedious and time consuming process involving cleaning and preparing of bones. Even then the result may be quite erroneous because of considerable statistical differences between the lengths of fresh and dry bones. 1 In past many authors have studied on Stature estimation based on measurements of Ulna and other long bones. Several authors have offered regression equations based on the length of long bones; however it is well known that formulae that apply to one population do not always give accurate results for other populations. Pearson2 stated that a regression formula derived for one population should be applied to other groups with caution. Most studies have stressed that regression formula for stature estimation should be population specific. So there is a need to develop a separate regression formula for stature estimation from long bone measurement for a particular population. Since Olecranon process and styloid process are easily felt through the
Corresponding author: Dileep kumar R Email: drdileepr@gmail.com
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skin, it becomes easy to measure the length of the Ulna bone. So the present study Estimation of Stature from Percutaneous Ulna Length is taken up. Materials and Methods The present study was carried out in S. S. Institute of Medical Sciences and Research Center, Davangere, Karnataka. Total 100 students (50 males and 50 females) are randomly selected. Subjects with congenital or acquired skeletal abnormalities were excluded from the study. Height, length of both right and left ulna of each student was measured during the time period of 2.00pm to 4.00pm to eliminate diurnal variation of height and by the same observer, using the same instrument to avoid personal error in methodology. Ulna length is measured with the help of spreading caliper from the tip of olecranon process to tip of the styloid process with elbow flexed and palm
spread over opposite shoulder. The height of the individual was measured using standard anthropometer. After collection of data, it is subjected to statistical analysis. Mean, Standard Deviation, Standard error of estimate and Range for height, right ulna length and left ulna length is calculated separately for males and females. Independent linear regression equations to calculate the height were obtained for both right and left ulna length, separately for males and females. Results The statistical data which are extracted from calculation are tabulated in Table-1 and Table-2 & Table-3.
Table-1 Parameter Right Ulna Length Left Ulna Length Height Males Range 26.0 - 30.5 26.0 - 30.5 158 - 182 Mean 28.20 28.12 172.00 SD 0.99 1.08 5.80 Females Range 23.6 - 27.7 23.1 - 27.6 148 169 Mean 25.42 25.30 158.13 SD 0.99 1.08 5.41
Table-2 Correlation with Height P Value P Value Right Ulna 0.85 <0.001 0.92 <0.001 Length Left Ulna 0.84 <0.001 0.93 <0.001 Length Karl Pearson coefficient of correlation Males Co efficient Females Co efficient
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Table-3 Regression Equation Height = 30.4 + 5.02 Rt Ulna Males Height = 45.0 + 4.51 Lt Ulna Height = 29.2 + 5.07 Rt Females Ulna Height = 40.3 + 4.66 Lt Ulna R square 0.73 0.71 0.86 0.86 SE of Estimate 3.01 3.1 1.9 2.02
Table - 1 Shows Range, Mean and Standard deviation for height, right ulna length and left ulna Length for male and female. Table -2 Shows Correlation Co-efficient of height with right ulna length and left ulna length and P values, separately for male and female. For males, correlation co-efficient X4 denotes left ulna length of male of height with right ulna length and left The standard error of estimate ulna length are 0.85 and 0.84 works out to be 3.01 for right ulna length respectively which show significant and 3.1 for left ulna length in males, 1.9 positive correlation. Similarly for females for right ulna length and 2.02 for left ulna Correlation Co-efficient of height with length in females. right ulna length and left ulna length are 0.92 and 0.93 respectively, which also Thus at 95% confidence level the show significant positive correlation. P estimated height of male and female are value in all the cases is <0.001 which is as follows: statistically significant. In Males Table - 3 Shows Standard Error of Y1 = 30.4 + 5.02X 5.89 1 Estimate for right ulna length left ulna Y2 = 45.0 + 4.51X 6.07 length in males and females.
2
Regression formulae for estimation of height; In males Height from Right Ulna Length; Y1 = 30.4 + 5.02 X1 Height from Right Ulna Length; Y2 = 45.0 + 4.51 X2 In Females Height from Right Ulna Length; Y3 = 29.2 + 5.07 X3 Height from Right Ulna Length; Y4 = 40.3 + 4.66 X4 Where, X1 denotes right ulna length of male X2 denotes left ulna length of male X3 denotes right ulna length of female
In Females Y3 = 29.2 + 5.07X 3.72

