Covering letter

Mahatma Gandhi Medical College & Hospital, Jaipur

To,
The Member Secretary, IEC
Mahatma Gandhi Medical College & Hospital, Jaipur.
Subject:- Submission of thesis plan
Respected Sir,
I, Dr Mahendra kumar Bajiya, registered for the M.D. (Forensic Medicine) 2023
session, hereby submit my thesis plan titled“AN AUTOPSY BASED STUDY ON
PATTERN AND PROFILE OF NECK INJURY IN SUICIDAL HANGING”
AtMAHATMA GANDHI COLLEGE & HOSPITALS, JAIPUR" to be done under the
guidance of Dr. B.M.GUPTA , Sr.Professor, Department of Forensic Medicine &
Toxicology, Mahatma Gandhi Medical College and Hospital.

Dr. MAHENDRA KUMAR BAJIYA Dr. B.M.GUPTA

(PG Student ) (Sr.Professor&Head of Department)

IEC FORMAT -A

I. TITLE OF PROPOSAL
“AN AUTOPSY BASED STUDY ON PATTERN AND PROFILE OF NECK
INJURY IN SUICIDAL HANGING”
II. DETAILS OF INVESTIGATOR/PG STUDENT
NAME AND ADDRESS OF THE CANDIDATE:
Dr. MAHENDRA KUMAR BAJIYA
POSTGRADUATE STUDENT (M.D.)
MAHATMA GANDHI MEDICAL COLLEGE AND HOSPITAL(MGMCH),
SITAPURA, JAIPUR
PHONE NO. –09639966700
EMAIL ID – mbssan88@gmail.com
NAME AND DESIGNATION OF GUIDE:
Dr. B.M.GUPTA
SR.PROFESSOR
DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY
MAHATMA GANDHI MEDICAL COLLEGE AND HOSPITAL (MGMCH),
SITAPURA, JAIPUR
PHONE NO. – 09413333714
EMAIL ID --drbmgupta@gmail.com
III. BRIEF DESCRIPTION OF THE STUDY
1. INTRODUCTION
The high incidences of suicidal hanging among young adults impose an
enormous socio-economic burden on the society and are very sparingly
reported from rural parts of India.Hanging is a form of mechanical asphyxia
caused by suspension of the body by ligature which encircles the neck, the
constricting force being the weight of the body1.
Depending on method adopted for hanging, body is either completely
suspended without any part touching the ground as in Complete hanging or
as in Partial hanging, some part of the body touches ground. A slight force
produced by Weight of the head [5-6 kg] acts as a constricting force and
can kill a person2.
In India, killing a victim and suspending the body from a tree or a rafter to
avert suspicion is very common practice, such postmortem hangings
simulate suicidal hanging and it is necessary to find out if hanging is the
cause of death in a suspended body . Thorough external and internal
examination helps in arriving at an opinion on the cause of death and to
forward the same to Investigating officer3.
The forensic pathologist has to distinguish between hanging and other forms
of strangulation and between suicidal, homicidal and accidental hangings. A
study on common methods of suicide, risk factors, sociodemographic
factors,cultural aspects and other established etiologies in an area serve as
road map not only for a forensic expert but also for local governing bodies to
take appropriate control measures. This study is meant to conclude the
The rate of suicide per one lakh population has increased to
above prospective4
12.4 in 2022 which is the highest rate of deaths from suicides since 1967, which
is the earliest recorded year for this data. Suicides during 2022 increased by 27%
in comparison to 2018 with India reporting highest number of suicides in the
world.
 2. Brief Review of Literature:-
Kandade PS, Zanjad NP et al. (2023)1 During the study period
3780medico-legal autopsies were performed, of which total 368 cases
(9.73%) of death due to hanging were observed. Among 368 cases of
death due to hanging, 366 (99.45%) were suicidal in nature while 02
cases (0.55%) were accidental in nature. Male outnumbered female
with male: female ratio 3.46:1. The maximum number of cases
(60.92%) was observed in age group of 21 to 40 years. The soft
material was used in 190 cases (51.91%) while hard material was used
in 176 cases (48.08%). The ligature material most commonly used for
committing hanging was rope (46.17%) followed by saree (28.96%)
and dupatta (17.75%). Most of victims 342 (93.44%) committed
suicide by hanging in closed space like home and common close
places
. Vishwakarm KumarAshish , Thakur P.S et al. (2021)2 cases of death due to
hanging in mortuary of Department of Forensic Medicine & Toxicology, Mahatma
Gandhi memorial Medical College and M.Y. Hospital, Indore, (M.P.) between
February 2019 and January 2020. In our study, 172 cases (134 males & 38 females) of
death due to hanging brought for medico legal post mortem examination were taken.
The most common age for hanging is found to be between 21-30 years in 36.63%
cases. Hindus constituted 93.02% of total study population. 57.56% were married and
42.44% cases were unmarried. Hanging deaths occurring in urban areas (83.14%)
outnumbered that of rural area (16.86%). 45.35% cases had completed their secondary
education. 61.04% incidences happened in nuclear families. Students (30.81% cases)
and self employed persons (30.81% cases) constituted more than half of total cases.
Majority of victims (72.09% cases) in this study belonged to the middle class
socio-economic group, with 19.77% brought in on Wednesday followed by Sunday in
16.86% cases. In our study, majority of victims were found at night time (in 36.63%
cases) followed by early morning (in 25.0% cases). 95.93% cases were found hanging
at indoor locations. Tiwari
3
Pramod , Sharma Deepak et al. (2019) . The study included 372 (11.5%) cases
of suicidal asphyxiation in Kota city. Hanging and drowning were reported as common
methods to commit suicides. The most commonly affected age group was 21years to30
years, which contributed to about 35.4% of total suicidal asphyxial deaths. Males were
more commonly involved (79%). Educational stress was the main reason to commit
suicide, and included 107 cases contributing to 29% of the total asphyxial suicidal
deaths.
Shankar B S Udaya , P L Sujatha,et al. (2018)4.The study of “Profile of suicides
amongst autopsies” was carried out at a tertiary care centre over a period of 36 months
with aims to identify methods and reasons of suicides and to correlate them with age and
sex. A total of 357 cases fulfilled the criteria. The most vulnerable age group was 21-30
years (30.4 %); males (64 %) outnumbered females; 275 cases (77 %) were due to
hanging and 73 (20 %) due to poisoning, 6 (2 %) and 3 (1 %) due to burns and drowning,
respectively. More victims died in morning hours (29%), followed by night (27%). 47
cases (13%) had consumed alcohol, more prevalent in 31-40 year age group (21 cases).
Hesitation cuts were seen in 11 cases (3%) and previous attempts of suicide in 7 cases
(2%) were more prevalent in 21-30 year age group .
Thus this study emphasizes that psychological autopsy is the gold standard in reconstructing
proximate and distal causes of an individual's death by suicide

