Incidence and Comparison of Suicide in Various Phases of the Menstrual Cycle: a Systematic Review and Meta-analysis.

Background: Suicide is a global health concern. There are reproductive health-related factors that are responsible for increasing the risk of female suicide. There are a number of studies examining the association between suicide and the menstrual cycle, but still, there are no conclusive findings. Aim: We aimed to pool data from all the studies reporting data on suicides and the menstrual cycle phase to report the following outcomes: incidence of suicidal deaths in the menstrual, secretory, and proliferative phases, and to find out whether the burden of suicide in the menstrual phase in particular, was more at a young age (18-35 years) or middle age (36-50years). Methods: The PubMed database was extensively searched from inception till 12th April 2022. The data for the number of events occurring for each outcome were pooled using random-effects model and forest plots were created. Results: Five articles were shortlisted for inclusion in our analysis. Incidence of suicide in the secretory phase was highest at 45.2% [95% CI, 0.367-0.537]. The incidence of suicide, when occurring in the menstrual phase, was reported to be 68.4% (95 CI, 0.317-1.052) and 31.6% (95 CI, -0.052.3-0.68) for young-aged and middle-aged victims, respectively. Conclusion: Our results demonstrate that the menstrual phase has a lower risk of mortality due to suicide when compared to the other two phases of the menstrual cycle. Nevertheless, when suicide occurred in the menstrual phase, the incidence of suicide among the younger age-group was higher than for those in the middle age-group.

Workplace hazards in forensic mortuaries in Saudi Arabia: A survey of forensic mortuary personnel.

Forensic mortuaries have always presented a potential threat to workers who come into contact with dead bodies. This research aims to identify hazards faced by forensic mortuary personnel, including forensic pathologists and technicians working in forensic mortuaries in forensic medicine centres throughout Saudi Arabia, to recognise the prevalence of exposure to workplace hazards and to discover the degree of awareness and use of safety practices. A descriptive, cross-sectional study was conducted in a total of 20 forensic medicine centres, using an online questionnaire distributed among forensic mortuary personnel. A total of 113 participants responded to the questionnaire. Just over half (53%) of workplaces always provided personal protective equipment, and 75% of participants always used them. The most common hazards were needle-prick wounds and accidental slips or falls. Almost two thirds (64%) of participants witnessed or experienced a work-related accident in the forensic mortuary. The lack of previous studies concerning hazard exposure among forensic mortuary personnel in Saudi Arabia means that this study provides foundational evidence for future research concerning forensic autopsy-related work accidents in Saudi Arabia.

Postmortem Changes of Female External Genitalia and Their Importance in Suspected Sexual Abuse.

Examination of the female external genitalia to assess for sexual abuse is performed in living individuals, and the interpretation of the findings is based on evidence-based studies. However, in the deceased, no such studies are available, and postmortem changes could present as suspicious findings that can be mistaken for trauma. Patches of discoloration in the hymen were reported previously in one case as hypostasis (i.e., livor and lividity), and based on this finding, it was listed as a finding that is not associated with trauma. This was a retrospective study that was conducted in the Center of Forensic and Legal Medicine in Dammam, Saudi Arabia over a 4-year period. The study included 30 deceased women in whom photographic documentation of their external genitalia was assessed for postmortem changes. The postmortem interval ranged from less than 24 h to more than 100 days, and the ages of these deceased women were in the 20-40 year-old age group. In cases where the hymen, vagina, and/or fossa navicularis were clearly visible, none of these areas showed any hypostatic discoloration. A comparison between antemortem and postmortem appearance of the hymen in one case clearly showed the absence of hypostatic changes in the hymen. In conclusion, any discoloration of the external genitalia that is detected in a female decedent requires serious consideration.

Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study.

BACKGROUND: Worldwide, tobacco smoking is a major risk factor for morbidity and early mortality among adult population. The present study aimed to find out the association between current smoking and suicidal ideation among young people in Nepal. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey was carried out among 452 youths from Pokhara, Nepal. The present study included both genders (age 18-24 years) who were smokers as well as non-smokers. RESULTS: Across the study period, 452 participants were identified after matching for age, and sex (226 in the smoking group and 226 in the non-smoking group). The mean age of participants was 21.6±1.2 years and 58.8% were males. The overall rate of suicidal ideation in our cohort was 8.9%. Smokers were slightly more likely to report suicidal ideation than non-smokers (aOR 1.12). The risk of developing suicidal ideation was 3.56 (95% CI 1.26-10.09) times more in individuals who smoked greater than 3.5 cigarettes per week (p=0.01). CONCLUSION: The rate of suicidal ideation was slightly higher among smokers and a dose-response relationship was identified with the number of cigarettes smoked per week. Being aware of the link between smoking and suicidal ideation may help health care professionals working with young people to address more effectively the issues of mental well-being and thoughts about suicide.

Gastrointestinal causes of sudden unexpected death: A review.

Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.

Commotio cordis: A review.