3
Y4 = 40.3 + 4.66X 3.95

4
Discussion Results of present study are in good agreement with the study done by Mondal M.K. et. al.3 (where in correlation co-efficient (R) of height with right ulna length and left ulna length are 0.78 and 0.68 respectively), Umesh S. R.4 (R = 0.79 for male right ulna length, R = 0.77 for male left ulna length, R = 0.74 for female right ulna length, R = 0.83 for female left ulna length.) and Sorojini Devi et. al.5 (R = 0.619 for male and R = 0.584 for female).
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Duyar I. et. al.6 mentioned in his study that separate regression equation is needed to estimate stature depending upon length of ulna (short, medium and tall) in order to have accurate results. Allbrook D7 derived regression equation formulae for height estimation from ulna length as, Stature = 88.94 + 3.06 (ulna length) 4.4 (S.E.) but he had not derived regression equation separately for male and female. Agnihotri A. et. al.8 are of the opinion that there is no need of separate regression formulae for right and left ulna and also no need of separate equation for male and female, but Mohanty 9 suggested a need for gender based different regression equations to predict the height. Athawale MC 10 showed that there is definite correlation between stature of an individual and length of forearm bones. The regression equation derived for stature estimation from ulna length is; Stature = 56.97 + 3.96 x Length of ulna 3.64. Here the author has taken average length of right and left ulna length for estimation of stature. In this study we have derived a separate regression equations for both right and left ulna length for males and females to estimate the stature of an individual. Conclusion The results of the present study indicate that the percutaneous length of ulna can be efficiently used for estimation of stature. Most authors have underlined the need for population-specific stature estimation formulae. The main reason for this is, the ratio of various body parts differ from one population to another. In addition to ethnic differences, secular trends, factors such as socioeconomic and nutritional status can also influence body proportion. So in this study we
have derived a separate regression equation to estimate stature from percutaneous ulna length for Davangere region. References
1. Brues AM. Identification of skeletal remains. J Crim Law Crimon & Pol Sci 1958; 48:551-63. 2. Pearson K. Mathematical Contribution to the theory of Evolutions v on reconstruction of stature of the prehistoric races. London: Philos. Trans. R Soc; 1898. Series A 192: p. 169-244. 3. Mondal MK, Jana TK, Das J et. al. Use of length of Ulna for estimation of Stature in living adult male in Burdwan District and adjacent areas of West Bengal. J. Anat. Soc. India 2009; 58(1):16-8. 4. S. R. Umesh. Estimation of Stature from Percutaneous Ulna Length. Medico-Legal Update, July-December 2011; 11(2):94-6. 5. Sorojini Devi H., Das BK., Purnabati S., Singh D. and Yayashree Devi. Estimation of stature from upper arm length among the Marings of Manipur. Indian Medical journal August 2006; 100(8):271-3. 6. Duyar I., Pelin C., Zagyapan R. A new method of stature estimation for Forensic Anthropological application. Anthropological Science 2006; 114:23-7. 7. Allbrook D. The estimation of stature in British and East African males based on the tibial and ulnar bone length. Journal of forensic medicine 1961; 8:15-27. 8. Agnihothri AK, Kachhwaha S, Jowaheer V et. al. Estimating stature from percutaneous length of tibia and ulna in Indo-Mauritian population. Forensic Science International 2009; 187:109:e1109.e3. 9. Mohanty MK. Prediction of height from percutaneous tibial length amongst Oriya population. Forensic Science International 1998; 98:137-41. 10. Athawala MC. Estimation of height from the length of forearm bones. A study of 100 Maharastrain male adults of age between 25-30 years. American journal
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of Physical Anthropology 1963; 21:10512. 11. Meadows L., Jantz RL. Allometric secular change in the long bones from the 1800s to the present. J. Forensic Sci 1995; 40:762-7. 12. Malina RM. Ratios and derived indicators in the assessment of nutritional status.
In: Himes JH, Editor Anthropometric assessment of nutrition status. New York: Wiley-Liss; 1991. p. 151-71.
Fig 1. Scatter diagram showing correlation of height with right Ulna length in Males.
185 180
Height in cm
175 170 165 160 155 25 26 27 28 Right Ulna Length Height Linear (Height) 29 30 31
Fig 2. Scatter diagram showing correlation of height with left Ulna length in Males.
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Fig 3. Scatter diagram showing correlation of height with right Ulna length in Females.
Fig 4. Scatter diagram showing correlation of height with left Ulna length in Females.
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CASE REPORT
FATAL ELECTROCUTION BY OVER-HEAD WIRE: A CASE REPORT M. D. Nithin 1, Suraj S Shetty 1, Gopal B.K 2 1 Department of Forensic Medicine and Toxicology, J.S.S University, J.S.S.Medical College, Mysore. 2 Department of Forensic Medicine and Toxicology, KIMS, Bangalore
Abstract High voltage or low voltage with high amperage is dangerous to life. Long duration and close contacts are also the essential features of danger from electric current. Alternating currents are considered more dangerous than direct currents. Many of the fatal accidents have occurred from currents carrying more than 1000 volts. But cases have been recorded where death has resulted from currents of 200 or even lower deaths. Herewith, presenting a case where a 24 year old man got electrocuted by a domestic over-head wire while at work.
Keywords:- Electrical deaths, electrocution, fatal

