Variability in human external ear anthropometry- Anthropological and forensic applications

The human auricle has attracted the attention of forensic scientists since a long for its unique morphological characteristics. In modern times, these unique features can be captured by CCTV cameras, which may be extremely useful during the identification process in a criminal investigation. Unique morphological characteristics such as Darwin's tubercle, shape, and size of the ear, different morphological features of the helix, tragus, lobule, etc. are frequently used in the identification and individualization process. The human ear was not only accessi-ble for its morphological and morphometric variations, but also its existing bilateral, sex, and population differences. The present study was conducted on 140 individuals (71 males and 69 females) aged between 18 and 30 years. The data were collected from the colleges of Nahan city of Sirmaur district in Himachal Pradesh state of North India. Various anthropometric measurements were taken independently on the left and right ear of each individual with the help of a pair of sliding calipers using a standard method. These linear measurements were physiognomic ear length, physiognomic ear breadth, ear length above tragus, distance from tragus to antihelix, distance from tragus to the helix, lobule height, and lobule width. Auricular index, lobular index, and lobular ear index were calculated from the aforementioned measurements. Further, an independent t-test/ Mann Witney U test and paired sample t-test/ Wilcoxon Signed Rank test were applied for the evaluation of sex differences and bilateral differences in the human ear, respectively. For the prediction of sexual dimorphism, discriminant function analysis was applied. Physiognomic ear length, physiognomic ear breadth, ear length above tragus, distances from tragus to antihelix (left ear only), and tragus to helix exhibited significant sex differences on both sides (p<0.05). Significant bilateral differences (p<0.05) were reported for all the measurements of the ear in males except for lobule height, whereas, significant side differences (p<0.05) were shown for ear length above tragus, distance from tragus to helix, and lobule width among females. The discriminant function model showed 82.10% accuracy for determining sexual dimorphism. The study highlighted sexual dimorphism and bilateral differences in ear morphometry in a north Indian population and provided a database of anthropometric variables in the human ear for forensic and anthropological uses.

"Getting to zero" HIV/AIDS requires effective addressing of HIV issues in LGBT community

This communication is regarding the necessity to address the HIV-related needs of LGBTQIA+ community (Lesbian, Gay, Bisexual, Transgender/transsexual, Queer/Questioning, Intersex, Asexuality, and others) for attaining the 'GETTING TO ZERO' theme for zero new HIV infections, zero AIDS-related deaths and zero discrimination. Most of the times, prevention of HIV/AIDS is talked about in terms of faithfulness to one's partner, use of protective devices such as condoms, pre and post exposure prophylaxis, using anti-retroviral therapies and use of microbicides, behavior change etc. HIV-related issues are however, one of the pertinent issues that needs to be effectively addressed in the LGBTQIA+ community.

Study on Hanging with Brief Discussion upon Ambiguity in Method of Choice and Gender Differences for Completed Suicide in Existing Literatures in Nepalese Scenario

Background Hanging is one of the common forms of violent mechanical asphyxial deaths. When compared to other forms of unnatural death all over the world this method stands on top as death is instantaneous. Death due to hanging is always suicidal until and unless otherwise specified. Objective To explore the socio-demographic characteristics in cases of death due to completed hanging in Nepal. Method This prospective study of death due to hanging was conducted during the period of July 2011 to July 2013. Meticulous autopsy of the body was done in all cases with bloodless dissection of the neck was carried out. Result During the study period medico legal autopsy of 91 cases of death due to hanging was conducted, out of which 57 (63%) were males and 34 (37%) were females. Majority of the deceased were suspended at their own house or peri-domestic settings. Based upon the circumstantial evidences 95.61% (n=87) cases attributed to suicide in nature. Conclusion Hanging undoubtedly is one of the most preferred methods to commit suicide, popular for its lethality. Lack of suicide surveillance system and national data bank in Nepal has resulted into equivocal findings. More studies should be encouraged based upon autopsy findings to get a clear picture on mortality rates.

