The objective was to evaluate the point prevalence of Hepatitis B in India. The design used was a meta-analysis of data on point prevalence from different parts of the country. Searches were made in Medline Cochrane Library and Best bets and previous reviews. A limited hand search of cross references was also done. Finally a consultation with experts was held to enlarge the references base. Studies reporting prevalence of HBsAg were selected. Data from high risk groups were excluded. 54 papers reporting data on 61 populations were identified. The true prevalence for each study was calculated from the reported prevalence using the specificity and sensitivity of the test employed. The true prevalence in non-tribal populations is 2.4% (95% CI: 2.2% -2.7%). True prevalence among tribal populations is 15.9 % (CI: 11.4% -20.4%). These figures may be useful in estimation of the burden of the disease in the country and for projecting the cost-benefits of immunization. (authors)

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Sytematic review and meta-analysis of prevalence of hepatitis B in India.

Publication bias can result from the propensity of researchers to document what is unusual. This can distort the inferences drawn in systematic reviews. To measure the distortion, it has been suggested that a second analysis be done; using weights proportional to the size of the population from which the samples are drawn. We re-evaluate data from a published meta-analysis on prevalence of hepatitis B in India, to see how this approach alters the results. Prevalence of hepatitis B among tribal and non-tribal populations in different States was analyzed. Weights were then assigned according to population of the State. The overall country prevalence was then calculated. Using population-weights it is estimated that the point-prevalence of hepatitis B among non-tribal populations is 3.07% [95% CI: 2.5-3.64]. Among tribal populations it is 11.85% (CI 10.76-12.93). Overall prevalence was 3.70 (CI: 3.17-4.24) (corresponding to a chronic carrier rate of 2.96%). The present analysis using population-weights has resulted in the estimated prevalence among non tribal populations increasing by 24% and that among tribal populations decreasing by 25.5% when compared to figures of the meta-analysis published earlier. The advantages and drawbacks of this procedure are discussed.

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Calculating prevalence of hepatitis B in India: using population weights to look for publication bias in conventional meta-analysis.

Synopsis On December 16th 2012, Jyoti Singh, a 23 year old physiotherapy student, was brutally gang raped by six men on a bus in South Delhi, India. The severity of the attack and the inadequate response of the Indian government to the crime provoked nationwide protests and demands for legal reform. While other rapes have prompted public outcry, this particular crime inspired elevated interest, not only in India but around the world. This article addresses the relationship between the evolving social, political, and legal discourses surrounding rape in India that permeated the attack and its aftermath. By situating Jyoti Singh's case within a longer genealogy of responses to sexual violence in India this article reveals several unanticipated outcomes such as the distinct patterns of public outcry and protest, notable shifts in prior socio-legal narratives of rape and the pioneering content of the Justice Verma Committee report.

From “living corpse” to India's daughter: Exploring the social, political and legal landscape of the 2012 Delhi gang rape

Background: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial haemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial haemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. Methods: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. Results: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. Conclusions: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.

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Skull fracture and haemorrhage pattern among fatal and nonfatal head injury assault victims – a critical analysis

The scope, roles, and tasks of forensic medicine and forensic medical experts currently vary widely between countries and legal systems, which has resulted in barriers to organization, standard setting, and quality assurance for practice in forensic medicine, including for reporting. The legal fact finder is thus confronted with variability in the quality, structure, and content of forensic medical reports. We sought to define and categorize the scope, methods, and practices that fall under the description of forensic medicine, the various issues encountered in current forensic medical practice, and the potential role of evidence-based practice in forensic medicine. We searched electronic databases and reviewed relevant articles, as well as conducting personal correspondences with forensic medical practitioners around the world, to obtain a description of current forensic medical practice. The terms forensic medicine, legal medicine, medical jurisprudence, medico-legal services, forensic pathology, and clinical forensic medicine are used with mixed interpretations in different countries. The systems and services rendered are not uniform either. The methods used by forensic medical practitioners are not always evidence-based, or based on standardized methods, and vary greatly between experts and centers. There are also no universally accepted guidelines to prepare a standard and admissible report. The lack of a uniform system in forensic medicine creates difficulties in assessing the development and performance of forensic medicine as a distinct discipline. To prepare evidence-based forensic medical reports, generally accepted guidelines are necessary.