Nayak Ranjan Soumya, Naik KumarSubal, et al. (2017)5,A retrospective study

was conducted by the authors on a total 134 cases of deaths due to hanging during 2009 –
2014 at S.C.B Medical College, Cuttack. In this study, the number of female victims 70 (52.2%)
were more or less equal to males, 64 (47.8%); 74.3% females, in comparison to 59.4% males,
were in the age group 21 - 40 years. 71.4% female victims were married. The present study
also showed that ligature mark was detected on the neck between thyroid cartilage and chin in
80% cases and at the level of thyroid cartilage in 20% cases. Saliva dribbling mark was seen
in 16.4% cases while 24.6% victims were of typical hanging, by nature. Cloth based ligature
materials were seen in 64.3% cases and rope based materials in 35.7% cases.

Jugtawat Jagdish, Vyas.P.C et al. (2016)6.A total 356 cases of death due
to hanging, involving both males and females, were identified and studied during
medicolegal autopsy at the Department of Forensic Medicine and Toxicology, DR
SN Medical College, Jodhpur. Male preponderance was observed with a majority
being in middle age group (72%). In females, the most commonly affected were the
adolescents and the young (77%). Atypical hanging with right sided knot
dominated the picture. The rope (hard material) was the most common ligature
material used by males whereas females preferred dupatta (soft material). Closed
places were preferred to open areas. Most of these deaths were reported among
Hindus, followed by Muslims. Majority were married (males,72.7%;
females,59.1%). Most of the male victims were either involved in private jobs or
worked as labourers; while the females were either housewives or students.
3. Aims and Objectives:-
AIM: “ PATTERN AND PROFILE OF NECK INJURY IN SUICIDAL HANGING”
OBJECTIVES:
1. To study of socio-demographic profile and pattern In Suicidal hanging.
2. To study the prevalence of Suicidal hanging fatalities.
3. To identify the reasons of suicidal hanging and to correlate them with age and sex .
RATIONALE OF STUDY
This study examines the pattern of fatal Neck injuries in Suicidal Hanging. The
study will aid in medico-legal inquiry and serve as a valuable resource for preventing and
managing Neck injury.
Detailed description of Methodology:The present prospective study will carried out at the
Department of Forensic Medicine and Toxicology,from March, 2024toSeptember 2025. A total
of 112 cases of deaths due to hanging will be studied autopsies conducted during period .
The details about the victims regarding the age, sex, circumstances of death, type of ligature
material, manner and supposed cause of death will be obtained from inquest papers and police
documents; history given by the relatives and crime scene photographs.The ligature mark will be
meticulously examined.Neck will be opened in the "V" shaped incision from the mastoid process
and carrying it along the lateral aspect of the neck up to the manubrium and then reflecting the
flap of the neck skin. Internal findings of the neck will be describe by layer by layer dissection of
the neck. Meticulous Examination of ligature material,whenever available,will be done.