Germline Editing: Editors Cautionary

This communication is regarding the recent editing of the genome of the human embryo with CRISPR/Cas9 which generated a debate amongst the biological scientists around the world. Editing human germline genes may act as godsend in some serious genetic and other disorders as the genes related to these disorders can be replaced effectively. The scientists are in dilemma whether the human germline gene modification is a boon or bane for the human society. Though editing human germline genes may be an answer to many serious genetic disorders however; it may have unpredictable effects on future generations. The ethical issues regarding the germline editing need further discussion which may have implications on human race and on-going human evolution. Thus, the researchers need to be doubly cautious and some stringent regulations should be framed regarding the various aspects of germ line gene modifications and any potential conflict with nature for future outcome.

Obligate Myiasis: A Case Series From Nepal

Although maggots are unanonymously linked to carcass or dead tissues, there are reports of its infestation into living tissues as well. Myiasis denotes maggot infestation in living tissue. There are two forms of myiasis namely obligate and facultative. Obligate myiasis denotes maggots feeding on living tissue whereas facultative myiasis represents the opportunistic behaviour of the fly taking advantage of wound or necrotic tissue, laying by eggs which hatch into maggots. Decreased physical activity and poor hygiene leads to maggot infestation. Maggot invasion of living tissues is undesirable occurrence which can best be avoided by improving hygiene. People with low living standards in the developing nations are the occasional victims for maggot infestations. We present cases of obligate myiasis for their uniqueness and rarity.

Awareness and Perceptions of Medical Students towards Health Care Ethics - A Study from Nepal

Background Medical practitioners are the men of science who treat patients based on their knowledge and skill. Unethical and immoral conduct in the practice of medicine pertains to human right issues and litigation. Objective The present study is conducted to understand the perceptions and awareness of the moral and ethical responsibilities of future medical doctors in Nepalese scenario. Method This cross sectional study was carried out among the undergraduate medical students of Manipal College of Medical Sciences, Pokhara, Nepal who were administered a pre-tested, semi-structured questionnaire relating to various aspects of health care ethics. A total of 202 students (116 girls and 86 boys) voluntarily participated in the study. Based upon the criteria whether a student had attended forensic medicine lecture the study participants were thus divided into two groups Group I and Group II. The responses of the participants were obtained on a 5 point Likert scale and analyzed. Result The study observed that the overall awareness on issues regarding consent was proportionately higher than for issues dealing with patient's right to treatment. The awareness levels were similar among the students of both groups for most of the issues with exception of a few issues where awareness levels were higher among the Group II students when compared to the Group I students. Conclusion This present study attempts to present the assessment of students on issues relating to ethics and moral reasoning. The present study also emphasizes on the importance of ethics in the practice of medicine.

Intentional Head Injury: Survivor Victim's Profile, Gender Differences and Role of Alcohol Use at Manipal Teaching Hospital, Pokhara, Nepal

IntroductionHead is a vulnerable area in human body and also a favorable site for assaults which is easily accessible by assailant's raised arms. ObjectiveThe objective of this study was to evaluate the socio demographic spectrum, severity, radiological findings and outcome of victims assaulted to the head. Furthermore, the study aims to correlate such findings to the role of alcohol use in Nepalese context. MethodologyThis longitudinal prospective study includes victims of traumatic head injury as a result of physical assault who were admitted in the Neurosurgery Unit of Manipal Teaching Hospital Pokhara, Nepal from 1st January to 31st December 2015. ResultsIntentional head injury accounted to 17.40% of all head injury cases admitted during the study period. Among them 48 (76.19%) were males and 15 (23.81%) were females. The minimum age of the patient was 15 years and maximum was 84 years with a mean age of 33.89±14.67 years. Most of the victims of physical assault belonged to the age group of 21 to 30 years. Blunt object was the most commonly used for assault. Loss of consciousness was associated only with 49.21% of cases and 14.29% cases had bleeding from ear and/or nose. More than 75% of the cases had significant radiological finding in the form of fracture and/or intracranial lesion. Majority of the victims during the study were treated conservatively and were discharged with advice. Alcohol use was involved in 36.51% cases of intentional head injuries.  ConclusionIntentional injuries under the influence of alcohol use are totally preventable public health concerns. It can be ascertained that reducing availability and improving the environment in which alcohol is sold and consumed can result in a dramatic reduction in violent crimes.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 102-105

