The Current Regulations in Handling Autopsy of COVID-19 Corpses: A Narrative Review.

The COVID-19 pandemic has affected millions of people around the world either directly or indirectly. Deaths have been attributed to COVID-19 as the underlying cause of death or as a contributing cause of death. It is estimated that millions of excess deaths were associated with the COVID-19 pandemic in 2020 and 2021. The importance of a clinical autopsy on COVID-19 corpses lies in understanding the pathogenesis of the disease better. Moreover, a forensic autopsy may be performed on a COVID-19-infected corpse when indicated for medico-legal purposes. From the autopsy perspective, handling COVID-19-infected corpses requires specific guidelines and safety measures to be followed to limit the transmission of SARS-CoV-2, the causative virus. This is essential as COVID-19 is an emerging infectious disease caused by a newly discovered virus. This review narrates the safety measures that should be followed at different stages of handling COVID-19 corpses, starting from the death scene to burial and funeral. Ethical issues in handling COVID-19 corpses are also briefed in this review. As COVID-19 can be transmitted through infected bodies, it is crucial to wear recommended personal protective equipment, specifically for aerosol-generating procedures. There are specific safety measures to be considered before transporting the body to the mortuary, with particular requirements to be implemented there, such as specific engineering controls, staff training, and autopsy room precautions. After conducting the autopsy, disinfection of the tools and equipment, body bags, transport vehicles, and the autopsy room should be considered.

Predictability of Sex from Frontal Sinus in Nepalese Population.

Background Various methods had been used for personal identification. Scientific basis of identification was initiated and progressed after 19th century which may be attributed to various scientists. With the invention of X-ray the field of identification further progressed. Modern radiological diagnostic equipments have greatly assisted in the field of forensic. Frontal sinuses are paired lobulated air cavities located posterior to superciliary arches in the frontal bone. Computed Tomography is best used to study frontal sinuses. Objective To evaluate bilateral Frontal sinus for sexual dimorphism using Computed Tomography. Method Anterior posterior length, transverse width and height of the bilateral Frontal sinus were directly measured on CT DICOM image, using Electronic Caliper in DICOM viewer software. A total 100 CT scans, 50 of each sex were collected was analysed using SPSS-20 in present study. Result The mean age distribution for male is 34.74±8.66, and for females 35.34±8.88. The mean of all the measurements take was larger in males in comparison to females with p < 0.00. The paired t test showed left side is larger than right. The discriminant function showed high significance for each measurement and also when all the measurements were combined. Conclusion Though the study being unique for Nepalese population, caution should be taken when frontal sinus is used as the only parameter. However in combination with other morphometric data is advised.

Homicidal Pesticide Poisoning - An Overview.

Pesticides are chemical or biological agents used to repel or kill pests. Pesticides are potent and lethal toxic substances that are also being infamously used for homicidal purposes due to their easy availability and rapid action. In this review, we look at 21 articles related to homicidal pesticide poisoning in the literature with an emphasis on fatal doses, routes of administration, and profiles of victims and perpetrators. Organophosphates and rodenticides were the most commonly used classes of pesticides, and ingestion was the most common route of administration; however, other modes of administration, such as through intraperitoneal injection, were also reported. Interestingly, we have noticed that victims involved in homicidal poisoning were mostly in close relationships with perpetrators. Most perpetrators were either spouses or other immediate family members. Abiding by the regulations that govern the production, sale, and use of pesticides and proper documentation of the related trail can help control the prevalence of homicidal pesticide poisoning. Recognition of the distinct morbid anatomy of the poisoning cases, alongside a high index of suspicion in cases that fit the profile, is essential for forensic analysis.

Landmark publications on Sudden Infant Death Syndrome: A bibliometrics analysis.

Sudden infant death syndrome (SIDS) is a poorly understood disorder, and its pathophysiology and risk factors remain unclear. Research in the area is the key to combating the pervasive prevalence of this fatal disorder. We sought to identify the top 50 articles concerning SIDS and study their bibliometric characteristics to gain an insight into the research trends in this area. Using the Scopus database, two independent reviewers conducted a literature search using a prespecified search string. Results were arranged according to the citation count, and the top 50 relevant articles were selected. No time restrictions were set, and all types of articles were included. A detailed analysis was carried out to identify the trends and characteristics of the top 50 articles. The top 50 articles were published between 1972 and 2011, with the most productive 5-year interval being 1991-1995. These 50 papers accumulated a total of 13,703 citations (median = 236 citations per paper). Among these, about 9% were self-citations. The citations received by these core papers seemed to decline post-2009. The top 50 articles were published in 21 different journals, with Pediatrics contributing the most (n = 15). US authors were listed for 60% of the articles (n = 30). None of the articles originated from Asian authors. Our manuscript highlights the characteristics of impactful articles on SIDS - and this can act as a directive for researchers aiming to publish on this topic. Bibliometric parameters suggest a decreasing research interest in the fi eld of SIDS, which is concerning, and efforts should be made to promote research. Furthermore, the lack of influential research from Asian authors is also troubling. Funding should preferably be directed toward Asian researchers to bridge the gap in knowledge.

