Download rajiv gandhi university of health sciences, karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
2.
3.
4.
Name of the candidate and address
Name of the institution
Course of study and subject
Date of admission of the course
Dr. VEDANT KULSHRESTHA
POST GRADUATE STUDENT
DEPT OF FORENSIC MEDICINE
BANGALORE MEDICAL COLLEGE &
RESEARCH INSTITUTE,
BANGALORE
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE,
BANGALORE
MD FORENSIC MEDICINE
30/08/2013
5.
Title: “STUDY OF CARDIAC PATHOLOGY IN YOUNG ADULTS- AN
AUTOPSY BASED PROSPECTIVE STUDY”.
6. Brief resume of the intended work
6.1 Need for the study:
Cardiovascular disease is now the most common cause of death worldwide.1 The causes of
sudden cardiac death differ greatly among various age groups. In individuals > 40 years old,
atherosclerotic coronary heart disease is the most common cause. Between 1 to 40 years of
age, the causes of sudden cardiac death are commonly hypertrophic cardiomyopathy,
myocarditis, congenital heart disease, arrhythmogenic right ventricular dysplasia/
cardiomyopathy etc.2
The sudden death in apparently healthy young individuals is always a devastating and
shocking event. The incidence of sudden deaths in young due to various cardiac pathologies
has wide variations in different parts of the world. Very few studies are done in India to know
the incidence of various cardiac pathologies in young adults.
Now because of change in lifestyle and habits, many cardiac pathologies are noticed in
comparatively younger age group even in a developing country like India and some of these
cardiac pathologies are inheritable.
We have noticed that many cardiac pathologies are occurring in young IT professionals
because of their sedentary lifestyles, smoking and drinking (alcohol) habits.
Hence we, at the department of Forensic Medicine, Bangalore Medical College & Research
Institute, are doing an autopsy based prospective study in young adults dying due to various
reasons, to know the incidence of various cardiac pathologies in young adults and various
factors responsible for it so that we can counsel the close family members of the deceased to
go through essential investigations and take preventive measures. In this way we can protect
the close family members from fatal inheritable cardiac pathologies.
6.2 Review of literature:
Coronary atherosclerosis is sometimes called ‘the Captain of the Men of Death’. This is
certainly the most frequent cause of sudden death in Western societies. Cardiomyopathies
account for the second largest number of sudden deaths after coronary artery disease. Among
them Dilated cardiomyopathy ( DCM ) is the most common cause of congestive heart
failure.3
According to a report on medical certification of cause of death 2011 by Government of
Karnataka, a total of 123221 medically certified deaths were reported in Karnataka state of
India in the year 2011. Among them 26987 were young adults of age group 15-44 years, died
due to various reasons. Out of them 16773 were male and 10214 were female. It was also
seen that total 4499 (12.18%) deaths were due to diseases of circulatory system in age group
15-44 years. Out of them 3081 were male and 1418 were female. Among various cardiac
diseases 1127 males and 339 females died due to Ischemic heart diseases, 245 males and 313
females died due to chronic Rheumatic heart disease, 18 males and 10 females died due to
Hypertensive heart diseases and 476 males and 219 females died due to other forms of heart
diseases.4
In a study done by Chugh et al in US, they analysed 13 years (1984-1996) of autopsy series
of sudden cardiac death and found that women aged 35 to 44 years constituted 32% of all
women in the series in contrast to men, who constituted 24% of total male cases. There was a
higher proportion of significant coronary artery disease in men compared to women. Most
patients had evidence of ≥ 1 nonspecific structural cardiac abnormalities like mitral valve
prolapsed, left ventricular hypertrophy and non-specific myocardial interstitial fibrosis.5
In a study done by Ogeng’o et al in Nairobi from December 2005 to November 2009, they
found that cardiovascular causes comprised 13.2% of all autopsy cases. Among various
cardiac pathologies most common was myocardial infarction (18.7%) and next common was
cardiomyopathy (17.2%).6
Sarita Nibhoria et al did a study in Faridkot, Punjab between 2009 and 2011. A wide
spectrum of heart diseases were diagnosed during the study which revealed maximum cases
of cardiomegaly (16%) followed by myocardial infarction (14%), mural thrombus (06%),
fibrosis (06%), and a rare diagnosis of neutrophilic myocarditis.7
Alessandra Doolan et al did a study in Australia between 1994 and 2002 to know the cause of
sudden cardiac deaths in young Australians aged ≤ 35 years. The cause of sudden death in
this age group was not established in 31% of cases and was presumed to be due to primary
arrhythmogenic disorders. Coronary artery disease occurred in 24%, hypertrophic
cardiomyopathy/ unexplained left ventricular hypertrophy in 15%, and myocarditis in 12%.8
6.3 Objectives of the study:
1. To know the incidence of various cardiac pathologies in young adults dying due to
various reasons.
2. To know the epidemiological aspects of cardiac pathology.
3. To know the factors responsible for the cardiac pathology.
4. Counseling the close family members of the deceased about requirement of essential
investigations and preventive measures in case of inheritable cardiac pathology in the
deceased.
7. Materials and methods:
7.1 Study design:
Prospective study.
7.2 Study area:
Department of Forensic Medicine, Victoria Hospital, Bangalore Medical College and
Research Institute (BMC & RI), Bangalore.
7.3 Source of data:
1. Young adults aged between 18 to 40 years dying due to various reasons, subjected for
Medico legal autopsy at department of forensic medicine, Victoria hospital, Bangalore
Medical College & Research Institute, Bangalore.