Introduction The passage of a substantial electric current through the tissues can cause skin lesions, organ damage and death. This injury is called electrocution.1 Typically, the expression is used to describe an injurious exposure to electricity. Electrocution is death caused by electric shock, either accidental or deliberate. The word is derived from "electro" and "execution", but it is also used for accidental death. The term "electrocution," coined about the time of the first use of the electric chair in 1890, originally referred only to electrical execution (from which it is a portmanteau word), and not to accidental or suicidal electrical deaths. However, since no English word was available for non-judicial deaths due to electric shock, the word "electrocution" eventually took over as a description of all circumstances of electrical death from the new commercial electricity. The first recorded accidental electrocution (besides lightning strikes) occurred in 1879 when a stage carpenter in Lyon, France touched a 250 volt wire. However with ever increasing industrialization and wide spread use of electricity, accidental electrocution has steadily increased. Case Report Body of a 24 year old male was brought to our mortuary. On the fateful day, being a worker in a bore-well digging company, he was standing on the borewell truck and lifting the over-head electric wires using a wooden bar, to make way for the truck to get into field on behest of the lorry driver. One of the wires that he was lifting fell on him and as a result he got electrocuted. On postmortem examination following findings were observed. External examination: 1. A grooved, linear dermo-epidermal burn injury over the front of the neck, below the chin measuring 11cm x 10cm with blistering and charring (Fig 1) 2. Deep burns over the front of left knee joint, with a crater of 8cm x 8cm with everted edges and charring of the tissues along with superficial burns over the inner side of left thigh and
Corresponding author: Nithin M.D Email: nithin7755@rediffmail.com
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knees over an area of 27cm x 20cm (Fig 2) 3. Multiple chalky-white lesions over the right foot and heel, size varying from 5cm x 2cm to 0.5cm x 0.3cm. (Fig 3) 4. Chalky white lesion with a crater, over the outer aspect of the left foot just beside the little toe with charred and everted edges measuring 2cm x 2cm. The skin with these chalky white lesions was sent for histopathological examination. Internal examination: Multiple petechial haemorrhages were seen over the surface of heart. Petechial haemorrhages were also observed in the endocardium. The lungs, liver and spleen appeared congested. The brain was oedematous. Discussion A detailed history of the mishap was taken to correlate and interpret the various injuries present on the body. The victim was standing on the bore-well truck and lifting the over-head electric wires using a wooden bar. One of the three wires which he was lifting slipped from over the wooden bar and fell on his neck. Meanwhile his left knee was in contact with the sides of the lorry. Based on the history, the injuries on the neck were presumed to be entry wound and the ones on the knee and soles were presumed to be exit wound. At times the point of contact may bear the characteristic pattern of the (2) conductor. In this case a grooved linear mark was seen on the front of the neck and it correlated with the long axis of the wire. Moreover the area had a brownish tint and was charred. All these findings aided in concluding that the injury on the neck was indeed an electric mark or Joule burn. The exit marks are
characteristically described as grayish white circular spots that are firm to touch with no inflammatory reaction. Tissues in and around exit wounds may get split.(3) the injuries on the knee and sole fit into this description and were hence concurred to be exit marks. These electric marks, though specific of contact with the electricity, is not in itself a proof of electrocution because marks resembling those found on the victims of electrocution can be produced after death. The histopathological report was positive for features such as pallisading appearance of the cells,(Fig 4) separation of epidermis (Fig 5) and coagulation of dermis.