MATERIALS & METHOD

This study will be initiated after approval by the Institutional Ethics
Committee at Mahatma Gandhi Medical College, Jaipur.
 Type of study:-An prospective cross-section study
Period of study:-18 Months
Place of study:-Mahatma Gandhi Medical College & Hospital, Jaipur
Sample size:-112
Subject selection:-Based on inclusion and exclusion criteria
Inclusion criteria:-
1.All cases with history of suicidal Hanging brought for autopsy.
2.Cases of suicidal Hanging with Neck injury associated with other fatal
injuries
Exclusion criteria:-
1.Cases where bodies were in advanced state of decomposition.
2.Cases of Hanging which, on investigations, do not prove to be due to suicide
Hanging .
STATISTICAL ANALYSIS
1. OUTCOME MEASURES
Data will be recorded on a predesigned proforma managed in a Microsoft Excele spreadsheet.
Data will be analysed by frequency, percentage, mean, and standard deviation (S.D.).
Appropriate statistical tests will be applied.
2. STATISTICAL ANALYSIS
The values obtained will be entered into an Excel sheet, and then appropriate
statistical tests will be applied to obtain outcomes using SPSS software
2024 .
STATEMENT OF CONFLICT OF INTEREST
The study will be conducted per the approval of the Institutional Ethical Committee.
Proper following of the guidelines will be ensured. No conflicts will be involved.
DECLARATION
I declare that relevant intervention will be supervised by the authorised competent faculty
working in Mahatma Gandhi Medical College & Hospital, Jaipur. Any research-related injury or harm
will be managed in the hospital.
CHECKLIST FOR ATTACHED DOCUMENTS
1. Cover letter to Member Secretary, IEC, MGMCH, Jaipur.
2. Format A - for submission of study proposal to IEC.
3. Format B - participant information sheet.
4. Format C - informed consent form (in English)
SIGNATURE OF PG GUIDE/INVESTIGATOR & DATE:
Name of PG Guide: Dr. B.M.GUPTA
SR.PROFESSOR
DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY
MAHATMA GANDHI MEDICAL COLLEGE AND HOSPITAL (MGMCH),
SITAPURA, JAIPUR
SIGNATURE OF THE CANDIDATE/INVESTIGATOR & DATE:
Name of PG Student: Dr.MAHENDRA KUMAR BAJIYA
POSTGRADUATE STUDENT (M.D.)
DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY
MAHATMA GANDHI MEDICAL COLLEGE AND HOSPITAL(MGMCH),
SITAPURA, JAIPUR
REFERENCES
1.Kandade PS, Zanjad NP; On The Pattern of Suicidal Deaths by Hanging at Tertiary Health Care
Centre During COVID Pandemic J Indian Acad Forensic Med. 2023 April-June; 45 (2): 164-166

2. Vishwakarm KumarAshish , Thakur P.S ;An Autopsy Based Study about Epidemiological Profile
of Deaths Due To Hanging in Central India Region, Madhya Pradesh J Indian Acad Forensic Med. 2021
Oct-Dec; 43(4): 349-353 d

3. Tiwari Pramod , Sharma Deepak; Analysis of suicidal asphyxial deaths in Kota, the coaching city of
India J Indian Acad Forensic Med. 2019 Oct-Dec; 41(4): 243-244

4.Shankar B S Udaya , P L Sujatha;Profile of Suicides amongst Autopsies at a Tertiary

Care Centre in Bangalore North J Indian Acad Forensic Med. Jan.- March 2018, Vol. 40, No. 1:
38-45

.
5 Nayak Ranjan Soumya, Naik KumarSubal ;Analysis of Profile of Hanging Deaths
in Coastal Odisha J Indian Acad Forensic Med. January - March 2017, Vol. 39, No. 1 :16-19
6.Jugtawat Jagdish, Vyas.P.C ;Study of Epidemiological Profile of Hanging in Jodhpur
Region of Rajasthan: An Autopsy Based Study ,J Indian Acad Forensic Med. July - September
2016, Vol. 38, No. 3 ;306-308

