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A record based cross-sectional study of postmortems performed at the mortuary attached to the forensic medicine and toxicology department of RG Kar Medical College and Hospital from March 2008 to February 2009 comprising 1900 cases was conducted to determine the sociodemographic profile and to assess the nature and cause of such deaths. Bodies of 5 foetuses were decomposed which were excluded from the study. Out of a total of 1895 postmortems analysed, 23 autopsies were performed of limbs where the subjects were alive. Out of 1872 cases in 325 (17.4%) the manner of death was natural, whereas in 1547 cases (82.6%) it was unnatural. Accidents, suicides, homicides and undetermined deaths were 63.1%, 29.8%, 2.8% and 4.3% respectively. Among the natural deaths, evidence of pulmonary tuberculosis and coronary heart disease was found in 141 (43.4%) and 124 (38.2%) cases respectively. Burn injuries (22.6%) were the most common cause of unnatural deaths and occurred in 77.4% females. Rail track injuries and road traffic injuries were responsible for 21.9% and 14% of unnatural deaths. Hanging, poisoning and self-immolation were responsible for 48.4%, 28.9% and 19.7% of suicidal deaths respectively.

Dyslipidaemia in rheumatoid arthritis, is associated with accelerated atherosclerosis. A nonrandomised trial was conducted to find out the proportion of rheumatoid arthritis patients suffering from dyslipidaemia and change in lipid levels after an intervention with antirheumatic drugs in a tertiary care centre in Eastern India from April 2006 to July 2008. The trial was done on 161 diagnosed patients of rheumatoid arthritis (fulfilling the American College of Rheumatology criteria) on lipid levels. Lipids estimations were done enzymatically by semi-autoanalyser and dyslipidaemia was defined by taking the cut-off value of National Cholesterol Education Programme-Adult Treatment Panel III (NCEP-ATP III) guidelines. Patients with other comorbid illness and on statins were excluded. Disease activity score 28 (DAS-28) was also employed for evaluating disease activity. Patients were followed up to 10 -12 weeks for repeat lipid level estimation. Using the high cut-off values of NCEP-ATP III, 39.1% of the patients showed dyslipidaemia in initial visit. Low high density lipoprotein cholesterol (HDL-C) was the commonest abnormality seen in 37.2%. In the follow-up study after getting disease modifying antirheumatic drugs (methotrexate, sulfasalazine, hydroxychloroquine) therapy, 19.9% patients had dyslipidaemia again and there were increase in total cholesterol, low density lipoprotein cholesterol, HDL-C but triglyceride was reduced. Low HDL-C again became the commonest (17.9%) and rise in HDL-C level was statistically significant. DAS-28 showed a good reduction and significant negative correlation with HDL-C. Lipid abnormalities, common in Indian patients with rheumatoid arthritis, are also observed in Eastern India. Low HDL-C being the commonest abnormality. Disease activity in rheumatoid arthritis is inversely related to the lipid levels.

To find out the factors responsible for variations of adolescent blood pressure, a community-based cross-sectional study was undertaken among 1081 adolescents, aged 10-19 years, selected by simple random sampling in an urban slum of Kolkata, Chetla in 2003-04. Age, educational status, additional ghee/butter intake with diet, family history of hypertension, weight, height and body mass index were found to be associated with blood pressure in unifactorial analysis, hence these variables were considered for multifactorial analysis. All these independent variables were correlated with both systolic and diastolic blood pressure except additional ghee/butter intake with food. In stepwise multiple regression analysis, age, education, family history of hypertension, weight, height and body mass index contributed 64.6% of the total variation of systolic blood pressure, where weight alone contributed to 62.6% while 35.4% of variations remained unexplained. In case of diastolic blood pressure, 56.8% of the total variations were due to age, education, family history of hypertension, weight, height and body mass index, out of which weight alone contributed 56% while remaining 43.2% of total variations remained unexplained. Since single most important predictor of blood pressure was weight, regular aerobic physical activity, dietary modification, behavioral changes and health education are recommended for weight reduction and prevention of obesity.

A case of ascariasis of the common bile duct in the postoperative period of cholecystectomy and choledocholithotomy with T-tube drainage is reported. The living adult wandering ascaris came out through the T-tube tract immediately after removal of the T-tube. No such previous report has been found in the available literature.

