Introduction: Injecting drug use is a public health concern due to its clinical, social, economic, and legal consequences. Objective: (1) To evaluate the prevalence of infections associated with injecting drug use; and (2) To assess the social profile of substance users and high-risk behaviors among people who inject drugs (PWID) receiving opioid substitution therapy (OST). Materials and Methods: A cross-sectional study was conducted among 100 PWID who were deemed eligible using inclusion and exclusion criteria. Data were collected through an interviewer-administered structured questionnaire after obtaining informed written consent. Results: The results revealed that 14% of PWID had human immunodeficiency virus (HIV), 7% had tuberculosis, and 2% had hepatitis B virus (HBV). None of the PWID self-reported hepatitis C virus (HCV) infection. Importantly, 71% of PWID were living on the streets (i.e. homeless), and 41% of PWID had a history of sharing needles with other users in the preceding 3 months. Unmarried or single PWID had significantly increased risk of homelessness (χ 2 = 4.570; P = 0.032) and reported high-risk sexual practices with commercial sexual partners in the preceding 3 months (χ 2 = 4.163; P = 0.041). Homeless PWID had significantly increased frequency of injecting practices ( P = 0.020). Conclusion: Despite the higher global prevalence of HCV compared with HBV and HIV among PWID, HCV testing is not currently conducted at most OST centers in India. Access to free needles and syringes should be enhanced to reduce the morbidity associated with injecting drug use.

Substance use represents a global health crisis with its devastating consequences. Knowing the type and pattern of drug use, which usually varies across the countries, is indispensable in implementing tailored interventional studies among substance users, particularly people who inject drugs (PWID). We aimed to assess the pattern of substance use among PWID receiving opioid substitution therapy (OST) and to evaluate the characteristics of current injecting practice. This cross-sectional study was conducted between November 2016 to March 2018 among PWID receiving OST at a tertiary care center in New Delhi. A total of 100 PWID satisfying inclusion criteria were included, and the desired information on the pattern of substance use was collected using the interviewer-administered questionnaire method. Alarmingly, about 58% of PWID self-reported a history of injecting drug use in the preceding three months, in the frequency of twice or more than twice a day among them (n=49,85%), despite current OST. Alcohol (51%) followed by cannabis (28%) were the most common gateway drugs. Overall, the majority of PWID used smack (Heroin) (91%) along with a cocktail of drugs like pheniramine (Avil) (91%) and buprenorphine (81%). Peer pressure (64%) was the leading reason cited for initiation of substance use. Targeted interventional strategies should also be extended to school-going children since most substance users initiate substance use with readily available gateway substances during childhood and adolescentsș period. Effective implementation of the existing substance-related laws and rigorous securitization of drug sales is the need of the hour.

Sedative hypnotics class of drugs is increasing become the drug of choice for intentional overdose. The frequent prescription of these agents in those with psychiatric illnesses, insomnia and other substance use disorders has also increased the risk of accidental overdose. The growing use is reflected in the latest epidemiological findings and also underline the importance of the study of factors contributing to fatal overdoses so that appropriate steps can be taken to curb the growing epidemic of sedatives-hypnotic overdose.A literature review was conducted of articles on sedatives-hypnotic overdose/toxicity published in the last few years on search engines PUBMED, EMBASE, PsycINFO and Google Scholar.A plethora of studies existed on the epidemiology of sedatives-hypnotic overdose in various developed and developing nations. These data mainly came from countries with good reporting of fatal and non-fatal as well as intentional/accidental poisonings in the healthcare system. There is a lack of Indian studies focusing on sedatives-hypnotic or prescription drugs related deaths, overall. Various factors associated with increased risk of sedative-hypnotic overdosing have been studied in recent years. From the management perspective, use of flumazenil and its associate adverse effects have been extensively reported.The increasing number of emergency admissions and deaths owing to sedatives-hypnotics overdose place a huge economic burden. From the public health point it becomes important to regulate the prescription and availability of these drugs to reduce associated fatalities.

Background: HBV is spread by contact with blood or body fluids of an infected person. HBV is said to be 50 to 100 times more infectious than HIV. Most of the unclaimed dead bodies brought for medico-legal autopsies at Lady Hardinge Medical College, New Delhi are beggars and destitute who remain indulged in drug addiction and unsafe sex, thus more prone to HBV infection than general population. Aims: To evaluate whether unclaimed dead bodies pose more risk of transmitting HBV infection than claimed dead bodies. Methods: As out of all the markers for HBV, detection of HBsAg reveals present infectious status of the individual, present study was conducted on 100 claimed and 100 unclaimed dead bodies using HBsAg marker. Results: Out of total 200 cases, 30(15%) cases were positive for HBsAg and hence HBV infected. On comparison, in claimed dead bodies, 7% cases were found positive for HBsAg whereas in unclaimed dead bodies, 23% cases were positive for HBsAg. Conclusion: Unclaimed dead bodies brought for medico-legal autopsy should be screened for HBsAg prior to autopsy so that all the precautions can be taken to avoid contracting HBV infection. (C) 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.