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A review of the diversity in taxonomy, definitions, scope, and roles in forensic medicine: implications for evidence-based practice

Pedestrians injured in automobile accidents constitute one of the most frequent serious problems in management for emergency room surgeons. The incidence of deaths in pedestrians is significantly higher than in other road users. This study attempted to analyse the pattern of injuries sustained by 129 pedestrians in road traffic accidents. It was found that the pedestrians were the commonest group of victims involved in fatal road accidents comprising 28.7% of all cases. 83.7% cases were males. There were two peaks of incidence in relation to age; one at childhood (20.9%) and the other in elderly (19.37%). Cars and heavy vehicles were the commonest offending agents comprising 41.9% and 31.8% respectively. The pedestrians themselves were at fault in 43.4% cases. Head injury was seen in 80% cases; followed by lower limb fractures (42.6%), and chest injury (38.8%). The cause of death was head injury in 56.6% cases followed by thoraco-abdominal injuries in 8.5% cases and multiple injuries in 7.8% cases.

A review of pedestrian traffic fatalities

Role of e-trainings in building smart cities

To study the normal bowel habits of healthy Indian children up to 2 y of age. This cross sectional study was conducted in medical college associated teaching hospital in Delhi. Ethical clearance was obtained from Institutional Ethical Committee. A total of 500 infants and toddlers up to 2 y of age were recruited for the study. Data were collected by interviewing parents of the eligible children who came for immunisation using pre designed Performa. There was steady decline in stool frequency with increasing age. Maximum decline in stool frequency was noted after 1 mo of age. Variation in stool frequency between children was maximum in 0–3 mo of age and decreased with increasing age. Stools at 4 wk were usually semiliquid, watery and semisolid. By 6 mo of age 55 % infants were passing semisolid stools and 40 % were passing formed stools. At 24 mo of age, 89.2 % children usually passed formed stools. This is the first study in India to date documenting the frequency and consistency of the stools of young children. These results make an important contribution to defining normal stool patterns in young Indian children.

Variation in Bowel Habits of Healthy Indian Children Aged up to Two Years

Trend of homicides by different means keeps on changing with the passage of time and development in different parts of the world. A study was conducted on 200 alleged cases of homicides (excluding deaths due to rash and negligent act). Different profiles from demographic and medicolegal aspects were evaluated. The incidence of homicidal deaths was observed as 12.03%, with male preponderant (82.5%) and the commonest age affected was 21 to 40 yrs (51.5%). Rural population was mainly affected. The blunt weapon (50.88%) was commonly used to inflict the injuries and ‘abrasion’ was the commonest manifestation (32.73%). The defence wounds were present in 36% cases. Head was the main seat of injury (13.65%). The cause of death in most cases was hemorrhage and shock (31.5%), followed by injury to brain (28.5%). Only 16% cases of these received hospital care. This necessitates the prompt medical care to be provided in the ‘Golden Hour’ to save valuable human life. Police patrolling for early detection of crime and shifting of injured to hospital/critical care center and provision of prompt ambulance service by state/private hospital/NGO's for medical care.

Medicolegal study of mechanical injuries in culpable homicides (excluding deaths due to rash and negligent act)

In the present society, which is gradually becoming over democratic it is natural that old values of sanctity of life changes and personality problems develop due to consequent stress of life. This ultimately results in violence. Killing of a human being is one of the most serious or major crimes. Since very long time, different judicial authority to prevent crime and its further occurrence framed laws. The laws were made according to the religious make up of the society but later the laws were according to the emperor's own convenience. In spite of all these, there has been a phenomenal rise in the incidence of homicide all over the world and also in India. The study was conducted on 200 alleged cases of homicides. The incidence of homicidal deaths was observed as 13.03% with male preponderance and the commonest age affected was 21 to 40 yrs. Out of different weapons used to inflict the injuries on dead bodies of homicides, 31(10.88%) sharp cutting weapons were used. Incised wounds were present maximum 38(29.69%) on head and face. Defence wounds were present in 72(36%) of homicide deaths.

Shilekh Mittal

Papers

A review of pedestrian traffic fatalities

Role of e-trainings in building smart cities

Variation in Bowel Habits of Healthy Indian Children Aged up to Two Years

Medicolegal study of mechanical injuries in culpable homicides (excluding deaths due to rash and negligent act)

Homicides by sharp weapons