RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (in block letters)Permanent Address / Dr. AKSHAY KUMAR RAMTAKE
POST GRADUATE, DEPARTMENT OF FORENSIC MEDICINE AND TOXICOLOGY, M.R. MEDICAL COLLEGE, GULBARGA.
DR. AKSHAY KUMAR RAMTAKE
S/o DR. R M RAMTAKE
‘HOUSE-VATSALYA’
VILLAGE-PATHARATOLA, DALLI-RAJHARA, DIST- BALOD CHHATTISGARH-491228
2. / Name of the Institute / H.K.E SOCIETY’S
MAHADEVAPPA RAMPURE MEDICAL COLLEGE, SEDAM ROAD, MAHADEVAPPA RAMPURE MARG,
GULBARGA – 585105.
3. / Course of the study and subject / M.D. FORENSIC MEDICINE AND TOXICOLOGY
4. / Date of admission to the course / 26-06-2013
5. / Title of the Topic / PATTERN OF AUTOPSY CASES OF UNNATURAL DEATHS AT MORTUARY OF BASAVESHWARA TEACHING AND GENERAL HOSPITAL, GULBARGA– A RETROSPECTIVE AND PROSPECTIVE STUDY.
6. / Brief resume of the intended work
6.1
6.2
6.3 / Need for study
Unnatural deaths are the deaths which are caused by any means like trauma or poisons and not by any diseases1. A death caused by external causes e.g., injury or poisoning which includes death due to intentional injury, such as homicide or suicide, and death caused by unintentional injury in an accidental manner, includes in unnatural deaths.
As just observed, most countries have a legal procedure for investigating deaths which are not obvious natural diseases. The system differs widely, but in general, those deaths which are criminal, suspicious, accidental, suicidal, sudden and unexpected ,unexplained or in any way not due to natural causes, cannot be certified by a doctor and must be reported for medico-legal investigation2.
Death can be natural or unnatural. Unnatural deaths claim a substantial number of lives in developing countries like India. Among the various types of deaths RTAs account for majority of deaths followed by burns, poisoning, fall from height, animal bite, hanging, drowning and electrocution. Suicidal and homicidal fatalities are common among both the urban and rural population3.
Death is a tragedy in whatever form, at whatever time and in whatever way it comes. Medico-legal autopsy, acts as one of the investigative tool that help the investigators in many ways. Positive identification of the deceased, determination of the cause of death, time since death, manner of death, time between injury and death, and to discover and recover any clue(s) from the body within and without, that can possibly connect the crime with criminal or unearth the role of negligent act or omission in bringing about the fatality are some of the resultant beneficial outcomes of a medico-legal autopsy4.
No study of unnatural deaths was conducted in Gulbarga region. There are relatively very few studies on this topic in India and in Karnataka state. Hence the present study is undertaken to investigate all cases of unnatural deaths from all possible aspect such as pattern of unnatural deaths, age and sex incidence, duration of survival, cause of death, and to suggest preventive measures to reduce the incidence and number of unnatural deaths due to various reasons.
Review of literature:
Santhosh et al (2011)3 conducted a cross sectional study on autopsy cases of unnatural deaths. In their study it was found that among the various types of deaths RTAs account for majority of deaths followed by burns, poisoning, fall from height, animal bite and hanging. Accidental deaths accounted for 87.5% cases followed by suicidal (10%) and homicidal (2.5%) deaths. Males (80.83%) were more commonly involved as compared to females (19.17%). The types of unnatural deaths encountered in this study were RTAs (61.67%), burns (15%), fall from height (7.5%), poisoning (6.67%), assault (2.5%), snakebite (1.67%), scorpion bite (0.83%), death due to blast injury (1.67%), death due to bull gore injury (0.83%), hanging (0.83%) and accidental fall of stone on head (0.83%). Poisoning 7 (58.33%) was the most common method of self-destruction followed by burns 2 (16.67%), fall from height 2 (16.67%) and hanging 1 (8.33%). In homicidal deaths, stabs 2 (66.67%) were the most common type of death followed by 1 (33.33%) case of combination of stab and blunt force impact. Preventive measures should be adopted where ever possible and prompt steps should be taken to decrease the incidence of road traffic accidents which take a lion’s share among the unnatural deaths.