2. History obtained from close relatives of the deceased through questionnaire.
3. Gross examination reports of the autopsied hearts at department of forensic medicine,
Victoria hospital, Bangalore Medical College & Research Institute, Bangalore.
4. Histopathological examination reports of the autopsied hearts sent to department of
pathology, Victoria hospital, Bangalore Medical College & Research Institute,
Bangalore.
7.4 Inclusion criteria:
1. Young adults aged between 18 to 40 years dying due to various reasons like road
traffic accidents, poisoning, burns, hanging, sudden natural deaths, assaults etc.
2. Both sexes (Male and Female) and Transgenders.
7.5 Exclusion criteria:
1. Individuals aged less than 18 years and more than 40 years.
2. Decomposed bodies.
3. Extensively mutilated bodies.
4. Cases in which there is mechanical injury to the heart.
5. Unknown bodies.
7.6 Study period:
November 2013 to May 2015.
7.7 Study sample size:
200 Cases.
About 4000 medico legal autopsies are conducted every year in Victoria hospital, Bangalore
Medical College & Research Institute. Last year in 2012 total 3876 autopsies were
conducted, among them about 2245 cases were young adults between 18 to 40 years age
group died due to various reasons.
7.8 Sampling method:
Simple random sampling.
7.9 Methodology for data collection:
In each case history will be taken from close relatives of the deceased about occupation,
significant past medical illness, personal history including lifestyle and habits of the deceased
through a questionnaire. Then thorough post mortem examination will be conducted. After
removing the heart, each heart will be grossed adopting the traditional method of opening the
heart in the direction of flow. The parameters which will be recorded are weight of heart, left
ventricular wall thickness, right ventricular wall thickness, inter ventricular septum thickness,
condition of valves, condition of main vessels including right & left coronaries, aorta &
pulmonary trunk, assessment of chamber size and assessment of papillary muscles &
chordiae tendinae. The patency of the four major epicardial coronary trunks will be analyzed
by taking transverse sections at 3-mm intervals. Representative sections will be taken for
histopathological examination after fixing in 10% Formalin solution. Then after subjecting
the tissue sections to routine tissue processing, staining with haematoxylin & eosin will be
done. Finally, the gross findings and the histopathological findings will be correlated.
After the analysis, in case of any inheritable cardiac pathology, counselling of close family
members of the deceased about requirement of essential investigations and preventive
measures will be done to prevent sudden cardiac death in family members due to inheritable
cardiac diseases in future.
7.10 Methodology for data analysis:
Data will be analyzed using descriptive statistics and chi-square test. Suitable statistical
software will be utilized for analysis and will be presented in the form of tables, figures,
graphs, diagrams wherever necessary.
7.11 Does the study require any investigation or intervention to be conducted on
patients or other humans or animals? If so please describe briefly.
Yes. Human cadaver is subjected to post mortem examination and heart is studied in detail.
7.12 Has ethical clearance has been obtained from your institution in case of 7.11?
Yes.
8. List of references:
1. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's
principles of internal medicine.18th ed. USA; Mc Graw-Hill Companies Inc: 2012. vol
2 p.1811.
2. Zheng ZJ, Croft JB, Giles WH, Mensah A. Out-of-hospital cardiac deaths in
adolescents and young adults in the United States, 1989 to 1998. Am J Prev Med
2005;29(5 suppl 1):36-41.
3. Saukko P, Knight B. Knight’s forensic pathology. 3rd ed. UK: Hodder Arnold
(publishers)Ltd; 2004. p. 493,507.
4. Report on medical certification of cause of death 2011. Government of Karnataka.
Office of the chief registrar of births & deaths and directorate of economics &
statistics, Bangalore; 2013. p.13,21,100-102.
5. Chugh SS, Chung K, Zheng ZJ, John B, Titus JL. Cardiac pathologic findings reveal a
high rate of sudden cardiac death of undetermined etiology in younger women. Am
Heart J 2003 Oct ;146(4):635-639.
6. Ogeng’o JA, Gatonga P, Olabu BO. Cardiovascular causes of death in an east African
country: an autopsy study. Cardiol J. 2011;18(1):67-72.
7. Nibhoria S, Jhajj KK, Nibhoria VK, Sandhu SK, Bamra NS, Padda P. A case studyRole of heart autopsy in evaluating the cause of death. Indian J FMT 2013 Jan-Jun
;7(1):72-75.
8. Doolan A, Semsarian C, Langlois N. Causes of sudden cardiac death in young
Australians. Med J Aust 2004;180(3):110-112.
9.
Signature of the candidate
This study has not been conducted in the recent past
hence the outcome will be useful to the doctors and
10.
Remarks of the Guide
11.1
Name and designation of
Guide
11.2
11.3
patients.
Dr. P.K. Devadass
Professor and Head
Department of Forensic Medicine
Bangalore Medical College and Research
Institute, Bangalore.
Signature
Name and designation of
Co-Guide
11.4
Signature
11.5
Head of the Department
Dr. Dayananda. S. Biligi
Professor
Department of Pathology
Bangalore Medical College and
Research Institute, Bangalore.
Dr. P.K. Devadass
Professor and Head
Department of Forensic Medicine
Bangalore Medical College and Research
Institute, Bangalore.
11.6
Signature
Remarks of the,
12.1
Director cum Dean
12.2
Signature