Commotio cordis is an increasingly reported fatal mechano-electric syndrome and is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium. By virtue of this impact, malignant arrhythmias consequently develop leading to the individual's immediate demise, accompanied by a relatively normal post-mortem analysis. The importance of an autopsy remains paramount to exclude other causes of sudden death. With increasing awareness and reporting, survival rates are beginning to improve; however, prevention of the development of this condition remains the best approach for survival.

Morphometric evaluation of the foramen magnum for sex determination: A study from Saudi Arabia.

The present study provides a database of various morphometric dimensions of the foramen magnum region in the Saudi population. The objective of this study was to evaluate various measurements of the foramen magnum region for sex determination in the Saudi population by using computed tomography (CT) images. The various radiological measurements of the foramen magnum region were measured in a total of 200 adult subjects of Saudi origin including 100 males and 100 females. Sexual dimorphism was observed in five parameters related to the foramen magnum, namely length of the right occipital condyle (LROC), length of the left occipital condyle (LLOC), width of the foramen magnum (WFM), area of the foramen magnum (AFM) and length of the foramen magnum (LFM). The accuracy to discriminate sex ranged from 65.5% to 62.5% when LROC, LLOC, WFM, AFM, and LFM were considered as individual parameters. When multiple parameters were combined to discriminate sex, the highest accuracy of 71% was achieved.

Consented Autopsy and the Middle-East.

Consented autopsy is almost non-existent in the Middle-East where established social and cultural beliefs regarding the procedure might discourage family members from requesting a consented autopsy. Evidence suggests that new information is obtained from consented autopsies. It would not be in the best interest of medicine if social and cultural misconceptions succeed in erasing the existence of consented autopsies entirely.

Undergraduate teaching of forensic medicine in Saudi Arabia.

Medico-legal tasks are not exclusive to forensic medical experts -any physician may face medico-legal issues in his career. Hence, the practice of medicine requires education in legal issues. In Saudi Arabia, there are 30 universities with medical colleges, but we do not know how they teach undergraduate forensic medicine and medico-legal issues. The aim of this study was to discover undergraduate training courses in forensic medicine in Saudi universities. We conducted a cross-sectional study involving all colleges of medicine in Saudi Arabia. A structured, self-administered questionnaire containing 13 items relating to the undergraduate forensic medicine course was distributed. Out of a total of 30 universities, 27 universities responded. Of these 27 universities, 16 (59.26%) teach forensic medicine to undergraduate medical students, and 11 (40.74%) do not teach forensic medicine in their undergraduate curriculum. Of the 27 universities that responded, none has a department of forensic medicine. Eleven universities that do not teach forensic medicine have no forensic medicine unit/division or faculty at all. Forensic medicine belongs to the pathology department in 11 universities, while it belongs to different departments in five universities. There is variation in teaching methods, years where the course is taught and length of the course. Practical and morgue visits take place in 7/16 (43.8%) universities, while 9/16 (56.3%) universities only teach the theoretical aspects of forensic medicine. All 16 universities teach forensic medicine only to medical students and do not teach it to students in other colleges such as dentistry and nursing.

The Islamic Approach to Modern Forensic and Legal Medicine Issues.

This article is a review, from a Saudi Arabian perspective, of selected historical Arabic books and recent medicolegal journal articles on 4 current controversial issues: medical ethics, forensic autopsies, end-of-life decisions, and genetic profiling. This article demonstrates the flexibility of the Islamic medical jurisprudence to accommodate medicolegal issues.

Authorship: Few Myths and Misconceptions.

This article seeks to address and dispel some of the popular myths and misconceptions surrounding authorship of a scientific publication as this is often misconstrued by beginners in academia especially those in the developing world. While ethical issues in publishing related to authorship have been increasingly discussed, not much has been written about the myths and misconceptions of who might be an author. Dispelling these myths and misconceptions would go a long way in shaping the thoughts and plans of students, junior faculty and researchers in academia especially in the developing world.

Chemical crowd control agents.

Chemical crowd control agents are also referred to as riot control agents and are mainly used by civil authorities and government agencies to curtail civil disobedience gatherings or processions by large crowds. Common riot control agents used to disperse large numbers of individuals into smaller, less destructive, and more easily controllable numbers include chloroacetophenone, chlorobenzylidenemalononitrile, dibenzoxazepine, diphenylaminearsine, and oleoresin capsicum. In this paper, we discuss the emergency medical care needed by sufferers of acute chemical agent contamination and raise important issues concerning toxicology, safety and health.

Evaluation of the mastoid triangle for determining sexual dimorphism: A Saudi population based study.