Dr. ME Bansude et al (2012)4 conducted an autopsy based analytic study on 722 cases of unnatural deaths in the department of Forensic Medicine during the year 2010. All data related to age, sex, marital status, religion and cause of death with manner were recorded with detailed autopsy examination and subsequently the cases were analyzed on various parameters to find the trends and other significant features of pattern of unnatural deaths in Latur district. Out of 722 unnatural deaths analyzed, 62.74% were male and 37.26% were female.87.26% was Hindu and 12.74% were Muslim. Married deceased were 80.06% and unmarried were 19.94%.Majority of causes of death were due to trauma 38.09%, thermal injuries 26.73% and poisoning 25.21%. Deaths due to asphyxia were 9.83% and those due to therapeutic misadventure were 0.14%.
Yousfani G M & Memon M U (2010)5 analyzed that out of total 697 medico-legal autopsies conducted males were (595) 85.4% and females (102) 14.6%. Accidental deaths (471) 67.58% outnumbered homicidal (219) 31.42% and suicidal (7) 01% manner of death. Weaponry for assault preferred was firearms followed by hard blunt weapons. Peri-urban inhabitant victims of unnatural deaths were 314 (45%) followed by those belonging to rural areas (209) 30% and urban dwellers (174) 25%.Unnatural deaths occur more in summer than in winter season.
Khan Md B H & Hossain Md M (2011)6 performed a retrospective study to ascertain the pattern of unnatural deaths, whose autopsies were performed by Forensic Medicine dept. of Dhaka Medical College from 1st Jan, 1996 to 31st Dec, 2000. A total 10436 death recorded was analyzed to see their age, sex etc. The study revealed that total number of unnatural deaths were 9413, out of them males were higher than females (M- 75.78% & F- 24.22%). Results showed that accidental deaths were 77.22%, Homicidal deaths were 14.02% and Suicidal deaths were 10.76%. Accidental & Homicidal deaths were more common in male, whereas suicidal deaths were more common in female. This study suggests extensive studies to formulate strategies to prevent those unnatural deaths to improve the situation.
Rahim M & Das T C (2009)7 this study is concerned with pattern of unnatural deaths in Dhaka Medical College mortuary during 1996. They found 1725 (97%) cases of unnatural deaths by analyzing 1772 cases of deaths. Data gives 18.37% increment in unnatural deaths 77.28% was males and 22.71% females. The frequency patterns of unnatural deaths were 68.92% RTAs, 11.69% homicide, 08.00% suicide and 2.80 natural. Burn, electrocution and others comprise the rest 11.565 unnatural deaths. Males suffer 3.4X more unnatural deaths than females. But RTAs males were 5.31X, in homicide 11.40X, in suicide 1.70X respectively than females. In hanging, female were predominant (1.72X of male deaths). 21-40 years is the age group showing peak frequencies on different types of unnatural deaths though hanging showed peak in 11-20 years. Besides, 95.47% of the unnatural deaths were the Muslims, 4.25% were Hindu and 0.14% was Christians. Firearms were used in 29.40% cases, blunt weapon in 38.46% cases and sharp cutting weapon in 31.60% cases of homicides respectively.
Singh B et al (2008)8 analyzed on 470 autopsy cases retrospectively for 3 years. Of these 344 (73%) were traumatic fatalities. Males were preponderant (71%). More than half of the victims were between 1-40 years. The youth age of 21-30 years was affected maximum due to all type of trauma except for falls and assault in this area of the country (India). The leading type of trauma was RTA (52%) followed by burn (24%). Females were predominant with 74% in trauma due to burns. In majority of cases where the death was reported in the hospital, among them more than 50% of victims were survived in hospital for more than 24 hours. The victims those expired within 3 hours were in majority from RTA and those who survived for more than 24 hours were in majority from burns. Majority (258) of the victims had head injuries followed by thoracic injuries (169), and abdomen (125). 24% of the victims died on the spot or before reaching hospital.
Dr. N Hussaini et al (2012)9 conducted a retrospective study that included 366 victims of Road Traffic Accident. The study shows that Road traffic accidents account for 29.51% of deaths, majority of victims were males (81.29%) between age group 21-30 years (24.80%) and 31 -40 years (18.86%). Most commonly injured body region was head (57.37%). Pedestrians were the worst affected (34.69%) and maximum numbers of Road Traffic Accidents were seen during summer months (30.87%).
