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Background Atypical presentation of coronavirus disease-19 (COVID-19) from classic acute respiratory distress syndrome needs to be extensively evaluated to understand the pathophysiology to optimize the management protocol for severely ill patients to abrogate the terminal event. Methods Autopsy core needle biopsies of lungs were obtained from 12 patients who died with COVID-19. Routine histopathological examination of lung tissue along with immunohistochemical analysis of C4d complement staining was studied. Formalin-fixed paraffin-embedded biopsy material was also subjected to real-time reverse transcription-polymerase chain reaction for severe acute respiratory syndrome - coronavirus (SARS-CoV2) gene. Results In the study, all the deceased patients were symptomatic with two-thirds suffering from isolated SARS-CoV2-related pneumonia while remaining one-third had secondary COVID-19 infection. Histopathological evaluation highlights diffuse alveolar damage as the predominant pattern; however, complement-mediated endothelial injury of septal microvasculature, and microthrombi was also distinctly observed with increased serum levels of D-Dimer and fibrinogen-degradation products. The patients who had extrapulmonary manifestations at the time of presentation also showed pulmonary vascular lesions on histopathologic examination. Our study confirms the presence of coagulopathy and immune-mediated microthrombi in pulmonary septal microvasculature in patients with severe disease. Conclusion The results of our small series of patients highlight the possibility of immune-mediated pulmonary vascular injury and thrombosis which has the potential to evolve into large vessel thrombosis and pulmonary embolism in critically ill patients. Definitive therapeutic management protocol including thromboembolic prophylaxis and development of effective immune-modulatory target could possibly reduce mortality in severely ill patients.

Introduction: A Firearm is a thermodynamic machine in which the potential energy of the gun- powder istransformed into the kinetic energy of the projectile.Aims and Objective: To assess the load and analyze the male cases of firearm injuries.Material and Methodology: The present prospective study had been conducted in the Department ofForensic Medicine, SMS Medical College & Hospital, Jaipur, Rajasthan during the period of One & halfyear from May 2014 to October 2015. All cases of firearm injuries that were received dead or live at SMSHospital and its attached Hospitals, Jaipur was included in our study.Result and Observation: In our study majority of firearm injury case [43 cases (40.78%)] were observedin the age group of 20-29 years followed by the age group of 30-39 years [28 cases (27.18%)]. Majorityof the incidences of gun-shot injuries were homicidal in nature (80.58%) followed by accidental episodes(14.56%). Land and property disputes were the most common reason behind firearm injuries in this study(42.72%) followed by revenge & robbery (15.53% & 13.59 % respectively);Majority of the incidencesoccurred during evening in 43 cases (41.75%), followed by afternoon 40 cases (38.83%). There waspresence of firearm entry wound in all victims. Overall,52 cases (50.49%) had a single entrance wound,13 cases(12.62%) had two entry wounds, In summer season 43 cases (41.75%), spring 24 cases (23.30%),winter 20 cases (19.42%), autumn 16 cases (15.53%), were reported in studied cases. In majority of thecases (81.55%), there was no exit wounds while one exit wound was found in 17 cases (16.51%).In rest ofthe two cases, two exit were found in two cases.Conclusion: The results of the present study support the argument that rigorous pursuit of campaign firearmswithout a license and country made guns may prove useful in reducing the number of firearm injuries insociety.

Introduction:-Sexual assaults are inhuman crimes against individual as well as the whole society. This study was thus initiated to obtain statistical pattern of sexual assaults pertaining to analyze various aspects including socio-demography and victim assailant relation, other relevant factors. Materials and Method:- Inclusion Criteria :-all the victims/sexual offence survivors examined at SMS Medical College, Jaipur during 1st January 2018 to 31st December 2018 Exclusion Criteria:- all the alleged cases of sexual offence whom consent could not be obtained. Results:- total 60 cases were studied. The mean age of the victims in present study was 20.98 years. 73.33% victims were from urban regions. 50% victims were educated. 70% victims in the present study were married. Most common place of commission of the crime was the victim’s own home (46.67%) . 43.34% victims reported within one week time period from the incidence. 88.33% victims were assaulted by a single person. 76.67% victims were assaulted by familiar persons. In 51.67% cases, the victim had been assaulted multiple times. In 85% cases, there was peno-vaginal intercourse. 71.67% cases had no injury in the present study. 3.33% victims got pregnant after the sexual assault. Conclusion:- Females of reproductive age group were the most common victims in the present study. Familiar persons committed the crime in most cases and victim’s home was the most common site of occurrence. There was delayed reporting of the crime in most cases which was the main reason for loss of vital trace evidences. Suggestions:- Strict adherence to protocols for medical examination of victims of sexual assaults should be mandatory. Sex education should be provided to school students of teenage to increase awareness regarding medical and legal issues related to such events to increase the reporting of this crime.

Background: Neonatal small bowel obstruction is the most commonly encountered paediatric surgical emergency worldwide and in India. The objective of this study was to study the prevalence and spectrum of neonatal small bowel obstruction.Methods: A retrospective chart review of all neonates aged between 1-28 days that underwent surgery for small intestinal obstruction between January 2017 to January 2019 at Department of Paediatric Surgery, R.D. Gardi Medical College, Ujjain, MP. A predesigned questionnaire was used to collect demographic, clinical and outcome related information. Exploratory laparotomy and type of surgical intervention was done as per the cause.Results: A total of 52 neonates (M: F ratio 1.74: 1) were included in the study. The most common clinical features were vomiting (92%), bilious vomiting (85%) and abdominal fullness (75%) and laboratory feature was leucocytosis (42%) and thrombocytopenia (31%). Most (66%) neonates presented between 2-7 days and belonged to rural areas (65%). The two most common final diagnosis were malrotation (56%) and intestinal atresia (23%). Associated anomalies were seen in 29% [vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities association (8%) and congenital heart disease (8%)]. The mean (±SD) duration to reach full feeds and duration of neonatal intensive care unit stay was 6.2±1.3 and 14.1 (±5) days, respectively. Complications were seen in 20% cases, most common being early bowel obstruction. A total of 6 (11.5%) neonates died in the post-operative period, 83% because of sepsis.Conclusions: Small bowel obstruction is common neonatal surgical emergency. Most common cause is malrotation and intestinal atresia. Neonatal sepsis is the most common underlying cause of death post-operatively.

Background: The trends of deaths due to unnatural incidents are on the rise each year throughout the world, including India. Incremental trends have been observed in all mortalities throughout the country. Although all these mortalities seem preventable, yet not much has been achieved over the years. Intentional mortalities are yet more preventable as compared to non intentional ones. The trends of unnatural deaths were observed at a tertiary care centre of the capital city of Rajasthan to determine the comparative magnitude of such fatalities to predict possible reasons for them.Methods: An observational study was carried out for a one year period (2013-14) at the Department of Forensic Medicine of an apex institution of the capital metropolitan city to determine the comparative trends of accidental to suicidal and homicidal deaths amongst the medico-legal autopsies carried out over the study period. The results were analysed to look into the probable reasons for these preventable deaths.Results: Accidental fatalities contributed maximally followed by suicides and homicides. All types of unnatural deaths were more commonly observed in young adult male population. Road accidents were the major offenders followed by thermal injuries and falls. Intentional fatalities due to self harm or other human beings shared a considerable burden among unexpected mortalities over the study region.Conclusions: Majority of the reported fatalities were preventable deaths occurring amongst the active and productive population and hence, it is of utmost importance to analyse such deaths to suggest remedial measures bring down the toll of such causalities.

Background Diarrhoea accounts for 20% of all paediatric deaths in India. Despite WHO recommendations and IAP (Indian Academy of Paediatrics) and Government of India treatment guidelines, few children suffering from acute diarrhoea in India receive low osmolarity oral rehydration solution (ORS) and zinc from health care providers. The aim of this study was to analyse practitioners' prescriptions for acute diarrhoea for adherence to treatment guidelines and further to determine the factors affecting prescribing for diarrhoea in Ujjain, India. Methods This cross-sectional study was conducted in pharmacies and major hospitals of Ujjain, India. We included prescriptions from all practitioners, including those from modern medicine, Ayurveda, Homeopathy as well as informal health-care providers (IHPs). The data collection instrument was designed to include all the possible medications that are given for an episode of acute diarrhoea to children up to 12 years of age. Pharmacy assistants and resident medical officers transferred the information regarding the current diarrhoeal episode and the treatment given from the prescriptions and inpatient case sheets, respectively, to the data collection instrument. Results Information was collected from 843 diarrhoea prescriptions. We found only 6 prescriptions having the recommended treatment that is ORS along with Zinc, with no additional probiotics, antibiotics, racecadotril or antiemetics (except Domperidone for vomiting). ORS alone was prescribed in 58% of the prescriptions; while ORS with zinc was prescribed in 22% of prescriptions, however these also contained other drugs not included in the guidelines. Antibiotics were prescribed in 71% of prescriptions. Broad-spectrum antibiotics were prescribed and often in illogical fixed-dose combinations. One such illogical combination, ofloxacin with ornidazole, was the most frequent oral antibiotic prescribed (22% of antibiotics prescribed). Practitioners from alternate system of medicine and IHPs are significantly less likely (OR 0.13, 95% CI 0.04-0.46, P = 0.003) to prescribe ORS and zinc than pediatricians. Practitioners from 'free' hospitals are more likely to prescribe ORS and zinc (OR 4.94, 95% CI 2.45-9.96, P < 0.001) and less likely to prescribe antibiotics (OR 0.01, 95% CI 0.01-0-04, P < 0.001) compared to practitioners from 'charitable' hospitals. Accompanying symptoms like the presence of fever, pain, blood in the stool and vomiting significantly increased antibiotic prescribing. Conclusion This study demonstrated low adherence to standard treatment guidelines for management of acute diarrhoea in children under 12 years in Ujjain, India. Key public health concerns were the low use of zinc and the high use of antibiotics, found in prescriptions from both specialist paediatricians as well as practitioners from alternate systems of medicine and informal health-care providers. To improve case management of acute diarrhoea, continuing professional development programme targeting the practitioners of all systems of medicine is necessary.

Background: Head Injury is the single most common cause of mortality in vehicle accidents. Its outcome is a product of different mechanisms, types and amounts of head injuries and their anatomical locations. Objective: To analyze the pattern of fatal head Injury in road traffic accidents at SMS Hospital, Jaipur; a tertiary care centre. Subjects: Cases of Road Traffic Accidents with fatal head injury subjected to medico-legal autopsy at the Department of Forensic Medicine, SMS Medical College and Hospital Jaipur, Rajasthan, India - a tertiary care center. Main outcome: Young adults (both males and females) in their most productive years of life are especially prone to head injury, as a result of vehicle accidents. The use of helmets as preventive measure has checked the external and bony injuries to skull region but there is an urgent need to plan further prevention in such cases to check internal brain injuries caused due to movement of brain in cranial cavity. Results: Males clearly outnumbered females with male to female ratio as 4.7:1. Motor-cyclists were the commonest group of victims. Head injury was the commonest cause of death comprising 53.5% cases. Intracranial hemorrhage of one or more vascular components was the commonest type of injury. The most frequent pattern was a combination of subdural, subarachnoid and intracerebral hematomas i.e. 23 (34.9%). This was followed by Subarachnoid and Intracerebral 13 (19.7%) and subdural and subarachnoid 09 (13.6%). Out of 16 (24.24%) single compartment hemorrhage, the most frequent was intracerebral 08 (50%), followed by subdural 5 (31.25%) and subarachnoid 2 (12.5%) hemorrhage. Conclusion: Prompt treatment should be instituted to all cases of trauma particularly head injury to prevent fatality. Also there is a need to plan preventive measures.