The Problem of Acid Violence in Bangladesh

Evaluation of emergency skin decontamination protocols in response to an acid attack (vitreolage)

The incidence of "acid attacks" (vitreolage) is a global concern, with those affected often receiving lifelong medical care due to physical and psychological damage. The purpose of this study was to evaluate the effectiveness of several emergency skin decontamination approaches against concentrated (>99 %) sulphuric acid and to identify the effective window of opportunity for decontamination. The effects of four decontamination methods (dry, wet, combined dry & wet and cotton cloth) were assessed using an in vitro diffusion cell system containing dermatomed porcine skin. Sulphuric acid (H2SO4) was applied to the skin with decontamination protocols performed at 10 s, 30 s, 8 min, and 30 min post exposure. Skin damage was quantified by tritiated water (3H2O) penetration, receptor fluid pH and photometric stereo imaging (PSI), with quantification of residual sulphur (by SEM-EDS) to determine overall decontamination efficiency. Skin translucency (quantified by PSI) demonstrated a time-dependent loss of dermal tissue integrity from 10 s. Quantification of dermal sulphur content confirmed the rapid (exponential) decrease in decontamination efficiency with time. The pH of the water effluent indicated complete neutralisation of acid from the skin surface after 90 s of irrigation. Wet decontamination (either alone or immediately following dry decontamination) was the most effective intervention evaluated, although no decontamination technique was statistically effective after 30 s exposure to the acid. These data demonstrate the time-critical consequences of dermal exposure to concentrated sulphuric acid: we find no practical window of opportunity for acid decontamination, as physical damage is virtually instantaneous.

Spectrum of vitriolage in India: A retrospective data record-based study

Introduction

Vitriolage or acid attack or acid throwing is a gender-based terrible violent crime. There are many everlasting sequels of vitriolage which consist of permanent scarring of the face or body, blindness as well as socioeconomic and psychological intricacy. The sufferer of acid attack is competitor, hatred, enmity or jealousy. Vitriolage are most common in the Asian countries especially in south east Asian region followed by Europe and South America. Bangladesh, India, Pakistan, Colombia and Cambodia are the countries having the highest incidence of acid attacks. There is a sharp rise in vitriolage cases in India in the last few years as indicated by data from the National Crime Record Bureau (NCRB). Seventy per cent victims of vitriolage are women in India as indicated by the annual reports of the Acid Survivor Foundation.

Aims and Objective

The aim of the study was to report incidence of acid attacks in India, Indian states and metropolitan cities. To analyse various police and court procedure and to discuss various steps to give justice to the victim of vitriolage.

Materials and Methods

Present study is a retrospective data record-based study. Available data for the last 5 years (from 2017 to 2021) were taken from National Crime Report Bureau (NCRB). Available as per NCRB, data were analysed as per aims and objectives.

Results

The trend of incidence of acid attacks in India was decreasing in the last 5 years, that is, the incidence was 244 in the year 2017 which become 176 in the year 2021. West Bengal and Uttar Pradesh were the states having the highest number of acid attack incidence during the last 5 years. Delhi city was the top most metropolitan city having the highest acid attack incidence in the last 5 years. Police investigation of cases of acid attacks against women and cases disposed of by the police decreased in the last 5 years. The chargesheeting rate was better in metropolitan cities than overall chargesheeting in India. There was an increased trial of cases of acid attacks against women and a decrease in cases disposed of by the court during the last 5 years. Conviction rate by the court was better in India than the metropolitan cities of India during the last 5 years. Case acquitted by the court in India was 24, 9, 10, 4 and 10, and in metropolitan cities it was 2, 1, 3, 0 and 2 during year 2017, 2018, 2019, 2020 and 2021, respectively.

Conclusion

Vitriolage not only destroys physical health but also destroys mental health. Despite of strict action taken by the Indian government, vitriolage is still prevalent in India. Male dominancy and inadequate legal systems are responsible for this. Though there is a standard set by the Supreme Court for the sale of acid, it remains easily available as the guidelines are frequently violated by the preparator. Case investigation and chargesheeting should increase by the police. Trial of the case and conviction should increase by the court. Vitriolage victims must be sure of their scope to obtain education and job opportunity and societal fiction should be reviewed to support people to acknowledge why vitriolage is committed mainly against females.

