Pattern of Head Injuries (Cranio-cerebral) due to Homicide in Association with Other Injuries: A Retrospective Post-mortem Study Autopsied at Dhaka Medical College Morgue House.

Annually, homicide contributes to a greater number of the total head injury cases. This retrospective study was conducted from 1(st) January 2009 to 31(st)December 2011 at Dhaka Medical College Mortuary. During this study period of three years a total of 15300 autopsies were done of which 5649 cases (36.84%) were of head injuries. Of them 747(13.22%) were of homicidal, 4080(72.22%) road-traffic accidents, 502(8.88%) accidental and 320(5.66%) cases of fall from heights. Three hundred ninety eight (398) urban cases (53.27%) out numbered 307 rural cases (41.09%) followed by 42 unknown cases (5.62%). Most cases belong to the younger age group i.e. 21-40 years (43.34%) with male preponderance 470(63.10%). Defense wounds were present in 281 cases (37.82%) out of the total 747 homicidal head injuries. There were 206(27.57%) upper limb, 176(23.56%) spinal, 139(18.60%) abdominal, 135(18.07%) thoracic, 58(7.76%) lower limb and 33(4.41%) pelvic injuries found as associated injury. There were 258(34.53%) fractures of occipital followed by 209(28.29%) parietal, 113(15.01%) frontal, 104(13.75%) temporal, 24(3.21%) ant. Cranial fossa, 23(3.07%) post. Cranial fossa and 16(2.08%) of middle cranial fossa fractures. Extradural haemorrhage was more i.e. 434 cases (58.43%) followed by subdural, combination of all, subarachnoid and intra-cerebral haemorrhages. Cases of concussion were more common i.e. 445(59.75%) than lacerated and combination of them. Blunt weapon tops the list of causative weapons i.e. 669(89.22%) than firearms 59(8.07%) and sharp pointed weapons 19(2.68%).

Outcome of Percutaneous Tenotomy in the Management of Congenital Talipes Equino Varus by Ponseti Method.

Congenital talipes equino varus (CTEV) is a common complex congenital anomaly affecting approximately 1 per 900 live births in Bangladesh. Current trends in the treatment of idiopathic clubfoot have shifted from extensive surgical release to more conservative techniques. The Ponseti method that includes manipulation, serial casting, percutaneous tenotomy and bracing has recently become very popular for the management of CTEV with reported excellent outcomes. The purpose of this study was to evaluate the outcomes of Percutaneous Tenotomy in the treatment of equinus deformity of idiopathic clubfoot. Between June 2012 and November 2013 we treated 47 feet in 34 children by the Ponseti method. The standard protocol described by Ponseti was used. Percutaneous tenotomy of the Achilles tendon was performed under local anaesthesia in the outpatient department of Dhaka Medical College Hospital. The Pirani score was used for assessment and mean follow up time was 12 months. The compliance of percutaneous tenotomy among the 47 feet was recorded and 40(85.1%) were good, 4(8.5%) were fair and 3(6.4%) were poor. The rating of final outcome of percutaneous tenotomy after one year follow-up periods among 47 feet, 36(76.6%) were good, 11(23.4%) were fair and zero (0%) were poor. This study permits to conclude the percutaneous tenotomy in Ponseti method as a safe, effective outdoor procedure to correct the residual equinus deformity of club foot after serial casting.

Outline and Medico-legal Drift of Asphyxial Deaths.

Cases of asphyxial death are frequently come across and the numbers are remarkable now-a-days. The study was aimed to estimate the frequency and to determine the socio-demographic pattern of the victims of asphyxial death. It was a cross-sectional variety of descriptive study and carried out in the Department of Forensic Medicine, Dhaka Medical College, Bangladesh from 1st January 2018 to 31st December 2019. A predesigned proforma was made first, and then various data were assembled, tabulated and analyzed there. In the midst of 2199 medicolegal autopsies, there were 224 cases of asphyxial death. Male victims (62.05%) were mostly found and the most affected age group was 30-39 years (35.26%). Victims were predominantly married (53.57%) and were mainly from urban areas (38.39%). The Muslims (76.78%) were the major victims followed by the Hindus (17.41%), Christians (2.67%) and the Buddhists (1.78%). Maximum victims were unemployed (31.69%) followed by students, day laborers & cultivators. Hangings (54.01%) were mostly encountered followed by drowning (23.21%) and throttling (7.14%). Majority of the cases were suicidal (58.48%) followed by homicidal (24.55%) and accidental (16.96%). The main provoking factors in suicidal cases were unemployment (22.13%) followed by failure in examination (20.61%) and domestic violence (12.97%). Hangings were proven to be suicidal. In cases of drowning manner of death could not be given and throttling were homicidal by autopsy.

