Death in the home: domestic violence against women in Khyber Pakhtunkhwa.

BACKGROUND: Domestic or Interpersonal Violence (IPV) remains a major global problem often resulting in morbidity and mortality. The present study was conducted to determine the scope of deaths related to domestic violence in the Khyber Pakhunkhwa province, Pakistan. METHODS: Data were collected on all reported female fatalities due to domestic violence for the years 2009-2011 from the records of the department of Forensic Medicine, Khyber Medical College Peshawar for analysis. RESULTS: A total of 305 deaths were reported, showing an increasing trend of 115 deaths for 2009-10 and 190 deaths for 2010-2014. The majority, 182 (59.7%) belonged to the rural areas and 123 (40.3%) to urban areas of the province. Victims were generally of the younger age groups (17% below age 16 and 42.3% between 17-32 years). Homicide was the manner of death in 293 (96.1%) while the most common causative agent was firearm injury (235, 77.1%). Head and neck injuries were most common (52.6%) followed by the chest and abdomen (31.6%) while multiple sites and extremities accounted for 15.8% of injuries. CONCLUSION: Young and adult females of KPK province of Pakistan are susceptible to homicidal deaths due to domestic violence, perpetrated through firearm injuries to the head and neck regions.

Physical trauma--a leading cause of medico legal cases at DHQ Hospital Abbottabad.

BACKGROUND: Trauma is one of leading cause of suffering to mankind. No study has yet been done to see the incidence, pattern of injury, outcome and declaration according to Qisas and Diyat in the city of Abbottabad. The objectives of the study were to determine the frequency of age and sex with type of lesion and causative weapon after trauma in a medico-legal clinic and to find the impact on the commonest target organs in the study area. METHODS: This cross-sectional study was conducted at District Headquarter Hospital, Abbottabad between 1st January 2004 and 31st December 2004. Cases presenting for medico legal examination in Medico-legal Department of DHQ Hospital Abbottabad. Patients were selected on basis of purposive sampling technique. Physical trauma group was sub-divided into firearms, sharp, blunt and road traffic accident. This group was further classified according to age, sex, area of body involved, type of weapon, seasonal prevalence, and whether injuries were declared according to Qisas and Diyat ordinance. RESULTS: A total of 759 cases of physical trauma reported for medico-legal examination. Out of 759 cases of physical trauma, 3.4% cases of firearm weapon, 7.9% cases of sharp weapon, 16.2% of road traffic accidents, and 72.5% of blunt weapon presented in the medico-legal clinic. Male preponderance with 97% was noted. Two-third of victims were between 10 and 39 years of age. The months of May-July and October-December showed slightly elevated number of cases. The head and neck was the most commonly involved area. No case was certified according to Qisas and Diyat Ordinance. CONCLUSION: Physical trauma constitutes the leading cause to the mankind which makes about 91.6% of cases. Males between 10 to 39 years of age are most likely to be victims. The face and head is the most affected area.

Trauma management in a tertiary care hospital in Peshawar, Pakistan.

BACKGROUND: With an increasing incidence of road traffic accidents and weapon injuries there is increasing need for improvement in trauma management. Liver being a highly vascular organ and strategically located is difficult to manage. METHODS: Study was conducted in Surgical 'A' Unit, Lady Reading Hospital, Peshawar from August 2003 to September 2005. It was a descriptive study and all patients were operated in emergency department. All relevant data of patients were recorded from the emergency and admission protocols. RESULTS: A total of 364 trauma patients were received and among those 48 patients had liver trauma, 75% of patients had penetrating and 25% had blunt trauma. Most of the patients had grade III liver injuries. There were no grade V and VI injury. Repair with perihepatic packing for liver injuries remains the most frequently performed procedure (41% of patients). CONCLUSION: In a stable patient blunt trauma liver can be managed conservatively by serial examinations and investigations with emergency laparotomy facilities at hand. Perihepatic packing and damage control surgery is the valuable procedure at hand. Increasing grades of liver injuries leads to increasing morbidity and mortality. The same is the case with multiple organ injuries.

Gastroenteritis exhumed.

Nature of presenting symptoms and even signs of disease can lead to a diagnosis that seems routine but is in fact erroneous because a sufficient index of suspicion is not generated in the mind of the physician dealing with the case. A young girl of about 16 years was brought to the Casualty Department, DHQ Hospital Bannu on 12 Sep 2004 with complains of severe vomiting and diarrhoea; the casualty medical officer diagnosed her as a case of acute gastroenteritis.