Demographic assessment of skeletal remains in forensic investigations includes identification of sex. The present study aimed to develop population-specific, sex-discriminating anthropometric standards for the mastoid triangle of a documented Saudi population using computed tomographic (CT) images of the lateral aspect of the skull. The present study was performed on 206 CT images of a documented Saudi population of known sex and age. The clinical CT images of subjects visiting the Department of Radiology, Dammam Medical Complex, Dammam, Saudi Arabia (KSA) were evaluated to know the validity of the metric assessment of the mastoid triangle for identification of sex in a Saudi population. The distance between asterion to porion (AP), asterion to mastoidale (AM), porion to mastoidale (PM) were measured and the area of the mastoid triangle (AMT) was calculated using these measurements. Discriminant function procedure was used to analyze the data for sexual dimorphism. In conclusion, the results of the present study indicate that all the 3 sides of the mastoid triangle and AMT were sexually dimorphic in the sampled Saudi population with PM being the best individual parameter in discriminating sex with an accuracy of 69.4%. Whereas, all the parameters combined showed the highest accuracy (71.4%).

Publication ethics.

High-quality scientific literature is the cornerstone of scientific progress and is highly regarded by academia. However, scientific literature is often marred by plagiarism, data fabrication and falsification, redundant publication and illegitimate authorship. These problems are discussed in this article.

Autopsy in Islam and current practice in Arab Muslim countries.

Autopsy, or post-mortem examination, is the dissection of a dead body. It is performed for many reasons. Attitudes toward dead bodies vary with religious beliefs and cultural and geographical backgrounds. We have carried out an extensive literature review to determine the Islamic view and current practice of Autopsy, in at least four Arab countries which published their experiences. Several research articles have studied the history of Islamic Autopsy as well as the current situation and legal debates about it. The overwhelming conclusion is that data is lacking. More must be published from Arabic Muslim countries and more research done to correct misconceptions. We also recommend more application of non-invasive Autopsy.

Suicidal ideation among students of a medical college in Western Nepal: a cross-sectional study.

Many studies have been conducted in the developed countries to know the magnitude and factors influencing suicidal ideation among medical students, but such data are sparse in developing countries. This cross-sectional study was therefore conducted to find out the prevalence of suicidal ideation and factors influencing such ideation among students of a medical college in Western Nepal. A total of 206 students were selected using random sampling and questioned about their socio-demographic factors, other risk factors and suicidal ideation using a preformed validated questionnaire. The data were analyzed using SPSS for Windows Version 16.0 and the EPI Info 3.5.1 Windows Version. Descriptive statistics and testing of hypothesis were applied for the statistical methodology. The univariate and multivariate logistic regression methods were used to examine the association between different variables. Suicidal ideation in the last one year was present in nearly one tenth of the study population and in almost one fifth of them life-time suicidal ideation was present. Factors that were associated with suicidal ideation were primarily dissatisfaction with academic performance, being in the clinical semesters, having history of drug abuse and feeling neglected by parents. Most common reason reported for suicidal ideation was family related followed by self-related. Recognition of suicidal ideation among students and their associated factors can help in detecting it on time, making the right interventions and controlling the problem. Understanding the magnitude of the problem and their epidemiology via scientific study like this would be the first step in this process.

Autopsy discoveries of death from malaria.

Malaria inflicts a huge health care burden in terms of mortality and morbidity worldwide. There has been evidence in the literature where many unexpected/unexplained deaths turned out to be related to malaria on autopsy. The aim of this study is to review autopsy diagnosed malaria related deaths in the literature with due stress to its biologic and forensic aspects. A meticulous literature search was performed for "sudden malaria death", "malaria death postmortem diagnosis" and "unexplained death malaria" across PubMed, SCOPUS, Cochrane Database of Systematic Reviews, Allied and Complementary Medicine, British Nursing Index, CINAHL, EMBASE, Ovid-MEDLINE and Google Scholar. All the literature was thoroughly reviewed and analyzed with reference to the type of study, location, travel history, age, gender, circumstance of death, method of diagnosis, species involved, chemoprophylaxis usage and take home message from the particular study. Plasmodium falciparum was responsible in most of the cases. The symptoms mimicked influenza in most of the case reports. Travel to endemic areas was common to most of the victims. The travelers were from all over the world including USA, France, Switzerland, Spain, Portugal, Germany and Asia (China and Japan). Vascular congestion with the presence of malarial pigment laden RBCs in capillaries of various organs was the major histopathology finding. Such lesions were found in the brains of all subjects (100%), liver of 78% of the cases, spleen in 67%, lungs in 56% and myocardium in 43% of the cases. Peripheral smear and rapid diagnostic test was of great aid to the autopsy in many cases. PCR was used for diagnosis as well as exclusion of possibility of co-infection with other species in case of Plasmodium knowlesi related death. The postmortem and histopathology findings in this case were similar to P. falciparum except for the fact that brain sections were negative for intracellular adhesion molecule-1. Chemoprophylaxis was not taken by the victims except for two in whom history of chloroquine based chemoprophylaxis was mentioned. Given the worldwide prevalence of the disease, increasing international travel and rapidly developing drug resistance, malaria will continue to be an important disease and should be considered in all cases of unexpected deaths particularly in malaria endemic regions or in presence of travel history to endemic regions.