(Fig 6) Petechial haemorrhages which were seen over the surface of heart as well as in the endocardium represent a non-specific but typical finding in electrocution irrespective of the mechanism leading to death. An autopsy study done by Kager B, Suggeler O, Brinkmann B showed presence of electrical petechiae in74% of the cases and the favourite sites were the skin of the eyelids, conjunctivae, visceral pleura, and the epicardium. The presence of petechiae did not depend on the voltage or the current pathway relative to the heart. It is, therefore, suggested that the petechiae are not caused by asphyxia but by a combination of venous congestion due to cardiac arrest and a sudden rise in blood pressure induced by muscle contractions. Unlike electrical marks, petechiae also indicate the vital origin of the event.(4) The cause of death was opined to be consistent with history of electrocution. Jellinek has categorized death due to electricity into exitus momentaneous (immediate death), exitus dilatatus (delayed death), exitus
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retardatus (late death) and exitus interruptus. In exitus interruptus the victim is made unconscious by the electrical trauma, then regains consciousness, speaks and walks, only to collapse dead shortly thereafter. Cases like the latter are however exceptional. More realistic is the categorization of death proposed by Boemke and Piroth. They categorized death due to electricity into instant death, death after a short time, delayed death, and death resulting from late complications.(5) Conclusion The present case emphasizes the need of education and awareness programs for the masses to lay emphasis on electrical safety. Also the development of protective gears for insulation especially in high risk occupations, development of tools based
on requirements and proper insulaton for overhead wires is recommended to prevent fatalities resulting from ignorance and/or negligence. References
1. 2. Saukko P, Knight B. Knights Forensic pathology. 3rd Ed London:Arnold;2004.383 Reddy KSN .The essentials of Forensic Medicine & Toxicology.29th Ed Hyderabad: Medical Book Company;2010.295 Vij K. Textbook of Forensic Medicine and Toxicology. 5th Ed New Delhi: Elsevier; 2011.178 Kager B, Suggeler O, Brinkmann B. Electrocution autopsy study with emphasis on electrical petechiae. Forensic Sci Int-2002, May 23:126(3):2103 Tedeschi C G. Forensic Medicine. W B Saunders company, Philadelphia, 1997: 649.
3.
4.
5.
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CASE REPORT
SUDDEN DEATH DUE TO CARDIAC TAMPONADE Prateek Rastogi 1, Alok Atreya 2, Jenash Acharya 1
1
Dept. of Forensic Medicine & Toxicology, Kasturba Medical College Mangalore (Manipal University), India
Dept. of Forensic Medicine & Toxicology, Manipal College of Medical Sciences, Pokhara, Nepal
Abstract:
Cardiac tamponade is life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, blood, clots, or gas, as a result of effusion, trauma, or rupture of the heart. Ventricular free wall rupture is a catastrophic complication that occurs within 7 days, in 1-4% of patients with acute myocardial infarction. We present a case of an elderly female who presented clinically mimicking sudden onset of gastrointestinal problem was later found to have cardiac tamponade on autopsy. Key words: cardiac tamponade, myocardial infarction, sudden death. Introduction Sudden death is defined as a natural, unexpected fatal event occurring within 1 hour of the beginning of symptoms, in an apparently healthy subject or one whose disease was not so severe enough as to predict such an abrupt outcome1. The emphasis is on unexpected character, rather than suddenness of death. The leading cause of sudden unexpected natural death is the disease of cardiovascular system amounting to 45% of total sudden death followed by respiratory (25%) and nervous system (20%).2 Death due to cardiovascular system are most commonly caused due to coronary artery disease, myocardial infarction or other forms of myocarditis, endocarditis, valvular heart disease, cardiomyopathies, and rupture of myocardium, also commonly known as hemopericardium or cardiac tamponade.
Corresponding author: Prateek Rastogi Email: rastogiprateek@rediffmail.com
