Background Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan. Aims Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons. Method We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria. Results Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide (‘wheat pills’) was a preferred agent in North Punjab, whereas paraphenylenediamine (‘kala pathar’) was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison. Conclusions Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.

Background: More than half of all road traffic deaths in the world occur among vulnerable road users including pedestrians, motorcyclists and cyclists whereas; motorcyclists contribute almost one fourth of the death toll of road traffic crashes. Implementation of suitable strategies to address the issues of road traffic crashes is much difficult without information, absolute value of the problem, patterns and risks of injuries & death. Objective: To determine the different patterns, severity and distribution of injuries & their frequency in motorized two wheelers accidents. Study Design: Cross-sectional Study. Settings: Study was conducted in the department of Forensic Medicine at Nishtar Medical University, Multan Pakistan. Duration: One year from January 01, 2018 to December 31, 2018. Methodology: Total 167 cases died of road traffic accidents brought for autopsy and of those, 104 cases were reported to be died of motorcycle accidents involving both riders & pillion riders. The data of victim’s age, gender, site and pattern of injuries were obtained through detailed examination of the hospital record, autopsy reports and police inquest. The injuries over head, neck & thoraco abdominal region were given due consideration being dangerous to life. Statistical analysis was done using SPSS version 20. Results: Of the total 104 cases died in motorcycle accidents; 99 (95.20%) were males & 5 (4.80%) female. Riders died in 81 (77.89%) cases & pillion riders 23 (22.11%). The age group between 21-40 years involved 67 (64.42%) cases; maximum injuries were observed on Head/Face affecting 84 (80.8%) cases while on thorax 26 (25%) cases, Neck/Spine 12 (11.5%), pelvis 14 (13.4%) and abdominal area sustained injuries in 8 (7.6%) cases. As regard pattern of injuries; abrasions were found in 48 (31%) cases, lacerations 38 (24%), contusions 14 (9%) while fractures were observed in 56 (36%) cases. Among fatal injuries, 74 (71%) were found on Head, 7 (6.7%) over cervical spines, 3 (2.8%) on limbs whereas fatal injuries on thorax & Abdomino-pelvic areas were found 6 (9.6%) in each category. Of the total 81 riders, fractures of skull were observed in 59 (73%) cases and of 23 pillion riders, 16 (69.5%) got fracture of skull. Conclusion: Male riders of motorcycles belonging to age range 21-40 years were more prone to fatal injuries i.e., fractures of skull, neck, spine & Abdomino-thoracic injuries. Abrasions, contusions and lacerations were the most common type of injuries. Helmet legislation needs to be supported by strong enforcement and social marketing campaigns. Reducing the incidence by strict implementation of traffic rules and safety education via electronic & print media is need of the day.

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