M. Arun

Pattern and trend of deliberate self-harm in Western Nepal.

Abstract:  Acts of deliberate self‐harm (DSH) not only affect the people directly involved, but also have grave psychological and social impact on the family and community. In the present study, a cohort of 173 cases of DSH reported from April 2002 to March 2005 was retrospectively analyzed, by perusing the medicolegal register maintained by the Emergency Department at the Western Regional Hospital, Pokhara in the Western Development Region of Nepal. The data were entered and analyzed using SPSS Version 10.1. More than two‐thirds of total cases were females. About 60% of cases were observed in the age group of 15–24 years. Poisoning (89.6%) was the most preferred method of deliberate self‐harm. Organophosphate pesticides were consumed in nearly two‐thirds of the poisoning cases. The majority of cases were reported during the months of May to July and had occurred during the last quarter of the day. More than a twofold increase was observed in the frequency of cases during the 3‐year study period. The said observations were compared and contrasted with the available literature across the globe. The presentation is concluded by highlighting the limitations encountered in Nepal and the scope to overcome the same.

Self-inflicted burns fatalities in Manipal, India.

Death due to burns is an important public health problem. Suicide by burning is uncommon in the Western world compared with Asian countries. This study presents retrospective research carried out in the tertiary care teaching hospital of Kasturba Medical College, Manipal, Southern India, between January 1993 to December 2003 (11years). Out of a total of 343 burns deaths during the above-mentioned period, 39 were victims of suicide. The majority of deaths (46.1%) occurred in the 21-30 years age group, with a preponderance of the female sex (79.5%). Most of the victims belonged to the Hindu religion and the incident occurred mostly during the daytime. In the overwhelming majority of cases, the incident occurred at home (97.4%). In all cases kerosene was the accelerant and flame was the causative agent. In more than fifty per cent of cases, the total body surface area (TBSA) involved was more than 80%. Dowry demands and harassment were the reasons for committng suicide in 12 cases. More stringent laws and empowering female independence, both mentally and economically, will reduce suicidal burns in young women.

Autopsy study of fatal deliberate self harm

A retrospective autopsy study of fatal deliberate self harm (FDSH) was undertaken in the mortuary of Kasturba Hospital, Manipal, Southern India over a period of 12 years (1993-2004). Out of 1917 cases autopsied, 21.2% were deaths due to deliberate self harm (DSH). The male sex (66.1%) and victims in the third decade of life (35.9%) predominated. More than two-thirds of the decedents were married. More fatalities were observed during the winter season (35.8%) and in the day time (62.2%). Dispair with life (61.9%) was the most common motive for FDSH. The majority of fatalities were due to poisoning (73.5%), where organophosphorous compounds topped the list (71.9%). About one-third of the victims survived for 18 to 24 hours after DSH.

A comparative analysis of suicide and parasuicide

A prospective study was conducted to analyse the spectrum of suicide attempters and completers at Kasturba Hospital, Manipal, India, over a period of three years (January 2001 to December 2004). The present study comprised a total sample population of 246 cases, of whom 90 died and 156 survived the attempt (1:1.73). Men outnumbered women in the deceased group and women surpassed men in the survivor group. The mean age for the deceased group was 42 years compared with 30 years for the survivor group. Prior attempted suicide in the deceased group was 6.6%. Eighty-three percent of the total population studied opted for ‘chemical methods’, where insecticides topped the list (64.6%) in both the deceased and the survivor group. Among those who preferred ‘physical methods’, 50% died and 50% survived. In the current study, 17% of the subjects had received a psychiatric consultation, of whom 91.3% were diagnosed in the spectrum of ‘depressive disorders.’ Knowledge about the legalities of suicide was lacking in 65% of victims and their kin.