Approximation of Height of an Individual Using Somatometry of Human Male Skull

INTRODUCTION

Numerous population specific studies conducted on skeletal remains have aimed to standardize the identification process. Known for ethnic and sexual variations, skull bone can also assist the identification process by estimating stature of the individual. The present study focuses on estimation of stature from skull bone using uni-variate and multi-variate regression models in south Indian population.

METHODS

Stature and maximum cranial length, maximum cranial breadth, bi-pterion breadth, parietal cord and upper facial breadth were measured in wet skulls of 113 males, autopsied at Government Hospital of Kudla, Karnataka.

RESULTS

All five measurements showed significant correlation with stature (P value <0.001). MCL showed the highest (r=0.77) and UFB the lowest (r=0.42) degree of correlation. Standard error of estimate was lowest for MCL (4.90 cm) in the derived uni-variate regression models. In the regression model obtained from the multi-variate analysis using all five skull measurements the β-coefficients were significant (P value <0.001) and the Standard Error of Estimation of the model was observed to be 4.45 cm. Bland-Altman analysis was conducted to explore the agreement between the actual length and the estimated lengths from the multivariate regression model. The mean of difference was 0.105 with a standard deviation of 4.3 and the upper and lower limits of agreement were 8.5 and -8.3 respectively.

CONCLUSIONS

The study concludes that stature can be estimated from skull measurements with reasonable accuracy, observations of multi-variate regression models being more precise than the uni-variate regression models. Data collected from South India was compared with data available for Nepalese population and validates the use of data of Indian population for extrapolation in Nepalese population.

Pressure Cooker-A Potential Hazard in Domestic Setting

Pressure cooker is an integral part of Asian kitchen, and is frequently used in Nepal. Steam under pressure generated while cooking has high boiling point and great penetrating power. The use of pressure cooker in kitchen is associated with unintentional injuries that mostly include pressure cooker burns. In rare instances the pressure cooker may accidently explode and may cause serious injuries. The same mechanism is used in making explosive device for mass homicides. An unusual case of penetrating facial injury sustained in a pressure cooker explosion in a domestic setting is reported along with a brief review of literature on pressure cooker explosions.

Clinico-epidemiological features of viper bite envenomation: a study from Manipal, South India

INTRODUCTION

Snakebite is an important and preventable health hazard. Viper bites are more common than other poisonous snakebites in human beings. The present study aimed to collate the victim profile of viper bite cases in the region and to determine the pattern, manifestations, complications and the associated risk factors of these bites.

METHODS

This was a prospective study of viper bite cases admitted to Kasturba Hospital, Manipal, India between August 2003 and November 2005. The demographic and clinical details of each case were obtained from the patients, their relatives and the patients' hospital records, and analysed.

RESULTS

A total of 31 viper bite cases were reported during the study period. The victims were predominantly male and aged 25-55 years. The highest number of cases occurred during daytime in the months of September and October, which coincided with the harvesting season, and involved the lower limbs. 94% of the snakebite victims were farmers, suggesting that this was an occupational hazard. Envenomation was observed in patients with scratch marks, suggesting the importance of keeping the victim under observation in all alleged snakebite cases, even in the absence of clear fang marks. The mortality rate in our study was 6.5%.

CONCLUSION

Immobilising and transporting snakebite victims to the hospital and prompt administration of anti-snake venom remain the best way to reduce morbidity and mortality. It is also important to practise correct first aid measures, as otherwise they may cause more harm than good.