Urban blue: A global analysis of the factors shaping people's perceptions of the marine environment and ecological engineering in harbours.

Marine harbours are the focus of a diverse range of activities and subject to multiple anthropogenically induced pressures. Support for environmental management options aimed at improving degraded harbours depends on understanding the factors which influence people's perceptions of harbour environments. We used an online survey, across 12 harbours, to assess sources of variation people's perceptions of harbour health and ecological engineering. We tested the hypotheses: 1) people living near impacted harbours would consider their environment to be more unhealthy and degraded, be more concerned about the environment and supportive of and willing to pay for ecological engineering relative to those living by less impacted harbours, and 2) people with greater connectedness to the harbour would be more concerned about and have greater perceived knowledge of the environment, and be more supportive of, knowledgeable about and willing to pay for ecological engineering, than those with less connectedness. Across twelve locations, the levels of degradation and modification by artificial structures were lower and the concern and knowledge about the environment and ecological engineering were greater in the six Australasian and American than the six European and Asian harbours surveyed. We found that people's perception of harbours as healthy or degraded, but not their concern for the environment, reflected the degree to which harbours were impacted. There was a positive relationship between the percentage of shoreline modified and the extent of support for and people's willingness to pay indirect costs for ecological engineering. At the individual level, measures of connectedness to the harbour environment were good predictors of concern for and perceived knowledge about the environment but not support for and perceived knowledge about ecological engineering. To make informed decisions, it is important that people are empowered with sufficient knowledge of the environmental issues facing their harbour and ecological engineering options.

Determination of Sex from the Foramen Magnum using 3DCT: A Nepalese Study.

Background Identification is of utmost importance in any medicolegal investigation with sex determination being one of the principle indicators of identity. Sexing of bones becomes easy when the skeletal remains are complete. However, the problem arises when the bones are fragmented. Many researchers have undertaken several studies in different populations to determine the sex with reasonable accuracy using numerous measurements of the skull including those of the foramen magnum. Objective The present study was aimed to find the sexual dimorphism of the foramen magnum in the Nepalese population by analyzing the antero-posterior length, transverse diameter and area of the foramen magnum. Method The antero-posterior length and transverse diameter of the foramen magnum were measured using three-dimensional computed tomography (3DCT) images of the head in a cohort of 100 Nepalese subjects. Radinsky's and Teixeria's formulae were used to calculate the area of the foramen magnum. Discriminate function analysis was used to analyze sex differences. Result Mean values of antero-posterior length and transverse diameter of the foramen magnum in males were higher than in females. The mean of the area calculated using Radinsky's formula was smaller than that calculated by Teixeira's formula and the areas calculated were higher in males. The measurements of the foramen magnum and the areas calculated showed significant difference (p<0.001) between males and females. Discriminate function analysis for the measurements of the foramen magnum and the areas calculated showed high predictability for both the sexes. Discriminate function analysis showed a maximum predictability of 75%. Conclusion Considering the percent of predictability of sex from the various variables related to the foramen magnum in the Nepalese population, it can be concluded that its restricted applicability in forensic investigations should be constrained to cases of fragmentary skull bases.

Sex Determination From the Bicondylar Width of the Femur: A Nepalese Study Using Digital X-ray Images.

Background One of the important components of forensic identification is sex determination. The prediction of sex becomes easy with a complete skeleton. The problem arises with mutilated and incomplete skeletal remains. The skull and pelvis are preferred for sex prediction, but not uncommonly, long bones are brought for forensic examination. The femur out stands as the most dimorphic long bone. The literature on sex determination from the femur in different population groups is in abundance. The forensic anthropology literature suggests that longitudinal dimensions are often less discriminating than the breadth and circumference of long bones. Many researchers have suggested that the bicondylar width of the femur is the most dimorphic dimension. Objective To evaluate the sexing potential of the bicondylar width of the femur in the Nepalese population using digital X-ray images. Method A sample of 200 digital X-ray images of the knee belonging to 100 males and 100 females was used to measure the bicondylar width of the right femur. These digital X-ray images were those of Nepalese patients who visited the Department of Radiology at the affiliate hospital of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal for diagnostic and treatment purposes. Result The resent study reveals a statistically significant difference for the bicondylar width of the femur between males and females. A regression equation was derived with sectioning point 77.84. Using the regression equation the prediction of sex was 68% with an overlapping of 32%. Having a low prediction in comparison to other studies in different populations, 95% confidence interval for the mean was used to get a range of measurements of the bicondylar width for males and females. The range stated in the present study is 79.47 mm to 82.20 mm for males and 73.75 mm to 75.93 mm for females. Conclusion The bicondylar width of the femur cannot be individually recommended for sex determination in the Nepalese population, but could be considered if analyzed along with the other morphometric traits for sex determination.

