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Sukumar S.,JIPMER | Das U.B.,Pondicherry Institute of Medical science PIMS
Indian Journal of Forensic Medicine and Toxicology | Year: 2015

In the examination of skeletal trauma, meticulous analysis of the skeletal remains is essential. In this paper we discuss a case where an autopsy was conducted on skeletonised remains of a body scattered in a grove. Some tell tale sign of injuries were present on the skull of the skeletonised remains, which indicated blunt and sharp force trauma sustained, but the samples taken at the site of injury sent to the forensic science laboratory for analysis turned out to be inconclusive. The focus of this paper is to highlight the fact that the fracture patterning in combination with fractured edge characteristics can be more useful for the assessment of perimortem skeletal trauma and that skeletal trauma is usually the only available source of information on cause and manner of death of skeletal remains. © 2015, Indian Journal of Forensic Medicine and Toxicology. All rights reserved.


Pal G.K.,Post Graduate Institute of Medical Education and Research | Pal P.,Post Graduate Institute of Medical Education and Research | Nanda N.,Pondicherry Institute of Medical science PIMS | Amudharaj D.,Post Graduate Institute of Medical Education and Research | Adithan C.,Post Graduate Institute of Medical Education and Research
Future Cardiology | Year: 2013

Hypertension (HTN) and prehypertension (pre-HTN) have been identified as independent risk factors for adverse cardiovascular events. Recently, increased psychosocial stress and work stress have contributed to the increased prevalence of HTN and pre-HTN, in addition to the contribution of obesity, diabetes, poor food habits and physical inactivity. Irrespective of the etiology, sympathetic overactivity has been recognized as the main pathophysiologic mechanism in the genesis of HTN and pre-HTN. Sympathovagal imbalance owing to sympathetic overactivity and vagal withdrawal is reported to be the basis of many clinical disorders. However, the role played by vagal withdrawal has been under-reported. In this review, we have analyzed the pathophysiologic involvement of sympathovagal imbalance in the development of HTN and pre-HTN, and the link of sympathovagal imbalance to cardiovascular dysfunctions. We have emphasized that adaptation to a healthier lifestyle will help improve sympathovagal homeostasis and prevent the occurrence of HTN and pre-HTN. © 2013 Future Medicine Ltd.


Pal G.K.,JIPMER | Pal P.,JIPMER | Lalitha V.,JIPMER | Amudharaj D.,JIPMER | And 3 more authors.
International Angiology | Year: 2012

Aim. Prehypertension has recently been observed as a potent cardiovascular risk factor. Though prehypertension has a strong familial predisposition, the pathophysiological mechanisms that cause its progression to prehypertension in normotensive sibling of hypertensive parents have not yet been fully elucidated. Therefore, the present study was conducted in normotensive and prehypertensive sibling by spectral analysis of heart rate variability (HRV) to understand the nature of change in sympathovagal balance (SVB) in this condition. Methods. Body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), basal heart rate (BHR), blood pressure (BP), rate pressure product (RPP) and spectral indices of HRV were assessed in three groups of subjects: Group I (normotensive offspring of normotensive parents, N.=231); Group II (normotensive offspring of hypertensive parents, N.=113); and Group III (prehypertensives offspring of hypertensive parents, N.=52). SVB was analyzed and correlated with BMI, WHR, BHR, BP and RPP in all the groups. Results. Sympathovagal imbalance (SVI) was observed to be present in both normotensive and prehypertensive sibling of hypertensive parents. In normotensive sibling, SVI was mild in the form of proportionate increase in sympathetic and decreased vagal activity. In prehypertensive sibling, SVI was prominent with more of vagal withdrawal. Though LF-HF ratio, the indicator of SVB was correlated with all parameters in groups II and III, the significance was more with diastolic pressure and WHR. Conclusion. It was concluded that vagal inhibition plays a critical role in modulation of SVB for progression into prehypertension in normotensive sibling of hypertensive parents and WHR is a prominent marker of SVI in these subjects.


Pal G.K.,Jawaharlal Institute of Postgraduate Medical Education & Research | Shyma P.,Jawaharlal Institute of Postgraduate Medical Education & Research | Habeebullah S.,Jawaharlal Institute of Postgraduate Medical Education & Research | Pal P.,Jawaharlal Institute of Postgraduate Medical Education & Research | And 3 more authors.
International Journal of Hypertension | Year: 2011

Objective. In this study, we have assessed sympathovagal imbalance (SVI) by spectral analysis of heart rate variability (HRV) that contributes to the genesis of early-onset PIH. Methods. Body mass index (BMI), basal heart rate (BHR), blood pressure (BP) and HRV indices such as LFnu, HFnu, LF-HF ratio, mean RR, SDNN and RMSSD were assessed in normal pregnant women (Control group) and pregnant women having risk factors for PIH (Study group) at all the trimesters pregnancy. Retrospectively, those who did not develop PIH (Study group I) were separated from those who developed PIH (Study group II). Study group II was subdivided into early-onset and late-onset PIH. Sympathovagal balance (LF-HF ratio) was correlated with BMI, BHR and BP. Results. LF-HF ratio was significantly high in study group II compared to study group I and control group, and in early-onset PIH group compared to the late-onset category at all the trimesters of pregnancy, which was significantly correlated with BHR and BP. Alteration in HFnu in early-onset category was more prominent than the alteration in LFnu. Conclusion. Though the SVI in PIH is contributed by both sympathetic overactivity and vagal withdrawal, especially in early-onset type, SVI is mainly due to vagal inhibition. © 2011 G. K. Pal et al.


Pal G.K.,Post Graduate Institute of Medical Education and Research | Pal P.,Post Graduate Institute of Medical Education and Research | Nanda N.,Pondicherry Institute of Medical science PIMS | Lalitha V.,Post Graduate Institute of Medical Education and Research | And 2 more authors.
International Journal of Hypertension | Year: 2011

Objective. Though prehypertension has strong familial predisposition, difference in pathophysiological mechanisms in its genesis in offspring of both parents and single parent hypertensive have not been elucidated. Methods. Body mass index (BMI), waist-hip ratio (WHR), basal heart rate (BHR), blood pressure (BP), HR and BP response to standing, deep breathing difference, BP response to handgrip and spectral indices of heart rate variability (HRV) were analyzed in normotensive offspring of two parents hypertensive (Group I), normotensive offspring of one parent hypertensive (Group II), prehypertensive offspring of two parents hypertensive (Group III) and prehypertensive offspring of one parent hypertensive (Group IV). Results. Sympathovagal imbalance (SVI) in prehypertensive offspring was observed due to increased sympathetic and decreased vagal activity. In group III, SVI was more prominent with greater contribution by vagal withdrawal. LF-HF ratio, the marker of SVI was correlated more with diastolic pressure, 30: 15 ratio and E: I ratio in prehypertensives and the degree of correlation was more in group III prehypertensives. Conclusion. Vagal withdrawal plays a critical role in development of SVI in prehypertensive offspring of hypertensive parents. The intensity of SVI was more in offspring of two parents hypertensive compared to single parent hypertensive. © 2011 G. K. Pal et al.

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