Jyoti Barwa

Width of Sternum at Suprasternal Notch and at the Level of Fourth Rib for Determination of Sex in the Population of Delhi: A New & Reliable Tool for Sex Prediction

Determination of sex of a person is an important aspect of identification and is required in the living as well as the dead. The sternum bone on its own has shown considerable sexual dimorphism and its various dimensions have been used for this purpose. Studies have shown significant sexual variation in the length and width of the sternum. This study was conducted to find out sexual variation in the width of the sternum at the level of 4th rib (WS4) and at the suprasternal notch (WSN). Though variation in width at different levels of the sternum have been studied but variations at all levels has not been explored in the past. We also studied the sternum in two states viz. the wet state i.e the freshly removed (F) and dry state i.e after processing the sternum (D). One hundred sternums with equal sex distribution were studied. The discriminant function analysis from sternum for sex variation using the combined width (WS4 + WSN) was quite high, ranging from 69% for wet sternum and 64% for dry sternum. These measurements were found to be more accurate in case of females, where the accuracy for sex determination was the highest for WS4 (D;76%), followed by WSN (F; 72%), followed by WS4 (F; 68%), and by WSN (D;66%), respectively. In males, the discrimination function was the highest with WSN in both wet and dry specimens, 64%, followed by WS4 (D; 62%) and WS4 (F; 60%), respectively. We concluded that determination of sex by means of width of sternum at supra-sternal notch and 4th rib is a reliable indicator in both wet and dried state of the bone having higher accuracy rate with examination of wet sternum and in case of females.

Uterine inversion after an unskilled delivery – still a concern for maternal mortality: A case report and discussion of the related medico-legal issues:

Uterine inversion is a life-threatening medical emergency, which can result in fatal shock and sudden unexpected death during and after delivery. Most cases of uterine inversion occur due to mismanagement of the third stage of labour. We report a case of sudden death occurring post full-term vaginal delivery conducted by a traditional birth attendant (TBA) popularly known as dai. Autopsy revealed signs of haemorrhage and shock due to an inverted uterus. This emergency medical condition, though frequently fatal, can be treated if prompt action is taken by a trained and skilled obstetrician, preventing morbidity and mortality. We discuss the incidence, aetiology, symptomatology, complications and the management of uterine inversion. We also review the capability and eligibility of TBAs in handling such obstetrical emergencies, along with their culpability, if any, in such cases of negligence as per the applicable statutes.

A five year retrospective study of fatal snakebite in Chandigarh region

This is a 5 years retrospective analysis and demographic study of cases of fatal snake envenomation presenting to the mortuary of Government Medical College & Hospital, Chandigarh, from January 2011 to December 2015. The purpose of this study is to present the epidemiological pattern of snake poisoning in this region, as also to describe the clinical characteristics and pathological changes in various organs. In our study, 49 cases of death due to snakebite were brought for medico legal post mortem examination to the Department. Of these, maximum number of cases, i.e. 15, belonged to the age group of 20–29 years; 42 were from rural areas and the time of incident of snakebite was mostly between 3 AM to 6 AM (28.5%), followed by 6 PM to 9 PM (14.3%). The months of the rainy season, i.e. July & August, accounted for the maximum no. of cases i.e. 32. The most common area of bite were the lower limbs (57%); swelling & cyanosis (41%), petechial hemorrhage (29%) and cellulitis (12%) were the common local changes at the site of bite. In 13 cases, no bite mark was seen; however, the involved limb showed local changes like swelling, ecchymosis, wet gangrene and cellulitis. Among the histopathological changes, acute tubular necrosis (41%), followed by disseminated intravascular coagulation (20%) & pulmonary oedema (12%) were the most common findings.