A Medical-Legal and Psychological Systematic Review on Vitriolage Related to Gender-Based Violence

Attacks perpetrated using acid are a particular form of interpersonal violence, possibly one of the most heinous manifestations of Intimate Partner Violence (IPV). Acid attacks are mainly motivated by extramarital cheating, marital conflicts, women's rejection of marriage proposals, and sexual advances. As these attacks are not well understood from a psychological perspective, we conducted a systematic review, following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, of 284 articles identified, 13 were eligible for inclusion. Three main focuses were identified: "Risk and vulnerability factors," "Consequences and implications," and "Interventions and treatments." Acid attacks seem to be more frequent in countries where social and economic development leads to greater tensions over traditional gender roles like Bangladesh, Pakistan, and India. Identified risk factors were young age, low socioeconomic status, low educational attainment, ethnicity, unemployment status of the victim, alcohol, and drug use of the perpetrator. Among the main psychosocial consequences of acid attacks, isolation and social exclusion emerged. Additionally, the paper will discuss the role of mental health consequences and specific treatments from psychological, clinical, and medical-legal points of view.

Resilience and Psychological Distress among Burn Survivors

INTRODUCTION

Burn is one of the highly occurring injuries worldwide. In case of an acid attack, survivors are considered an embarrassing element for the family. In other words, survivors' dignity is judged by the scars on their faces and bodies. Burn survivors experience physical pain of wounds, along with unseen psychological agony. Here, resilience is the most captivating phenomenon that can lead the survivor to normalcy in life after experiencing such traumas. The current study is aimed to explore the role of resilience in the psychological distress of burn survivors.

METHOD

160 burn survivors were selected with an age bracket of 18-78 years from indoor hospital settings. To explore resilience, Urdu translated version of the Connor-Davidson Resilience Scale (CD-RISC) by Naz (2011) was used and for symptoms of psychological distress, Urdu version of Depression Anxiety Stress Scale- 21 (DASS-21) by Aslam and Kamal (2017). was also used. The data were analyzed via SPSS 23.

RESULTS

Findings revealed that there is a significant negative relationship between resilience and psychological distress among burn survivors. Moreover, resilience predicted psychological distress. A significant difference was found between types of burn on depression and anxiety. Furthermore, the relationship between resilience to stress and depression is moderated by age of the burn survivor at the time of the incidence. A significant negative relationship between age with psychological distress among burn survivors was observed. The treatment period was associated positively with resilience and negatively with stress among burn survivors. Results also revealed no significant gender difference. However, a significant difference was found between types of burn on depression and anxiety.

CONCLUSION

The findings of current study would be helpful for the medical professionals, mental healthcare providers, and policymakers who can help to develop and implement rehabilitation programs and mental health demands for the said population and can initiate and plan resilience promoting programs that would help promote adaptive coping to deal with trauma.

Development of keratin-based membranes for potential use in skin repair

The layers in skin determine its protective and hemostasis functions. This layered microstructure cannot be naturally regenerated after severe burns; we aim to reconstruct it using guided tissue regeneration (GTR). In GTR, a membrane is used to regulate tissue growth by stopping fast-proliferating cells and allowing slower cells to migrate and reconstruct specialized microstructures. Here, we proposed the use of keratin membranes crosslinked via dityrosine bonding. Variables from the crosslinking process were grouped within an energy density (ED) parameter to manufacture and evaluate the membranes. Sol fraction, spectrographs, and thermograms were used to quantify the non-linear relation between ED and the resulting crosslinking degree (CD). Mechanical and swelling properties increased until an ED threshold was reached; at higher ED, the CD and properties of the membranes remained invariable indicating that all possible dityrosine bonds were formed. Transport assays showed that the membranes allow molecular diffusion; low ED membranes retain solutes within their structure while the high ED samples allow higher transport rates indicating that uncrosslinked proteins can be responsible of reducing transport. This was confirmed with lower transport of adipogenic growth factors to stem cells when using low ED membranes; high ED samples resulted in increased production of intracellular lipids. Overall, we can engineer keratin membranes with specific CD, a valuable tool to tune microstructural and transport properties.