For long time forensic investigators have considered Hyoid and laryngeal injuries as important findings in cases of deaths due to strangulation. Further the incidence of injuries to the neck structures in such cases being related to various factors like the age, gender, the type of the hanging based on suspension and the position of the knot are well documented. Our study highlights the impact of other crucial factors which are usually overlooked, but having strong association in the deaths due to strangulations in general and hanging in particular. The study was undertaken in Central Delhi in 100 cases of hanging, where we studied the association between the hyoid and laryngeal fractures with other variables like type of the ligature material used, the number of turns around the neck, the width of the ligature mark, the type of the knot (fixed/running noose), the duration of suspension and the Body Mass Index of the individuals. In our study 42% of cases had hyoid/laryngeal injuries. These injuries were more common in those who had used hard ligature material with more than one turn around their neck and with a broader ligature mark on their neck. Hyoid and laryngeal injuries were also more common in victims who had a running noose and a prolonged duration of suspension.

Diatom test was thought to be gold standard in diagnosis and confirmation of drowning related deaths. Besides determination of cause of death, it also helps to deduce the site of drowning. However, since detection of diatoms in the lung fields of non-drowned deaths in workers of kieshelgur industries by Otto H in the year 1961, many workers claimed that diatoms were also found in lung as well as other peripheral organs in non-drowned individuals, raising serious doubt about the reliability and utility of diatom test. Many of strong supporters of diatom test still rely upon it and attributed presence of diatoms in non-drowned deaths to post-mortem contaminations. Amid controversy surrounding the diatom test, the present study conducted over 750 different tissues from 150 non-drowned deaths using Nitric acid digestion method, diatoms could be detected in 27(18%) cases and 49 (6.53%) different tissues. Small sizes pinnate shaped diatoms were mostly found in liver, kidney, brain and bone marrow tissues where as both small and large sizes diatoms were found in lung tissues.

Fragmented skeletal remains are often presented for forensic evaluation which makes it difficult for the forensic investigator to derive basic anthropological profile of the decedent(s). Research workers have been trying to develop techniques that will enable them to overcome these problems. Earlier attempts notably by McKern and Steel were not successful when it was put to actual practice because of the vague nature of some of the vital anatomical landmarks. To overcome these, Simmons et al came up with a new approach. We adopted this technique to estimate length of femur from its fragments by analyzing 128 adult intact femora. The regression formulae thus obtained can be used while analyzing skeletal remains from North Indian population.

Boy uzunlugunun tahmini adli tip uzmanlari ve adli antropologlar tarafindan kimlik tespitinde yaygin bir sekilde kullanilmaktadir. Ayak izleri olay yeri incelemesinde onemli kanitlar saglayabilmekte, boy uzunlugunun tespit edilmesi ise kriminal olaylari aydinlatabilmektedir. Elinizdeki calismada, farkli kokenden insanlarin yasadigi bir grupta ayak boyutlari ile boy uzunlugu arasindaki iliskiler ele alinmaktadir. Boy uzunlugunu tahmin etmek icin ayak uzunlugu (AU) ve ayak genisligi (AG) olculeri kullanilmistir. Olculer 250 gonullu denek uzerinde alinmistir. Boy uzunlugu ile daha yuksek bir korelasyon gosteren degisken ayak uzunlugudur (r=0,575). Boy uzunlugunu tahmin etmede ayaga iliskin uzunluk olculerinin daha basarili oldugu sonucuna ulasilmistir.

Metamorphosis at the sternal extremity of the rib has already been established as a reliable indicator of age at death by Iscan's phase method introduced in 1985. The purpose of this paper is to apply rib phase standards to an Indian sample to test if the progression of morphological changes follows the same age sequence. The rib sample shows that an accurate estimation of age can be made by direct examination of the bone itself. The sample consisted of 63 ribs of known age, sex, and race. The ribs were assigned to one of nine phases (0 through 8) based on changes noted at the costochondral junction. These included the formation of a pit, its depth and shape, configuration of the walls and rim surrounding it, and the overall texture and quality of the bone. Statistical analysis revealed that the features chosen to delineate the phases are valid predictors of age. This study has shown that the sternal rib can provide an accurate estimation of age in females spanning a mean age of 14 to 85 years.