Scale for assessment of lethality of suicide attempt

Background: Lethality of suicidal attempt provides useful information regarding the behavior. There is a perceived need for a clinically useful scale that can be easily adapted to various methods and circumstances of attempt. Aims: The study intended to develop and test utility of a scale for measuring lethality that can reflect overall clinical observation taking into account various indicators of lethality and which can be used across clinical scenarios involving different methods. Settings and Design: Cross-sectional study in a hospital. Materials and Methods: The scale for assessment of lethality of suicide attempt (SALSA) has two components: The first component has four items indicating seriousness of the attempt and its likely consequences and the second component is the global impression of lethality. All the items are scored from 1 to 5, higher scores suggestive of increased lethality. SALSA was used to evaluate lethality of 82 consecutive suicide attempters; and it was compared with lethality of suicide attempt rating scale (LSARS) and risk-rescue rating scale. Statistical Analysis: Chi-square, t-test, analysis of variance, Cronbachs alpha, binary logistic regression. Result: There was significant correlation of SALSA score with that of LSARS (r: 0.89) and risk score of risk-rescue rating (r: 0.93, P < 0.001); and negative correlation with rescue score (r: −0.569; P < 0.001). Internal consistency reliability of SALSA was high (Cronbachs alpha: 0.94). Lethality scores of SALSA differentiated known groups with different lethality, e.g. deceased and survived; attempters with different levels of medical intervention: In-patient only, intensive care, ventilator support. SALSA score significantly predicted the lethal outcome (odds ratio: 3.2, confidence interval: 1.12-8.98). Conclusion: SALSA is a useful instrument for assessment of lethality of suicidal behaviors during clinical evaluations considering the ease of administration, its ability to differentiate clinical groups with known variations of lethality and clinical outcomes.

Arcing injuries in a fatal electrocution.

Electric arc injuries tend to be very severe and can cause skin burns by direct heat exposure or by igniting clothes. It produces intense heat, and fatal lesions can occur even when the victim is several feet from the arc. A fatal case of accidental high-voltage electrocution is reported, where multiple skin to bone-deep oval and circular lesions of varying dimensions caused by arcing was present.

The Recent Doctors’ Strikes in India: A Point of View

Health-care initiatives in recent years have led to the emergence of new forms of medical practices and new kinds of professional relationships. The relatively unrestricted autonomy that practitioners previously enjoyed has been undermined. Medical professionals in conflict with hospitals, health provision organizations and governmental agencies have translated their discontent with health systems into organized work slowdowns and strikes. These activities have generally been directed against governments for the purpose of preventing undesired structural changes in health-care delivery, preserving professional independence or extracting financial concessions. This paper presents the tale of two Indian cities where doctors have gone on strike. An analysis of the situations that might have induced the doctors to go on strike is made. The duties, obligations and legitimacy of doctors are discussed against a background of ethical, legal and moral concepts. A brief review of literature is made of the history and evolution of strikes in the modern era of human civilization.

The present legal perspective of narcoanalysis: winds of change in India.

In a recent judgment, when examining the implications of narcoanalysis tests, the Chief Justice of India, his Lordship Mr K.G. Balakrishnan, declared them to be unconstitutional and a violation of personal liberty. The use of narcoanalysis without informed consent raises important questions about the meaning and scope of fundamental rights that are available to all citizens. While investigative agencies will keep looking for newer and effective methods of interrogation in an ever-changing crime scenario, it is not acceptable if they violate accepted legal and ethical norms. The edifice of modern medicine is based on the notion of a fully informed individual or patient who is an active partner in decisions taken that relate to processes affecting his body, mind and soul. Obtaining fully informed consent is difficult but the attempt should be made and the advantages in doing so should never be underestimated. Objections have been raised when defendants, suspects or witnesses involved in an investigation are subjected to narcoanalysis without their consent. Its importance has been justified in terms of extracting important information, which may prevent future criminal activities, as well as gathering key evidence in circumstances where it is difficult to gather it through ordinary means. Some have relied on certain provisions of the Criminal Procedure Code 1973 in India, and the Indian Evidence Act 1872, to refer back to the responsibilities placed on citizens to fully cooperate with investigative agencies. It has also been argued that narcoanalysis techniques cause no bodily harm and that the information gathered will be used only to shore up the efforts of investigation and will not be admitted as evidence at trial; also that improvements in fact-finding during the investigation process will help to increase the rate of prosecutions and acquittals and that this kind of scientific technique is a “softer” alternative to the regrettable and allegedly widespread use of “third-degree methods”! The US Supreme Court has noted: