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Electricity is an integral part of modern society. Without electricity the existence of human life seems difficult, but it has the capacity to stand life and destroyed the life up to the death. The most fatalities caused due to electricity are accidental and result from passage of an electric current [both low & high voltage] through the body. Penile trauma presents a difficult physical and psychological problem and is rare. The causes of penile trauma are varied; it can be iatrogenic or caused by traffic accidents, thermal and electric burns, ritual circumcision, animal bites, gunshots or self-mutilation. The type and extent of penile trauma varies from mild to severe injuries, sometimes even with total amputation. In the present case, a 24 year old young male from Palwal (Haryana) sustained electric burn injuries while he was standing in the balcony and came in contact with high voltage electric wires passing in front of the balcony. He was admitted in Safdarjung hospital, Delhi and expired on the same day. During autopsy electric contact burn marks were present on unusual sites of the body like head, neck, abdomen, pubic region and root of penis with amputation of penis. Electric flash burns were also present on different parts of the body along with fracture of cervical vertebra. [ABSTRACT FROM AUTHOR]

Background A major factor contributing to global trauma mortality and morbidity is the lack of effective prehospital trauma services in developing settings. We developed a 2-d training course for nondoctor first responders featuring high-fidelity simulation and video-assisted debriefing, self-directed learning videos, and native language instruction. Materials and methods A pilot session was conducted in Jodhpur, Rajasthan. Eighteen local instructors were recruited to train 48 layperson first responders in 10 essential subjects. Didactic sessions of 15-20 min consisting of self-directed learning videos were followed by 30-40 min skill sessions featuring high-fidelity simulation, and concluded with 15-20 min video-debriefing periods. Changes in competence were evaluated using pretraining and posttraining surveys. Results Results demonstrated that statistically significant competence increases in all areas of trauma management assessed: airway (t[46] = 7.30, P < 0.000), hemorrhage (t[46] = 9.96, P < 0.000), fractures (t[46] = 9.22, P < 0.000), cervical spine injury (t[46] = 12.12, P = 0.000), chest injury (t[46] = 7.84, P < 0.000), IV line placement (t[46] = 4.36, P < 0.000), extrication (t[46] = 2.81, P < 0.005), scene assessment (t[46] = 7.06, P < 0.000), triage (t[46] = 5.92, P < 0.000), and communication (t[46] = 5.56, P < 0.000). Highest increases in competence were observed in cervical spine injury and hemorrhage management, with lowest increases in IV line placement and extrication. Conclusions Results suggest this approach may be effective in imparting prehospital trauma management concepts to layperson first responders. This study highlights an innovative educational avenue through which trauma management capacity can be enhanced in developing settings. [ABSTRACT FROM AUTHOR]

Background: The global status report of the World Health Organization (WHO) on road safety suggested that India is leading in road traffic accidents in the world. According to the report on road accidents in India in 2010 by the Transport Research Wing, Ministry of Road Transport and Highways, New Delhi, Kerala ranked third in accidents per lakh population and second in persons injured per lakh population. As the face, brain, and cervical spine are in close proximity with one another, associated injuries can be suspected. The aim of this study was to determine the relationship between the severity of head, cervical spine, and facial injury and incidence of facial injury in patients with head and/or cervical spine injury. Materials and Methods: A prospective cohort study was conducted over a period of one year. The study population included all patients having computed tomography (CT)-demonstrable head injury, radiographic evidence of cervical spine injury, and associated head or cervical spine injury with facial injury. Data were analyzed using the chi-square test using statistical package SPSS. A P value less than 0.05 was considered statistically significant. Results: Of 124 patients, 59 (47.6%) had facial injuries. As severity of head injury increased, the number of facial injuries decreased. Statistically, no significant association between facial and head injury was seen. A statistically significant association between dentoalveolar involvement and cervical spine injury was seen (P < 0.001). The proportion of injuries in patients with cervical spine injuries alone was significantly lower in the frontal (P = 0.001) and orbital (P = 0.004) regions and higher in the mandibular region (P = 0.010). Conclusion: Midface injuries were more commonly associated with head injuries. Decreased facial involvement leads to increased severity of head injury. Simple injuries of the cervical spine were more commonly associated with facial injuries. [ABSTRACT FROM AUTHOR]

Fatalities due to attacks by tigers on humans are uncommon and are rarely described in the medico-legal literature. We herein present a forensic investigation in a unique case of a fatal tiger attack in the wild on a 35 year old female in India by an Indian Bengal tiger (Panthera tigris tigris). The attack resulted in two pairs of puncture wounds over the nape area with occult cervical spine injuries resulting from transfixing of spine due to the tiger canines; multiple puncture wounds, numerous scratches and abrasions consistent with the tiger claw injuries and injury to the right jugulocarotid vessels. This case outlines the characteristic injury pattern from such an attack along with the multiple sources of the tiger injuries. The analysis of these injuries might reveal the motivation behind the attack and the big cat species involved in the attack. A tiger injury is sometimes compared with a stab injury, as the patterned injuries due to a tiger bite are characterized by multiple penetrating, stab-like wounds. So, a special attention is paid toward establishment of the cause of death from bites by the animal teeth under unknown circumstances of trauma and to exclude the possibility of a homicide beyond reasonable doubt in such cases. [ABSTRACT FROM AUTHOR]

Study Design:Retrospective study.Objectives:We aimed to correlate the spinal cord changes as depicted by magnetic resonance imaging (MRI) with the neurological deficit and motor recovery of patients with acute cervical spinal cord injury (SCI).Setting:A total of 57 patients with acute cervical spine trauma who presented to the Department of Radio Diagnosis, Kasturba Medical College Manipal, Karnataka, India, over a period of 5 years (August 2002 to September 2007) were studied.Methods:The pattern and extent of spinal cord changes on MRI were compared with the American Spinal Injury Association (ASIA) grade, motor index score (MIS) and the total number of useful muscles in the extremities on admission (ADM) and follow-up. The differences in the recovery rates (RR) among patients with cord edema (EDE), contusion and hemorrhage (HGE) were tested statistically.Results:Spinal cord edema was associated with a better neurological outcome than contusion or hemorrhage, and its overall length showed a negative correlation with the recovery rate (P=0.001).Conclusion:MRI is invaluable in evaluating cervical SCI. Cord edema is associated with a better neurological outcome when compared with cord contusion or hemorrhage.Spinal Cord (2008) 46, 791–797; doi:10.1038/sc.2008.55; published online 10 June 2008 [ABSTRACT FROM AUTHOR]

This report describes the outcome of 64 attempted suicidal hangings, 81% of whom made a full recovery. [ABSTRACT FROM AUTHOR]

Background and Objectives: The cost of medical care and availability of resources (human and facilities) which differs from nation to nation are amongst others, factors driving medical tourism (MT) despite its potential drawbacks. The aim of the study was to analyse all patients that presented with neurosurgical complications following MT., Methods: A single institution prospective study was carried out. Data which included patients' demographics, diagnosis, Glasgow coma scale score at admission, type of complication, and outcome were collected over a 3 year period and analysed., Results: A total of 23 neurosurgical cases were seen during the study period with a median age of 42 years (17-70 years). India is the most common country visited by Nigerian patients. Nine patients died from various complications on arrival in Nigeria. There was no significant statistical difference between the outcome and patients clinical status prior to travel (p=0.107), country where the surgery was done (p=0.776), admission GCS in Nigeria (p=0.169), and redo surgery in Nigeria (0.181)., Conclusion: Government in different nations should have legislations to ensure that medical tourists' receive appropriate care abroad, proper follow-up care upon their return, and also promulgate laws to regulate quasi and organised MT agencies that are operating in a regulatory vacuum.

Objective: To assess the survival in persons with traumatic spinal cord injury (SCI) receiving structured follow-up in South India., Design: Retrospective study., Setting: Rehabilitation center., Participants: Persons with traumatic SCI (N=490) residing within a 100-km radius of the institute who were managed and regularly followed up by the rehabilitation center between the years 1981 and 2011., Interventions: Not applicable., Main Outcome Measures: Survival rates and mortality risk factors. Measures were estimated using the product limit (Kaplan-Meier) method and the Cox model., Results: The survival rate after SCI was 86% after 5 years, 71% after 15 years, and 58% after 25 years. Survival of persons with complete high cervical injury is substantially low compared with other levels of SCI. Level of injury and extent of lesion (Frankel classification and/or American Spinal Injury Association Impairment Scale) play a significant role in predicting survival of this population., Conclusions: Survival rates of regularly followed-up persons with SCI from this study show promising results, though survival rates are lesser when compared with studies from developed countries. Better understanding of the predictors, causes of deaths, comprehensive rehabilitation, community integration, and regular follow-up could possibly assist in improving survival rates., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt trauma who undergo imaging studies. However, timely and accurate recognition of cervical spine injury is essential for the optimal management of patients with blunt trauma as subsequent morbidity includes prolonged immobilization. Evaluation of cervical spine injuries should begin in the emergency department and involves a combination of pediatric, trauma, orthopedic, and neurosurgeons for definitive management. Knowing which patients are at highest risk for injuries will undoubtedly influence decisions on how aggressively to pursue a potential cervical spine injury and can be achieved by establishing a multidisciplinary team approach that provides cervical spine immobilization, assessment, and clearance. Implementation of such guidelines will decrease time for cervical spine clearance and incidence of missed injuries. In this article different aspects of cervical spine injuries and cervical spine clearance protocols are reviewed.

Study Design and Subjects: Retrospective descriptive analysis of data of patients with spinal injuries admitted to a tertiary referral medical center from January 1, 2003 to December 31, 2004., Objectives: To identify the demographic profile of patients with spinal injuries admitted in this hospital., Setting: Medical records department, Kasturba Hospital, Manipal, Karnataka, India., Methods: A total of 207 patients with traumatic and non-traumatic spinal injuries were included in the study. The patient characteristics that were included were age groups, neurologic status, mode and neurological level of injury, management and recovery pattern., Results: Ratio of men to women who sustained spinal injuries was 3.6:1. The maximum number of patients was in the age range of 20-39 years. The different levels of spine that sustained injuries were cervical spine (36.2%), thoracic spine (34.3%) and lumbar spine (29.5%). There were 118 patients with neurological deficit. Mechanisms of injury recorded were fall from height (58.9%), fall of weight (7.2%), motor vehicle accidents (21.3%) and non-traumatic causes (12.6%). Of these 207 spinal injury patients, 74.4% were managed conservatively, whereas 25.6% patients were managed surgically., Observation: This study gives a preliminary overview of the characteristics of patients with spinal injuries in this hospital.

Strangulation is one of the common modes of violent asphyxias. Frequently, the deaths from strangulation are homicidal in nature. To study the pattern of the strangulation deaths in the capital city of Delhi, a retrospective analysis of 10 years records from the period 1993-2002 was undertaken in the department of Forensic Medicine and Toxicology at UCMS and GTB Hospital. During the above period, 8385 Forensic autopsies were conducted out of these 98 (1.17%) cases were found to be of strangulation. These 98 cases were analyzed in detail and showed that: (a) incidence of strangulation have increased many folds in comparison in 1970s; (b) maximum incidence of strangulation is amongst individuals in third decade of life; (c) male, female ratio was 3:2; (d) ligating material was found present in neck in 40% cases; (e) fractures of the neck bones/cartilage were observed in 80% cases; and (f) other associated injuries were seen in as high as approximately 90% of cases. The paper describes and discusses the findings in detail.

Objective: To find out the incidence of associated facial injuries and injuries to the cervical spine., Design: Retrospective study., Setting: Teaching hospital, India., Subjects: 536 patients treated for maxillofacial injuries between January 1992 and November 1993., Interventions: Review of hospital case notes and radiographs., Main Outcome Measures: Coexisting facial and cervical spine injuries, morbidity and mortality., Results: 16 patients (3%) had sustained both facial and cervical spine injuries. There were 14 men (median age 40, range 21-64) and 2 women (aged 19 and 30). In 10 of the 16 patients the cause of the injury was a road traffic accident. In 11 patients the facial injury was to the soft tissue only, in 4 it was to both hard and soft tissue, and in 1 it was to hard tissue only. Soft tissue damage to the midface was more likely to be associated with injuries in the area of C5-7 and that to the lower third of the face was more likely to be associated with damage to the upper cervical spine. 11 patients had neurological deficits as a result of their injuries and 2 died., Conclusion: If diagnosis and treatment of simultaneous facial and cervical spine injuries are to be improved, further study of the biomechanics of injury is necessary.