Lobed spleen: an autopsy case report with emphasis on surgical anatomy.

During the medico-legal autopsy of a male aged 45 years, a bilobed morphology of the spleen was observed. An oblique fissure was located longitudinally at the mid-region of the diaphragmatic surface of the spleen. The fissure was partially deep and observed throughout the diaphragmatic surface. The clinician should be aware of the developmental anomalies of the spleen; as such anomalies may cause confusion during the procedures like splenic biopsy and splenectomy. We believe that, the present case report is important to the radiologists and clinicians involved in the diagnosis and management of splenic pathology. The knowledge is also enlightening to the morphologists and embryologists. The radiologist and clinician should make sure that the fissure in a spleen is not misinterpreted as a laceration or rupture.

Dumb bell shaped morphology of liver: an autopsy case report.

Medicolegal autopsy on the dead body of an elderly female revealed that the liver was having some unusual shape. The left lobe of liver was bifid, having dumb bell type morphology. Also there were some furrows which were observed over the anterior surface of the liver. This type of morphological variant has not been reported hitherto. The clinicians should be aware of developmental morphological anomalies like in this case, as they might cause confusion during the procedures like biopsy, transplantation and lobectomies. We believe that this case report is important for the clinicians who are involved in the diagnosis and management of hepatic diseases. The knowledge is also enlightening for morphologists and embryologists.

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.

Tobacco Chewing and Associated Factors Among Youth of Western Nepal: A Cross-sectional Study.

BACKGROUND: Smokeless tobacco is found to be as addictive and harmful as smoking but have not been explored into, especially among youth. OBJECTIVES: This study was conducted to find the prevalence of tobacco chewing among college students in Nepal and the factors that have influence over their use. STUDY DESIGN: A cross-sectional study with a self-administered questionnaire. MATERIALS AND METHODS: Five colleges of different streams in Pokhara city were selected for the study. A total of 816 students participated. The study was conducted during the period of May 2006-February 2007, using a semi-structured, self-administered questionnaire. RESULTS: Overall prevalence of ever tobacco chewing was 21.3% (males 30.2% and females 10.9%) among the youth with average age of initiation 15.7 years. Pan masala and gutka were used by 63.6% and frequency of use varied widely and only 5.7% said they were daily users. Reasons cited for chewing were most commonly 'just like it' or 'friends chew'. Multiple logistic regression analysis showed age, ever smoking status, being ever alcoholic, and having friends or family members who chewed were significantly associated with students' tobacco chewing. Almost one-tenth of the students believed they were addicted to chewing tobacco and 42.5% of them had tried to quit the habit. CONCLUSION: The study shows a high prevalence of tobacco chewing by Nepali youth. Important factors that influenced the habit were having chewer friends, their own smoking and alcohol status and having family members who chewed. It is pertinent to consider these when formulating cessation and prevention programs.

Smoking among Nepali youth--prevalence and predictors.

Tobacco is the single largest risk factor for various diseases and its presence in the young heralds more serious problems as they may be exposed for longer periods. Prevalence and predictors of smoking among youth will aid in formulating effective preventive and control measures. A cross-sectional study was therefore conducted among 816 students selected from five colleges of Western Nepal using a self-administered questionnaire. Prevalence of ever smoking was 34.2% (males 47.6% and females 18.4%) and for current smoking was 17%. It was higher among youth belonging to 21 years or older as compared to younger age groups. Mean age of initiation was 16.8 years (standard deviation 2.8 years) and the most common reasons cited for smoking were; like it, to feel more relaxed, out of boredom and to look more mature. Proportion of youth who said they felt they were addicted was 43.1% and 64.7% said that they had tried to quit the habit. Most important predictors having independent effects on youth being ever smokers were having three or more smoker friends (OR=18), their own chewing (OR=4.8) or alcohol use (OR=4.2), male gender (OR=3.7) and the type of course they were pursuing, with professional course students having higher risk. With almost one fifth of college-going youth smoking and a higher prevalence in older age groups within them, smoking is a serious concern for young people in Western Nepal.