Epidemiological analysis of pediatric burns in the Dominican Republic reveals a demographic profile at significant risk for electrical burns

OBJECTIVE

Pediatric burns are preventable with legislative and infrastructural changes. Although retrospective audits of many low- and middle-income countries have aided preventative efforts, the epidemiological status of burns in the Caribbean is not known. This study characterizes pediatric burns in the Dominican Republic (DR) and compares these to age-matched North American records captured by the National Burn Repository.

METHODS

A retrospective audit of 1600 patients admitted to the Unidad de Niños Quemados Dra. Thelma Rosario Hospital, the island's only major pediatric burn center, between January 2010 to March 2017 was performed. Epidemiological variables analyzed included age, gender, burn mechanism, year, month, city, admission duration, nationality, mortality, and %TBSA.

RESULTS

Pediatric burn patients in the DR sustained larger burns (8.2% vs. 6.5% TBSA) and spent more days in the hospital (10 vs. 6 days). Females were overrepresented (M:F=1:1.5) and mortality amongst admitted patients was 4-fold higher (2.8% vs. 0.7%). Electrical burns were significantly overrepresented in DR (21%) compared to age-matched North American patients (2%). Although electrical burns were smaller (4% TBSA), compared to scald (14% TBSA), and flame (19% TBSA), these burns preferred hands and had a high mortality rate (3%). No significant seasonality in burn mechanisms were observed. Finally, we report geographical and age group differences in the distribution of burn mechanisms and highlight particularly vulnerable subpopulations.

CONCLUSION

This investigation identifies a demographical profile where electrical burns account for a significant percentage of the burn population. This provides a basis for concentrating preventative efforts in vulnerable populations.

Osseointegrated Implants: An Alternative Approach in Patients with Bilateral Auricular Defects due to Chemical Assault

Acid attacks committed as crimes of passion are unfortunately becoming far from infrequent occurrence. The injuries sustained in such attacks mainly involve the face and trunk, with the acid causing cutaneous and subcutaneous tissue burns that can result in permanent scarring, loss of the nose or external ear, and severe visual impairment. Different surgical solutions have been proposed for reconstruction of the auricle following loss of the ear through traumatic injury or cancer or in patients with congenital defects: surgical reconstruction may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has given good results but requires more than one surgical step and may be associated with adverse events involving both the donor site and the recipient site, while rejections of polymeric prostheses have been reported following their insertion into expanded postauricular flaps. The use of a titanium dowel-retained silicone prosthesis, in which the dowel is anchored to the temporal bone, is a surgical possibility, indicated particularly in cases of pinna resection due to tumour or auricular scarring following traumatic injury.

Epidemiology of burns throughout the World. Part II: intentional burns in adults

A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators.

Cases of chemical assault worldwide: A literature review

We reviewed 24 studies of chemical burns by means of assault in the last 40 years. We describe 771 cases of chemical assault in total. Jamaica had the largest absolute number of cases. Bangladesh had the highest reported incidence. Male victims were more common, with the exception of Bangladesh and Taiwan. The youngest cohort was from Bangladesh. The role of gender, agents used and legislation were discussed. We identified two broad motives; increases in violent crime and use as a crime of passion in disputes between men and women.

Psychosocial outcomes derived from an acid burned population in Bangladesh, and comparison with Western norms

Assault by acid burns typically results in severe disfigurement, yet the psychosocial impact of this injury is so far unreported. This study provides the first empirical data using standardised assessment scales, from 44 acid burns survivors in Bangladesh. Compared with published norms, individuals show high levels of psychological distress including social anxiety and avoidance, anxiety and depression. Consistent with the published literature, there is no relationship between severity of injury and level of psychological distress. One interesting feature of this population is the relative preservation of perceived self-concept, and this is discussed with relation to the supportive and therapeutic environment of the clinic where this group were studied. We also note an interesting sub-group who were attacked by members of their own family and for whom psychological morbidity seems particularly pronounced.