Ship Breaking Workers and Their Pattern of Work-Related Respiratory Problems: A Cross-sectional Study at Sitakunda Ship Breaking Industrial Area of Bangladesh.

A cross-sectional study was conducted from March 2019 to August 2019 to determine the pattern of work-related respiratory problems among workers in ship breaking industry at Sitakunda, Chittagong, Bangladesh as many unskilled and semiskilled worker are working there without having minimum knowledge and idea about the possible adverse health effect of different pollutants which also pose threats to the ambient environment. Total 120 male respondents were selected purposively. Majority 80.8% (97) of the workers were below 30 years. About 71.0% (85) respondents were working for less than five years. Majority of respondents worked 8 hours daily. Most of them worked each of the days in a week. About 66.0% (80) had smoking habit. Among 120 respondents, 95.8% (115) had no previous respiratory problem. But 63.3% (76) felt that their respiratory problems were increasing day by day due to current job (ship breaking). There were 85.0% (102) respondents who felt cold or sneeze mostly in working place. About 80.0% (96) of respondents felt better during holiday. There were different respiratory symptoms among the respondents like nasal irritation, hoarseness of voice, cough during cold, cough without cold, bringing up phlegm when catch cold, bringing up phlegm without cold, tightness of chest where the prevalence was 54.2% (65), 85.0% (102), 93.3% (112), 28.3% (34), 70.0% (84), 39.0% (27) and 67.5% (81) respectively among the workers. Majority respondents 96.7% (116) were conscious about using PPE. Only 17.5% (21) used mask during work. Different pulmonary lung function test like forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1%, peak expiratory flow rate (PFER) was done. Mean of FVC, FEV1 was 3.76 and 1.09 respectively. According to pulmonary statuses of workers as per spirometric findings 20.83% (25) had normal pulmonary function, 58.33% (45) had obstruction and 20.83% (25) had combined obstructive parameters. So in light of the study it is clear that the work organization has not developed in this particular industry. In every steps of their work ship breaking workers are facing violations of industrial codes which correspond with safe working environment. In long run the workers have to pay with their health and life about which they are unaware.

Silhoutte of Deaths In Connection With Fatal Fall from Height Injuries.

As medicolegal consultant, we often encounter cases of fall from height related deaths which are invariably subjected to medicolegal autopsy and the numbers are gradually increasing day by day. During the study period of three years data were collected by using a pre-tested structured proforma, police inquest reports, hospital records and thorough medicolegal autopsy done at Chittagong Medical College Mortuary. This retrospective autopsy based study revealed 175 cases of fall from height casualties out of the total 2850 autopsies. We observed that the age group of 41-50 years i.e. 55 cases were mostly affected followed by 31-40 years i.e. in 40 cases. Males (144) were the main sufferers than the females (31). Maximum victims were construction workers 57 cases (32.57%) followed by 45 factory workers (25.71%). Construction sites were the main place of fall i.e. in 57 cases (32.57%) followed by working places 46 cases (26.28%). Most of the victims had head-neck injuries i.e. in 143 cases (81.71%) followed by thoracic injury 82 cases (46.85%). Multiple injuries i.e. in 92 cases (52.57%) were the main cause of death followed by head-neck injuries in 79 cases (45.14%). These casualties are definitely preventable by adopting safety measures and by educating the workers in the factories and construction sites.

Hanging: Commonly Encountered by Forensic Experts at Autopsy.

