BackgroundRoad traffic accident (RTA) fatalities account for a significant number of unnatural deaths in Pakistan. Hence, it is necessary to investigate RTA fatalities in order to implement measures to reduce them. In the present study, we aimed to assess the detailed epidemiological characteristics of RTA fatalities by analyzing the data obtained from medico-legal autopsies performed at the Jinnah Postgraduate Medical Centre (JPMC) in 2019 and 2020. We assessed age-and gender-based variations in the pattern of RTA fatalities and determined the anatomical cause of death and sites of fractures among the fatalities. Moreover, we assessed the monthly distribution of cases in 2019 and 2020 to determine the impact of the coronavirus disease 2019 (COVID-19) on the number of RTA fatalities reported each month. MethodologyIn this retrospective study, data obtained from medico-legal autopsies of all RTA victims in 2019 and 2020 (n = 246) were collected from the Forensic Department of JPMC, Karachi. The data were then entered into Statistical Package for the Social Sciences version 24.0 (IBM Corp., Armonk, NY, USA) for analysis. ResultsThe highest number of fatalities was recorded in the age group of 18-40 years (54.5%), while the lowest number was recorded in the age group of ≥60 years (8.5%). The male:female autopsy ratio was 6.03:1. Most fatalities were recorded from 6:00 am to 11:59 am (41.9%), followed by 12:00 pm to 5:59 pm (37.4%). Moreover, most victims (76.8%) died instantaneously within seconds to minutes of the incident. The number of RTA fatalities reported in 2019 (50.4%) was similar to that reported in 2020 (49.6%). However, the number of RTA fatalities reported in March-July 2020 was 35.6% lower than that reported in the same period in 2019, possibly because of the restrictions (such as lockdowns) that were imposed to control the spread of the COVID-19 pandemic in 2020. There was a statistically significant difference in the number of RTA fatalities reported in March-July 2020 and that reported in the remaining months of 2019 and 2020 (p = 0.006).The cause of death was head injury in 159 (64.6%) cases and multiple traumatic injuries in 65 (26.4%) cases. Injury to the chest, abdomen, and pelvis caused death in 11 (4.5%), nine (3.7%), and two (0.8%) cases, respectively. Assessment of the site of fractures revealed skull fractures to be the most common type of fractures (53%), followed by rib/sternal fractures (19%). Upper limb and lower limb fractures occurred in 10% and 9% of the cases, respectively, while pelvic and neck fractures occurred in 6% and 3% of the cases, respectively. ConclusionsEfforts need to be made at both government and individual levels to reduce RTA fatalities. Strict implementation of traffic laws is necessary. Although we noted a male preponderance, the reluctance to get females autopsied should not be disregarded. The significant decrease in RTA fatalities during March-July 2020 could be attributed to the reduced traffic burden due to the restrictions imposed to control the COVID-19 pan...

An autopsy is performed in the occurrence of an out-of-the-ordinary manner of death where the cause of death is unclear. Through a detailed medicolegal investigation, it differentiates homicide from suicides or accidents. However, some people do not acknowledge its importance due to the conflict between science and religion. This is especially true for countries with a lack of education and awareness. The family of the deceased may be unmindful of medicolegal matters and hesitate to allow for an autopsy. In the instance that burial takes place before an autopsy was performed, the medicolegal officer requests for an exhumation. It is the act of digging up a body from its grave to be examined in more detail. Such was the case in our study. A dead body was retrieved from a water channel in the Sindh province, assumed to have accidentally drowned. The family held the funeral before an autopsy was performed. Later, suspicions arose surrounding the death, so the body was exhumed. The soft tissues were decomposed and unidentifiable. The examination suggested strangulation owing to the pivotal discovery of a fractured hyoid bone at the tip of the greater horn of the right cornu. Chemical tests came out negative for intoxication. Therefore, the cause of death was concluded to be asphyxia due to throttling, secondary to hyoid bone fracture. Currently, technology was developed to introduce advanced tests in forensic sciences to differentiate multiple causes of drowning. However, the dissatisfactory budget limits forensic experts in their work. There is little use in testing for diatoms to rule out drowning, as it has been proved to show discrepancies sometimes leading to a false-positive result. Hence, alternative methods need to be explored for a more efficient approach to find the cause of death.

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Madam, allogeneic hematopoietic stem cell transplant (HSCT) remains a life altering cure to exceptionally challenging diseases ranging from hematologic malignancies to primary immunodeficiencies and blood cancers. One of its adversities includes graft versus host disease (GVHD), a lethal immunologically mediated condition wherein the donor's T-cells attack the host's tissues. The presentation can be classified as acute or chronic. Acute GVHD is divided into four grades. Despite current prophylaxis, including a combination of calcineurin inhibitor with either methotrexate or sirolimus, the incidence of grade-II or higher GVHD is between 30% to 80%, with grade-IV GVHD approaching mortality rates up to 90%.1 A recent phase II trial by Farag et al. addresses the issue by introducing a novel combination of sitagliptin – a specific DPP-4 inhibitor used to manage type 2 diabetes in adults – along with tacrolimus and sirolimus for prevention of GVHD.2 Using the new blend, an overall marked reduction in the risks of grade-II to IV (5%) and grade-III to IV (3%) acute GVHD was shown, compared to previous studies using only sirolimus and tacrolimus.3 Moreover, no adverse effects were associated with the drug during the period of study. Advancements in the field of HSCTs are particularly crucial in developing countries such as Pakistan. The high prevalence of consanguineous marriages and insufficient genetic counselling make the country especially vulnerable to diseases like thalassemia, bone marrow failure syndromes and immunodeficiency states. Up to 9000 children require transplantation each year due to the high prevalence of beta- thalassemia major.4 The situation is further complicated by limited resources and few stem cell transplant centres, which are limited to major cities. Although HSCT efficiently treats numerous life-threatening conditions, only 719 patients underwent HSCT till mid-2017 cumulatively in Pakistan.4 In accordance with the aforementioned factors, the number of transplants performed heavily outnumbers their demand, making it essential to tackle a complication as deadly as acute GVHD. In a 2005 study conducted in Rawalpindi by Hashmi et al., the overall incidence of acute GVHD grade-II to IV after standard immunosuppressive therapy was 44.2%.5 While the results were comparable to other studies, the high f morbidity and mortality rates necessitates alternate treatment courses. Sitagliptin, a locally manufactured, cost-effective drug, will be an appropriate choice of medication in Pakistan where average income amounts to a meagre US$1000 per year.4 However, randomized trials are needed to further investigate its role in the prevention of acute GVHD. Continue....