We present a case, where cardiac tamponade was revealed in an old lady who complained of sudden onset of severe abdominal pain and symptoms mimicking gastritis. She was taken to a local hospital where she died before the diagnosis could have been made. Case Report Deceased was an elderly female, aged 69 years, measuring167 cm in length and weighing 54kgswith no external injuries on the body. Internal examination revealed tensed pericardium with purplish discoloration exteriorly. Opening the pericardium revealed 210 gms of blood clot. (Fig 1)Heart showed necrosed and hemorrhagic area with thinned out ventricular walls measuring 4x3cms at anterior surface of upper part of left ventricle. Sub endocardial surface below this lesion showed softening and necrosis. Posterior surface of the heart (lower part of right ventricle near interventricular septum) showed a rupture measuring 2x1cm with underlying necrosis of sub-endocardium.(Fig 2) The
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adjacent area on the interventricular septum was ruptured giving way to communication between right and left ventricles.(Fig 3)Anterior surface of heart near the origin of pulmonary trunk showed epicardial hemorrhages. Coronary vessels showed calcification of vessel wall with patent lumen. Stomach contained reddish brown colored partially digested liquid without any abnormal odour. Liver was congested. All other internal organs were healthy. Thoracic cavity was intact except for right sided pleural adhesion. Cause of death was opined as cardiac tamponade resulting from rupture of heart as a complication of natural disease process. Discussion The typical patient with left ventricular free wall rupture is usually described as an elderly female of lower body weight and smaller stature, with no previous myocardial infarction, no left ventricular hypertrophy, who has never experienced myocardial ischaemic symptoms or had only minor symptoms previously and who has acute transmural myocardial infarction, without mural thrombus. Chandra et al showed that when age was taken into consideration, women had higher mortality from all causes following myocardial infarction.3, 4 The primary abnormality in cardiac tamponade is rapid or slow compression of all cardiac chambers as a result of increasing intra-pericardial pressure. The pericardial contents first reach the limit of the pericardial reserve volume 5, the volume that would just distend the pericardium and the rate of expansion then increases, soon exceeding that of pericardial stretch. Although the pericardium stretches normally over time, at any instant it is inextensible, making the heart compete with the increased
pericardial contents for the fixed intrapericardial volume.5, 6 As the chambers become progressively smaller and myocardial diastolic compliance is reduced, cardiac inflow becomes limited, ultimately equalizing mean diastolic pericardial and chamber pressures. 7 Key elements are the rate of fluid accumulation relative to pericardial stretch and the effectiveness of compensatory mechanisms. Thus, intra-pericardial hemorrhage from wounds or cardiac rupture occurs in the context of a relatively stiff, unyielding pericardium and quickly overwhelms the pericardial capacity to stretch before most compensatory mechanisms can be activated, whereas in the case of a slow increase in pericardial volume as a result of inflammation, 2 liters or more may accumulate before critical, lifethreatening tamponade occurs. 8It has been stated that (Moritz 1942) about 400500 ml of blood is sufficient to cause death. 9 In present case, the deceased was an elderly female who had no previous history of any ailment of cardiovascular system. No external injuries were present. Thickness of wall of the left ventricle was within the normal limit. However, free wall rupture of left ventricle resulted in collection of 210gm of blood clot in the pericardium, which in ordinary course of time is sufficient to cause death. The symptom mimicking that of gastric origin is supposed to have masked the manifestations of myocardial infarction which later lead to cardiac tamponade. Possibility of diseases of cardiac origin should be explored in patients with complain of epigastric irritation so that prompt and early diagnosis and interventions could be made.
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References 1. Goldstein S. The necessity of a uniform