Though human lives have become easier and faster due to rapid twist in urbanization, industrialization and digitalization suicidal tendency among common people are often seen. Hanging is the commonly chosen method to do so. The study was designed to find out the pattern of hanging cases and to discover the immensity of hanging as a method of committing suicide. This retrospective study was done for three years by retrospectively collected data at the department of Forensic Medicine and Toxicology of Chattogram Medical College. A total of 193 cases (6.73%) of hanging were observed among 2850 autopsies done from January 2015 to December 2017. The age group of 31-40 years was mostly affected i.e. in 54(27.97%) followed by 21-30 years 48(24.87%). Males 112(58.03%) out numbered the females 81(41.96%). Clothes 88(45.59%) were mostly used as ligature material followed by jute rope (33.67%) and nylon rope (20.72%). Maximum cases were atypical hanging 160(82.90%), while we observed 33 typical (17.09%) hangings. In 166 cases (86.01%) we observed no injuries to the neck while contusion of the neck in 27 cases (13.99%). This study revealed fracture of the thyroid cartilage in 5 cases (2.59%) and hyoid in 2 cases (1.03%). One hundred & eighty five (185) cases (95.85%) were of suicidal and only 8 cases (4.14%) were of accidental. As per observation of this study, hanging has been found to be a common means of committing suicide in Bangladesh.

Forensic Profiling of Cut Throat Wounds.

This study was conducted to reveal the causative factors and injury pattern of cut throat wounds. This is a retrospective study of three years done at Chattogram Medical College Morgue House from January 2014 to December 2016. This study revealed 106 cases of cut throat wounds out of the total 7300 medico-legal autopsies of which most of the victims were male (74 cases) whereas females were 32. The most affected age group was 21-30 years (both male & female) i.e. 47 cases (44.33%). Homicides in 91 cases were the prime manner of death followed by suicide 13 and 2 accidental cases. Associated injuries were found in 70 cases out of the total 106 cases of cut throat wound. Haemorrhage was the main cause of death in 58 cases (54.71%) followed by air embolism (19 cases), other causes (15 cases) and asphyxia from aspirated blood in 14 cases. Fields were the mostly observed places of occurrence i.e. in 61 cases (57.54%) followed by outside house (18 cases), within the house (11 cases), public place (10 cases) and working place (6 cases). Criminal gang violence were the predominant motivational factors i.e. in 48 cases (45.28%) followed by robbery (26 cases), love or relationship (17 cases), domestic violence (9 cases) and financial hardship in 6 cases. Butcher's knives were the most commonly used weapon i.e. in 69 cases (65.09%) followed by kitchen knives (24 cases), ramda (8 cases) and axe in 5 cases.

Death Due To Electrocution- An Autopsy Based Study at Chattogram Medical College Morgue House.

As we less frequently encounter cases of death due to electrocution, less attention is given to them. These all have significant impact on morbidity and mortality of the common people of different ages. This autopsy based retrospective study (from January 2014 to December 2016) was carried out by the history of the case, inquest report and by doing thorough autopsy of each of the cases at Chattogram Medical College Mortuary, Bangladesh. Fifty (50) cases of electrocution accounted for 1.23% of the total 4020 autopsies. Male victims i.e. 43(86%) outnumbered the females 7(14%). The majorly affected age group was 21-30 (24 cases) followed by 31-40 years (13 cases) and 41-50 years (5 cases). The commonest place of occurrence was on the street side in 33 cases (66%) followed by home 17 (34%). High tension wire i.e. in 28 cases (56%) were the main causative agents followed by home appliances 16 (32%) and water pump 6 (12%). In relation to distribution of entry and exit wounds, we observed evidence of both entry and exit wounds in 32 cases (64%) followed by no entry or exit wounds in 11 (22%) and entry wounds only in 7 (14%). As per this study, entry wounds were present in the upper limbs in 34 cases (68%) followed by head-neck (7 cases) and lower limbs (3 cases). We also observed maximum exit wounds were in the lower limbs i.e. in 36 cases (72%) followed by upper limbs (5 cases) and chest-abdomen (2 cases). Considering manner of death, we observed all the cases of electrocution i.e. 50 cases (100%) were of accidental. Electrocution accounts for a smaller proportion of all unnatural deaths which could be prevented by adequate awareness and adopting safety measures.

A Rare Case of Polyorchidism: Sonographic and MR Evaluation of Four Testes.

Polyorchidism is a rare congenital anomaly reported about 200 cases in the world text. A number of theories have been planned concerning the making of polyorchidism, but the real explanation is still not acknowledged. Here we are going to present a case study of polyorchidism. A 70 years old gentleman complained with left supernumerary testes in the left hemiscrotum. His left hemiscrotum was painless with mass. Polyorchidism without malignancy or any other concomitant features were revealed by both ultrasound and MRI examinations. In most cases the ultrasonograph alone is diagnostic. In complicated cases of polyorchidism MRI may provide additional information.