Dhiraj Buchade et al (2011)10 collected 237 cases for study purpose. Female victims were most commonly affected as compared to male victims. The age group of 21-30 years 97 (40.93%) was most commonly affected followed by age group 31-40 years 54 (22.79%). The thermal burns 184 (77.63%) was most commonly noted followed by electrical burns 23 (9.71%). Married females 114 (76.51%) are most common victims and most of victims survived for a period of 12 to 24 hours are 61 (25.74%). Head, face & neck 206 (86.91%) region of body was most commonly affected followed by Chest 174 (73.41%) region of body. The most of victims sustained 51 to 75% burns133 (56.12%) and most common manner of death was accidental burns 147(62.02%).
B. Maharani and N.Vijayakumari (2013)11 conducted a retrospective study from Jan 2009-Jan 2012. Among 150 cases, 148 cases were of intentional poisoning and two cases were of accidental poisoning. In all the cases the route of exposure was oral. Males (92 cases) outnumbered females (58 cases) and 101 cases were married. Peak occurrence was in the age group of 21-30 years (47 cases). Occupation wise poisoning was commonly found among male laborers (18.66%) and farmers (13.33%) followed by house wives (28%) and students (16.66%). 147 cases (98%) were Hindus. More cases were reported during summer season (36%) and day time (80%). Organophosphorus was the commonest agent (58.66%). Associated co-morbid conditions were found in 16 cases. The incidence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies.
Objectives of the study:
· To study the various pattern of unnatural deaths.
· To determine the age and sex incidence.
· To find out the duration of survival and cause of death.
· To suggest preventive measures to reduce the incidence and number of unnatural deaths due to various reasons.
7. / Materials and Methods
7.1 / Source of data:
Autopsy on all cases of unnatural deaths conducted at mortuary of the Basaveshwara teaching and general Hospital, Mahadevappa Rampure Medical College, Gulbarga.
7.2 / Methods of collection of data:
1. Inquest report (Panchanama).
2. Hospital case reports.
3. Post Mortem findings.
Inclusion criteria:
Autopsy on all cases of unnatural deaths conducted at mortuary of the Basaveshwara teaching and general Hospital, MRMC, Gulbarga.
Exclusion criteria:
Alleged unnatural death, which later turned out to be due to natural causes.
Place of study :
· Mortuary, Basaveshwara Teaching and General Hospital, Department of Forensic Medicine and Toxicology, MRMC, Gulbarga.
Duration of study :
· The study is both retrospective and prospective for a period of 4 and half years from Feb 2011 to August 2015.
7.3 / Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly / The study doesn’t require any investigation to be done on humans or other animals.
7.4 / Has ethical clearance been obtained from your institution in case of 7.3? / Yes, ethical clearance has been obtained from ethical committee of M.R. Medical College, Gulbarga
8. / List of references:
1) Reddy KS Narayan & Murty O.P. The Essentials of forensic Medicine and Toxicology, 32nd Edition, Hyderabad, K Suguna Devi; 2013: 145.
2) Knight Bernard. Simpson’s Forensic Medicine, 11th edition. London. Arnold; 1997: 14.
3) Santhosh C S, Vishwanathan K G, Satish Babu B S.Pattern of Unnatural Deaths- A Cross Sectional Study of Autopsies at Mortuary of KLES'S Hospital and MRC, Belgaum. JIAFM.Jan-Mar 2011; 33(1):18-20.
4) Dr. ME Bansude, Dr. RV Kachare, Dr. CR Dode, VM Kumre. Trends of Unnatural Deaths in Latur District of Maharashtra. Journal of Medico legal Association of Maharashtra. Jul-Dec 2012; 21(2): 17-24.
5) Yousfani G M & Memon M U. Spectrum of Unnatural Deaths in Hyderabad: An Autopsy Based Study. JDUHS. 2010; 4(2): 54-57.
6) Khan Md B H & Hossain Md M. Study on Unnatural Death Patterns in Dhaka City. AKMMC J. 2011; 2(2): 18-20.
7) Rahim M & Das T C. Mortuary Profile for Unnatural Deaths at Forensic Medicine Department of Dhaka Medical College. Bangladesh Med J. July 2009; 38(2): 44-47.
8) Singh B, Palimar V, Arun M, Mohanty M K. Profile of trauma related mortality at Manipal. Kathmandu University Medical Journal. 2008; 6(3): 393-398.
9) Dr. N Hussaini, Dr. AA Mukherjee, Dr. R Bele, Dr. A Rahule. A Retrospective Study of Death due to Road Traffic Accident at Akola. Journal of Medico legal Association of Maharashtra. Jul-Dec 2012; 21(2): 41-44.