Various studies have shown that certain behavioral disorders like Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), and Oppositional Defiance Disorder (ODD) are closely associated with criminal behavior. Onset of these disorders occurs early in life. If diagnosed in early childhood, they can be prevented from progressing to cause major problems in adulthood.101 juvenile delinquents from 2 juvenile homes in Delhi, India were studied over a period of one year, using ICD -10 Classification of Mental and Behavioral Disorder Diagnostic Criteria for Research. 59.4% showed presence of ADHD and related disorders, 2.97%, had ADHD, 4.95% were found with ADHD and CD, and one child had ADHD, CD and ODD. 38.61% were found to be positive for CD and 11.88% had ODD. It is imperative for health professionals to recognize the importance of this problem and its proper management at an early stage.

Diatom test is utilized as an important tool for diagnosis and confirmation of drowning deaths, and also for deducing the possible site drowning. For extraction of diatoms from human tissues like lung, liver, kidney, brain and bone marrow, several methods like Acid Digestion Method, Soluene-350 Method, Enzymatic Method, Membrane Filter Method, Colloidal Silica Gradient Centrifugation Method, Dry Ash Method etc. are used. Even for one method of extraction, different modifications have been used by different workers. For the purpose of identification and comparison of diatoms both in human tissue sample and water sample, besides commonly practiced light microscopy, scanning electron microscopy (SEM) are environmental scanning electron microscopy (ESEM) are also used by different workers. In the future, newer methods of identification of diatom using Nuclear Magnetic Resonance and Inductively Coupled Plasma Hyphenated Technologies, Atomic Force Microscopy (AFM), Flourimetry, Automatic Diatom Identification and Classification (ADIAC) etc. may add great value to the utility and reliability of diatom test for diagnosis and confirmation of drowning related deaths. The present paper is an overview of all such methods.

Bullet entering into the human body chooses its own path. Exit of bullet from the body depends upon its type, muzzle velocity, shooting distance and internal structures coming along its internal path. Exit of bullet through its own entry wound is possible theoretically, especially when wound track is short and limited by bony structure. In those circumstances, there may be atypical appearance of the external gunshot wound, posing problem to differentiate entry wound and exit wound, calculating number of bullets entered or lodged inside, besides estimating the shooting distance. The present authors had reported a fatal case of rifle firearm injury where one bullet fired from intermediate range had exited through its own entry wound, on back of the neck.

The determination of age remains as an important tool towards establishment of identity of an individual. The Iscan's phase method for the estimation of adult age at death from the sternal extremity of the fourth rib was introduced in 1983. Over the years, numerous tests have confirmed the reliability of this technique on varied samples. Therefore, the purpose of this paper is to apply rib phase standards to an Indian sample to test if the progression of morphological changes follow the same age sequence. This study introduces the sternal end of the rib as a site for age estimation by direct observation. The sample consisted of 101 male ribs of verified age, sex, and race. The ribs were assigned to one of nine phases ( 0 through 8) based on changes noted at the costochondral junction. These included the formation of a pit, its depth and shape, configuration of the walls and rim surrounding it, and the overall texture and quality of the bone. It was revealed that the mean ages per phase were nearly identical in both Indians and American whites.

Attention Deficit Hyperactivity Disorder (ADHD) a common childhood onset psychiatric disorder distinguished by the symptoms of inattention, hyperactivity and impulsivity. It is frequently found in association with Oppositional Defiant Disorder, Conduct Disorder, Depressive Disorder and Anxiety Disorder. It manifests early in childhood and more common in boys than in girls. It is now increasingly being felt that criminal behavior has a biologic and medical basis. Various studies suggest association of ADHD and juvenile delinquency. If detected early in life, with proper management, these disorders can be checked from progressing to some extent. This may help in reducing the incidence of crime. The present review is aimed at bringing more awareness about these disorders and their role in juvenile delinquency, especially in India.

The present study was undertaken in order to describe histopathological changes by studying risk factors which will lead to development of ARDS. We investigated a total of 50 cases (31 males) ranging in age from 18–63 years. The extent of diffuse alveolar damage, a classical histopathological manifestation of ARDS was assessed. Burns was the most commonly presented risk factor constituting 34% of the total cases. Overall extra pulmonary cases were 78% and pulmonary cases constituted 22% of total number of cases. Gross examination showed 7 cases of consolidation and 4 cases of superficial hemorrhage. On histopathology, 8 cases showed hyaline membranes, Interstitial and Intra-alveolar edema and inflammation and Intra alveolar hemorrhage. In 4 cases, findings of type 2 pneumocyte proliferations were present. 42 cases showed no significant findings. Overall, 1 case of septicemia, 2 cases of major trauma with shock,4 cases of burns, 1 case of aspiration of gastric contents were found positive for ARDS. 8 cases (16%) fulfilled histopathological criteria for diagnosis of ARDS in our study. Study described etiologic and histopathological basis of ARDS, and summarizes our understanding of how the co-relation exists between postmortem histopathological findings with known risk factors of ARDS. We conclude that autopsy in cases with risk factors for ARDS will help in diagnosis & better understanding of the condition.