An anthropometric study of facial height among four endogamous communities in the Sunsari district of Nepal

INTRODUCTION

Facial anthropometry has well-known implications in health-related fields and has been utilised for forensic purposes in the past. It provides an indication of the variations in facial shape in a population. The facial anthropometric profile of a population can characterise the distinctive features of a likely face in that population. The present study aimed to examine the differences in facial height proportions and facial growth patterns in different communities in the Sunsari district of Nepal.

METHODS

The upper facial height (UFH) and lower facial height (LFH) proportions of 857 subjects (429 male and 428 female) aged between three and 18 years old from four communities (Brahmin, Chhetri, Rai and Limbu) in the Sunsari district of Nepal were calculated, and comparisons were made.

RESULTS

Significant differences (p is less than 0.05) in the UFH and LFH percentages were observed between the Brahmin and Rai, Brahmin and Limbu, Chhetri and Rai, and Chhetri and Limbu communities.

CONCLUSION

The study concluded that there is evidence of statistically significant differences of the upper and lower face height proportions among the different racial groups. A change in the facial height proportions of the various age groups was evident. However, differences in facial height proportions between male and female were found to be insignificant.

Tubercular granuloma in the myocardium: an autopsy report

Granulomatous myocarditis is a rare disorder of the myocardium, and is usually associated with various inflammatory and autoimmune conditions. We report granulomatous myocarditis in an apparently healthy 58-year-old Indian man, who developed sudden chest pain and died while being escorted to the hospital. At the autopsy, no gross distinct cardiac lesions were observed. The histopathological sections from the left ventricular apex revealed a granuloma comprising a central area of caseous necrosis surrounded by lymphocytes, and epithelioid, plasma and Langhans giant cells. Myocardial tuberculosis was suspected as the underlying aetiology based on the histological features of the granuloma.

Lumbosacral transitional vertebra: clinical and forensic implications

The identification of skeletal remains is one of the classic problems faced by forensic experts. Congenital and acquired malformations can prove to be an important tool for identification, provided antemortem records are available. A lumbosacral transitional vertebra is one such rare congenital anomaly that has clinical and medicolegal implications. We report a case of unilateral lumbosacral transitional vertebra, detected during medicolegal examination of skeletal remains that were recovered from a forested area in coastal Karnataka, India. The congenital anomaly of the transitional vertebra helped in the forensic identification of the deceased.

Phylogenetic variation in flexor digitorum brevis: a Nepalese cadaveric study

Understanding muscle architecture of the foot may assist in the design of surgical procedures such as tendon transfer, biomechanical modeling of the foot, prosthesis design, and analysis of foot function. Flexor digitorum brevis (FDB) is the most superficial intrinsic muscle of the sole of the foot. When compared to the little finger, the little toe has less function and opposition is absent in humans. Hence, the muscles acting on the little toe are undergoing evolutionary changes. The objective of this study was to review the phylogenetic variation occurring in FDB in the Nepalese cadavers. Sixty soles in 20 male and 10 female adult embalmed cadavers were dissected and attachments of FDB observed. It was noted that the tendon for the fifth toe was missing in all sixty soles. The action of FDB can be compensated by other long flexors of the foot. This could have resulted due to gradual reduction in the usage of the little toe as the bipedal posture evolved. Variations of FDB are clinically important because FDB musculocutanous flap is used in the reconstruction of the heel pad.

Ectopic partial intrahepatic gall bladder with cholelithiasis--a rare anomaly

The study was aimed to view the developmental anomalies of gall bladder (GB) in Nepalese cadavers. Forty GBs were studied for any anomalies during routine cadaveric dissection at the Department of Anatomy, Manipal College of Medical Sciences, Nepal. The study found that the congenital anomalies of GB are very rare. Only one case of ectopic partial intrahepatic GB with cholelithiasis was observed, which to our knowledge is the first reported case in Nepal. Awareness of GB anomalies is important to surgeons, radiologists, and clinicians in general. An ectopic partial intrahepatic GB can make cholecystectomy hazardous, when indicated.