7. Guntheti Kumar Bharath , KhajaSheik , Singh Pal Uday ;Profile and Pattern of Hanging Cases
at a Tertiary Care Hospital, Khammam; Telangana, J Indian Acad Forensic Med. January- March
2016, Vol. 38, No. 1 ;P 67-71
8. Marak K.Fremingston, Balaraman R. ;Delayed death in hanging J Indian Acad Forensic Med,
30(3);P149-150

.
9 Khaja Shaikh ; Fractured hyoid bone with separated fragment and type of fracture ;J Indian Acad
Forensic Med, 31 (1) P45-46

.
10 Kanchan Tanuj ; Day, week and month of suicide by hanging ;J Indian Acad Forensic Med,
30(4) ;P202-206

PRO FORMA
Case No.: Date: Name:
Son/Daughter/Wife of:

Age: Sex:

Address:

1. Rural 2. Urban
Religion
1. Hindu 2. Muslim 3. Christian
4. Sikh 5. Other
Marital status
1. Married 2. Unmarried
3. Widowed 4. Separated
Education: Occupation:
Hospitalised / Brought dead:

If hospitalised
1. UHID No.: 2. PD/OPD No.: 3. OPD Date:
Duration between Accident & Hospitalisation:
Brief History / Incidence Description
Date: Time: Place:
Type of Hanging:

1. Complete 2. partial Ligature mark : present /absent

Ligature mark type Ligature mark dimensions

Ligature Material :1.wire 2.Nylon rope 3.Odhni 4.jute. 5.other

Muscle ecchymoses: Hyoid bone fracture:

Laryngeal and tracheal cartilage injury: Thyroid bone fracture:

Cervical vertebrae fractures

knot position petechial hemorrhage

Format B
GUIDELINES FOR PARTICIPANT INFORMATION SHEET AND CONSENT
FORM SUBMITTED TO IEC

1) Title of study:“AN AUTOPSY BASED STUDY ON PATTERN AND PROFILE OF NECK INJURY IN SUICIDAL HANGING”

2) Purpose of the study:- To study of socio-demographic profile and pattern In Suicidal hanging. And to study
the prevalence of Suicidal hanging fatalities.
3) What kind of study products/procedures/tests/examinations to be conducted on

subjects under study:- A pre designed and pre tested questionnaire all cases with history of suicidal Hanging
brought for autopsy.Cases of suicidal Hanging with Neck injury associated with other fatal injuries

4) What is the approximate number of participants involved: The study will be carried
Out based on the inclusion and exclusion criteria 112 cases were considered for
the study.

5) What will happen if patient decide to take part in study mention as per thesis
study
Risk and discomforts –No
Benefits – Better management of public health indicators.
Is there compensation for participation -No
What is the compensation for study related injury –NA
6) Alternatives to participation- list alternative treatments if patient do not have to
participate in study –NA
7) Confidentiality of records- The information in the study records will be kept
confidential. Data will be stored securely and will be made available only to the persons conducting the
study and to the regulatory authorities.
8) Participation- The participation in this study is voluntary. The participant may decline to participate at
any time without penalty and without loss of benefits.
Results of study will be used for publication and will be presented in conference related to scientific
research.
9) Contact information- Please contact if there is any question or problem for research related
matters and in case of new events of research related injury.

Dr. Mahendra kumar Bajiya

Mobile no 9636966700
Email id mbssan88@gmail.com
 Format C
Informed Consent Form (English)
Study Title :-“AN AUTOPSY BASED STUDY ON PATTERN AND PROFILE OF NECK INJURY IN
SUICIDAL HANGING”
I. Subject’s Name : .........................................................................
Date of Birth/ Age (Years): ............................... Sex: .....................
Please √ the
box given here
(1) I confirm that I have been explained the purpose and the methodology of the
study and I have cleared every doubt about the study. []
(2) I understand that my participation in the study is voluntary and that I am free to
withdraw at any time, without giving any reason, without my medical care or legal []
rights being affected
(3) I have been informed that this study is purely a research study and participation in
the above study would not be of any direct benefit or risk to me and results of this
study may be of help in future for the society.
[]
(4) I understand that the investigator of this study and others working on the
investigator’s behalf, the Institutional Ethics Committee will not need my
permission to look at my health records both in respect to current study and any
future research study that may be conducted in relation to it.
[]
(5) I understand that my identity will not be revealed in any information released to
third parties or Published.
[]
(6) I agree not to restrict the use of any data or result that arises from this study []
provided such a use is only for scientific purpose(s).
(7) I agree to take part in the above study []
Name of the subject: ................................................................................
Signature of the subject: ..................................... Date: ....../......./.........
Name of the Investigator: ........................................................................
Signature of the Investigator: .............................. Date: ....../....../..........
Name of the witness: ...............................................................................
Signature of the witness: ....................................... Date: ....../....../.......