definition of coronary death: witnessed death within 1 h of the onset of acute symptoms. Am Heart J. 1982; 103:156159.
2. Pillay V V. Textbook of forensic medicine and

toxicology, 2010; 15th edition; Paras Medical Publisher; 268.
3. Lateef F,Nimbkar N. Ventricular free wall

rupture after myocardial infarction. Hong Kong journal of emergency medicine.2003; 10(4):238-246.
4. Chandra NC, Ziegelstein RC, Rogers WJ, et al.

Observations of the treatment of women in the United States with myocardial infarction: a report from the National Registry of Myocardial Infarction-I. Arch Intern Med. 1998; 158(9):981-988.
FIG1
5. Spodick
DH. Threshold of pericardial constraint: the pericardial reserve volume and auxiliary pericardial functions. J Am CollCardiol. 1985; 6:296-297. WE. Effects of increased pericardial pressure on the coupling between the ventricles. Cardiovasc Res. 1990; 24:768-76.
6. Santamore WP, Li KS, Nakamoto T, Johnston
7. Spodick DH.Acute Cardiac Tamponade. N

Engl J Med. 2003;344(7): 684-690.
8.
Reddy PS, Curtiss EI, OToole JD, Shaver JA. Cardiac tamponade: hemodynamic observations in man. Circulation. 1978; 58:265- 272. pathology 3rd edition, 2004; Arnold, London; 226-22.
FIG 2
9. Saukko P, Knight B. Knights Forensic
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Guide for Authors