Morbidity & mortality of firearm injury in Peshawar Region.

BACKGROUND: Firearm injuries cause significant morbidity and mortality among its victims. The present study, carried out at a major tertiary care hospital of Peshawar, Pakistan was aimed at highlighting the extent and severity of firearm-related morbidity and resultant mortality despite expert medical care. METHODS: All victims of firearm injury brought to the Lady Reading Hospital Peshawar Emergency Department and thereafter admitted to hospital wards during the period mid-2006 to mid-2007 were included in the study prospectively regardless of age, gender or socio-economic status. Data relevant to the background of firearm use, type of firearm used, types and extents of injuries, clinical condition of the patients and final outcome were collected on performas and entered into SPSS 15.0 for analysis. RESULTS: Seventy-four cases of firearm injury were recorded during the study period, with a predominant male to female ratio (9.6:1). Most victims (79.7%) were in the age group of 15-35 years. Although there were more cases from Peshawar (28.4%), there was no major referral pattern noted. High velocity weapons were used in 95.9% of cases and homicide was the main motive for injury (60.8%). Injuries were sustained most frequently in the abdomen and pelvis (44.6%) and 67.6% of victims sustained internal injuries. There were only 5 (6.8%) deaths from firearm injuries. CONCLUSION: It is concluded, the young males of the population must be targeted for lifestyle adjustments such as training to refrain from anger or disputes (usually over petty things) and to prevent the easy access of firearms as a weapon to settle disputes.

Homicidal deaths by firearms in Peshawar: an autopsy study.

BACKGROUND: Medico legal autopsies can be valuable sources of information about the distribution of causes of reported deaths, particularly in homicidal cases. The present study provides information regarding the homicidal deaths due to firearm injuries in the district of Peshawar, NWFP, Pakistan. METHODOLOGY: This descriptive study was conducted over the period of the year 2004. Data were collected from the autopsy records of the Department of Forensic Medicine, Khyber Medical College Peshawar and included all reported unnatural deaths from urban and rural areas of district Peshawar on whom autopsies were conducted in the department. RESULTS: Homicidal deaths constituted 77.7% (492/633) of all autopsies for the year 2004. Of 492 homicidal deaths, a vast majority of 452 (91.87%) were caused by firearm injuries. Among these, the male to female ratio was 5.5:1. The most common firearm weapon (418/452, 92.5%) were high velocity rifled weapons (Kalashnikov, rifles, pistols), followed by low velocity rifled weapons (18/452, 3.98%) and shotguns (16/452, 3.54%). A total of 956 injuries were found in various body areas, giving an average of over two injuries per person. The head, face and neck sustained the highest injuries (257, 26.9%), followed by the chest (248, 25.9%) and abdomen (149, 15.6%); the extremities, buttocks and genitalia together sustained 302 (31.6%) injuries. CONCLUSION: The vast majority of reported homicides in Peshawar are caused by firearm injuries, which bring up issues related to possession of firearms and changes in cultural attitudes towards use of firearms, if a decrease in firearm-related homicides is desired.

Homicide in Abbottabad.

BACKGROUND: Homicide is one of the oldest crimes in human history. Although a large number of dimensions have been added to this crime, the age-old factors like revenge, rage, jealousy and honour persist even today. This study was conducted jointly at the attached hospitals of Women Medical College and Ayub Medical College. Abbottabad to know the various dimensions of the victims of homicide. METHODS: The present study encompasses all 40 cases of homicide, which presented for autopsy at DHQ hospital and Ayub Medical Complex Abbottabad during the year 2002. The manner of death was categorized as homicide on the basis of police inquest and the autopsy findings. RESULTS: The homicide rate in Abbottabad was found to be 4.22/100,000 per year. Males were the primary targets usually in their prime of youth with 40% victims between 20-29 years. Firearms formed the major weapon of offence. Most victims died before reaching the hospital. Deaths were more common during the daytime and in summer months. CONCLUSION: Homicide rate is on the lower side in Abbottabad amongst places where firearm possession is not strictly controlled, but can be further reduced. Limiting firearm possession alone can go a long way in this goal.