A 61-year-old male presented with recurrent bouts of haematemesis and melaena for last 10 days. On examination, he was found anaemic and had jaundice and a mass felt in the right hypochondrium. He required multiple blood transfusions. Oesophagogastroduodenoscopic (OGD) evaluation demonstrated no lesion, no fresh bleeding noticed from ampulla of Vater. Ultrasonographic evaluation demonstrated a heterogeneous mass within the gall bladder lumen with a chink of free lumen between the mass and gall bladder wall and also dilated biliary tract. Laparotomy confirmed mass within the gall bladder lumen without any lymph node involvement at porta or any liver metastasis, and had dilated common bile duct. Cholecystectomy was carried out. The cut section of the gall bladder showed a polypoid mass (5.5 cm x 4 cm) projecting inside lumen having a haemorrhagic spot on irregular surface and which was attached with fundus of the gall bladder through a small stalk. Choledochotomy showed only blood clots within the duct-choledochoduodenostomy was also done. Histopathological examination showed adenomatous polyp with foci of carcinoma in-situ or ly without any evidence of local metastasis. Follow-up was uneventful till after 11 months.

An evaluation of the Pulse Polio Immunisation Programme (PPI), 1995-96 in West Bengal was undertaken. It was observed that the PPI coverage (with two rounds) was 84.1%. Variations in the PPI coverage level were documented in relation to age, sex, residential status and parental literacy status of the beneficiaries. However, significantly lower PPI coverage was observed among Muslims (p < 0.001) and Scheduled Tribes (p < 0.01). The principal agency responsible for disseminating information about PPI was identified to be the multipurpose health workers. Some of the major reasons for non-acceptance of PPI were lack of information, illness of the child, absence of the child on the "PPI day", lack of faith in immunisation and fear of adverse reaction.

A 5-year sentinel surveillance of diphtheria from 1989 to 1993 was undertaken at a rural medical college hospital. No significant change in the number of diphtheria cases was observed in spite of sustained high level of diphtheria, pertussis, tetanus vaccine-3 doses (DPT3) coverage. Most of the diphtheria cases occurred during July to November. Age distribution of diphtheria cases showed that more than 75% occurred above 2 years age (except in 1989) and around 65% cases above 3 years age. The age shift in diphtheria signified success of primary diphtheria immunisation, as well as indicated the lack of coverage with booster doses at appropriate ages. Because of high coverage with primary diphtheria immunisation there was decrease in circulating toxigenic C diphtheriae resulting in less natural boosting of antibody titre. Thus, in absence of booster immunisation, the older children and adults were more vulnerable to diphtheria. The findings of the study justified the need of emphasising importance of booster diphtheria immunisation at appropriate ages for effective control of diphtheria.

The performance of the Diarrhoeal Training cum Treatment Unit (DTTU) of NRS Medical College and Hospital, Calcutta, in a 2-year period was evaluated by record analysis. The study revealed that 73.6% cases out of a total 4349 could be successfully managed at the oral rehydration therapy (ORT) area and only 16.5% cases required indoor admission. Rest of the cases (9.9%) with "no dehydration" were sent home with advice. There were 84.7% cases out 3919 dehydration cases who could be successfully treated by ORT and only 15.3% required intravenous (i.v.) therapy. A definite decline was also evident in the proportion of diarrhoea cases requiring antibiotic therapy (13.5% in 1991 to 6.8% in 1992). The case fatality rate due to diarrhoea was 1.7% in 1992. Had all cases of diarrhoea with dehydration being admitted and treated with i.v. fluids and antibiotics, the estimated cost would have been Rs 14.2 lakhs, which with ORT, actually cost Rs 2.4 lakhs. Thus estimated total cost reduction was to the extent of Rs 11.8 lakhs in a 2-year period.

The incidence of stillbirths in "one year period" was studied by record analysis in a teaching hospital. A stillbirth rate of 38.4 per 1000 live births was observed. On admission 96.3% cases had some adverse foetal conditions detected readily. Leading factor detected was intra-uterine growth retardation (45.4%). Other major conditions observed were intra-uterine hypoxia (18.4%), malpresentation (11.9%), multiple pregnancy (8.3%). Birth weight was below 2000 g in 53.1% cases. Records showed 78.5% mothers had not received antenatal care.

Study of perinatal mortality in a Medical College Hospital revealed stillbirth rate as 38.4, early neonatal death rate as 29.3 and overall perinatal morality rate as 67.7 per 1000 live births. More than half (53.6%) of the perinatal deaths were in primipara and another 22.8% in mothers of parity more than 3. Most mothers (85.9%) did not receive adequate antenatal care services. On admission 35.1% mothers presented with some risk factors. The major risk factors identified were toxaemia of pregnancy (14.8%), severe anaemia (13%) and antepartum haemorrhage (2.6%).