J-SIMLA is the official journal of the South India Medicolegal Association. The journal provides a forum for the publication of articles on subjects relating to the wide range of forensic and legal medicine. Subjects covered include forensic pathology, forensic toxicology, medical ethics and the law related to medicine, forensic odontology, forensic anthropology, and forensic aspects of biological sciences. The article should be original and should not be simultaneously considered for publication elsewhere. All authors should have participated sufficiently in the preparation of the manuscript. South India Medicolegal Association reserves copyright of all published material. Statements in articles are the responsibility of the authors. The Journal publishes under following categories: Original research, Brief communication, Case report, Review article, CME Supplements and Letter to the Editor. Papers submitted are subject to peer review. Papers requiring revision will be returned to the authors and the revised paper should be submitted within the specified time. Preparation of manuscript Manuscripts should be written in clear and grammatical English and should conform to the general style of the journal. It should be typed with double-spacing and wide margins. It should contain the following: Title page, Abstract and Keywords, Text, Acknowledgment (if any), References, Tables and Figures. Title Page should contain the Form of the paper (Original research, Brief communication, and so on), Title (should be informative and without abbreviations), Authors' names (the first or middle names, and the last name written out in full) and affiliations, and Corresponding Author's address (Name, mailing address, telephone number, fax number and e-mail address). Abstract and Keywords: Abstract should be unstructured and should describe the major findings of the study with a brief background and conclusion. It should preferably not be more than 250 words for research articles and 200 words for case reports. Abstract should be followed by 3-5 keywords. The Text: The text in Original Communications should contain Introduction, Material and Methods, Results, Discussion and Conclusion. Other type of articles should contain appropriate headings. Introduction should be brief stating the purpose of the study and its relationship to earlier work in the field. Material and Methods section should contain brief description of methodology. The new procedures should be described in detail. Details of statistical methods employed should be mentioned in the end of this. Studies involving ethical issues must contain a statement that their studies have been reviewed by the appropriate ethics committee. Details that might disclose the identity of the subjects under study should be omitted. Results should contain the relevant observations made from the study. It could be presented in text, figures, or tables, without repetitions in both forms. Discussion should be concise and focus on the interpretation of the results. It should involve the critical evaluation of the previously published studies. References References should be cited in the order of appearance in the text by superscript Arabic numerals. These references should be listed at the end of the paper in numerical order. The accuracy of references is the responsibility of the authors. For further details refer the webpage http://www.icmje.org.
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References to journals should include the authors' last name and initials (list all authors when six or fewer; when seven or more, list only the first six and add et al.), full title of the paper, journal titles (as abbreviated in Index Medicus), year of publication, volume number, first and last page numbers. 1. Menezes RG, Nagesh KR, Jagadeesh N, Nithin MD. Publishing case reports: a potent tool for better practice of forensic medicine. J South India Medicolegal Assoc 2009;1:1-2. References to a chapter in an edited book should be set out as follows. 1. Payne-James JJ. Assault and injury in the living. In: Payne- James JJ, Busuttil A, Smock W, editors. Forensic Medicine: Clinical and Pathological Aspects. London: Greenwich Medical Media, 2003.p.543-563. References to a book by one or more authors should be set out as follows. 1. Pillay VV. Mechanical asphyxia. In: Textbook of forensic medicine and toxicology. 15th ed. Hyder-abad: Paras Medical Publisher, 2010.p.274-301. Refrain from using online references if possible. When referring to internet sources, for example Wikipedia, please state so clearly, and indicate if this information can be checked and on which date you visited the online source. Preparation of tables and illustrations Tables and figures should have an appropriate title and should be numbered with Arabic numerals according to their appearance in the text. All the tables and figures with title and footnotes should be collected at the end of the manuscript. Photographs should be saved in JPEG or TIFF format. The Editorial Board reserves the right to edit all articles for purposes of style, format and clarity.
All manuscripts submitted to the J-SIMLA will be subjected to external and / or editorial review. Authors may be required to revise their manuscripts for reasons of style and content. Rejected manuscripts will be destroyed. J-SIMLA does not have page charges. The Editors, Editorial Board, Reviewers and the South India Medicolegal Association will not be responsible for plagiarism, if any, by the authors. Adhering to publication ethics is the responsibility of the authors. Permission Wholesale reproduction of all previously publicshed tables, charts, figures and photos will require written permission from the parent association of the journal. Reproduction of modified data will require at least a reference citing. Journal copy Corresponding author will receive one print copy of the journal. Further copies will be available at suitable price (as fixed by the board), on request before publication. Electronic version of the journal will be made available to the corresponding author, on request. Submission of manuscripts Articles can directly be sent to the following Email: j_simla@rediffmail.com The corresponding address is:
Dr. Pradeep Kumar M.V. Editor, J-SIMLA Professor, Department of Forensic Medicine & Toxicology, RajaRajeswari Medical College & Hospital, Kambipura, Mysore road, Bangalore-560074 Karnataka, India
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Aims and Objectives of South India Medicolegal Association

To organize in a body, all persons who are practicing or interested in the subject of Forensic Medicine to facilitate mutual acquaintance and collaboration among themselves. To maintain the honour and dignity of the members of the society. To promote professional fellowship, co-operation and exchange of views amongst members and to safeguard their interests in the sphere of their activity. To promote the study and do research in this discipline, and to share professional experience of the members among themselves. To suggest ways and means by which uniformity in the procedure of medico-legal service in South India can be achieved. To improve the organizational set-up and functioning of medico-legal service in the Southern States of India. To get affiliation with similar associations at National and International levels. To create a better understanding among the public regarding Medico-Legal and allied matters. To publish a biannual journal under the auspicious of the society. To exchange technical expertise with forensic scientists, legal experts and investigating officers to improve the scope of criminal investigation.
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To, The Secretary SIMLA-2013 I wish to enroll myself as member of the South India Medico-Legal Association (SIMLA) as _______________ member (Life / Short term). I am enclosing herewith the membership fee of Rs. ____________ in words _________________________________________ by D.D. Number _______________dated ________________drawn on_______________________ bank, payable at Bangalore.
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REVIEW ARTICLE
Sexual Harassment Of Women At Work Place A Review Edelweiss Rodrigues, Edlyn Rodrigues, Juliana Rodrigues, E. J. Rodrigues
36-42
The Need for Flexibility in the upper limit of Gestational Age for Fetal Anomalies in the MTP Act: A Questionnaire Survey Priya Ballal K, Raina Chawla, Pralhad Kushtagi A preventable death: suicidal patterns among women in metro-city Bangalore, India
43-49
50-57
Karthik S K, Balaji PA, Mohan VJ, Smitha R Varne, Poornima S, Syed Sadat Ali, Jayaprakash G Incidence Of Poisoning Reported At A Tertiary Care Hospital K.Padmakumar, B.G.Maheshkrishna, J.Jaghadheeswararaj, A.Natarajan Socio demographic profile of Cardiac deaths Dayananda R, Harish S, Girish Chandra Y P, Sampath Kumar P Prediction Of Stature From Percutaneous Ulna Length 67-72 63-66 58-62
Dileep Kumar R, Nagesh Kuppast, Shradha Iddalgave, Raju G M, Sunil S Kadam, Hemanthraj M N
Permanent Address:
CASE REPORT Fatal electrocution by Over Head Wire: A case report M. D. Nithin, Suraj S Shetty, Gopal B.K
Tel Nos with code: (Off): Sudden Death Due To Cardiac Tamponade Email:
73-75
76-78
Prateek Rastogi, (Res):Alok Atreya, Jenash Acharya

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J-SIMLA

Vol. 5, No. 2, Sep 2013

Journal of South India Medicolegal Association

Official publication of South India Medicolegal Association

Volume 5 Number 2 September 2013

Vol. 5, No. 2, Sep 2013

Office bearers Of South India Medico-Legal Association 2012-13

PRESIDENT Dr. Devdass P.K

VICE-PRESIDENT Dr. Bhemappa Havanur

Dr. K.V. Satish

SECRETARY Dr. S.Venkata Raghava

TREASURER Dr. C.N. Sumangala

EX-OFFICIO MEMBER Dr. Kusa Kumar Saha

Vol 5, No 2, September 2013

South India Medicolegal Association

Dr. Jagannatha S.R

Dr. Deepak H DSouza

National Editorial Advisory Board

International Editorial Advisory Board

2013 South India Medico-Legal Association. All rights reserved.

Vol 5, No 2, September 2013

Journal of South India Medicolegal Association

Incidence of Poisoning Reported At A Tertiary Care Hospital

Socio demographic profile of Cardiac deaths

Prediction of Stature From Percutaneous Ulna Length

2013 South India Medico-Legal Association. All rights reserved.

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Dept. of Physiology, Kannur Medical College, Anjarakandy, Kerala.

Goa Dental College. Bambolim, Goa.

Dept. of Biochemistry, Goa Medical College, Bambolim-Goa.

Dept. of Forensic Medicine, Goa Medical College, Bambolim-Goa.

KEY WORDS: Sexual, Harassment, Women, Workplace.

Corresponding author: Dr Edelweis Rodrigues E-mail: ejrrod2003@yahoo.co.in

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7) Complaints Committee: The

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affirmatively discussed Employee Meetings.

9) Awareness : Awareness of the rights

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Corresponding author: Pralhad Kushtagi Email: pralhadkushtagi@hotmail.com

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0 17 10 9 1 4 46 27 24.3 2.7 9.8