Evaluation of Gender in Living Male and Female Children Through the Measurement of Sternum Bone in the Population of Uttar Pradesh

S V Sharma, A K Pankaj, Navneet Kumar, Nilesh, H B Sharma Resident, Department of Anatomy, King George’s Medical University, U.P., Lucknow, Associate Professor, Department of Anatomy, King George’s Medical University, U.P., Lucknow, Professor & Head, Department of Anatomy, King George’s Medical University, U.P., Lucknow, Laboratory Assistant , Department of Medicine, King George’s Medical University, U.P., Lucknow, Ward Master , Department of Obstetrics & Gynecology, King George’s Medical University, U.P., Lucknow.


Introduction
To identify the sex of the specimen found, with great accuracy and precision, is of utmost importance. The bones are more resistant to the putrification process that makes it important to study, which in turn helps to identify the gender determination criteria. Next to pelvis, human skull is regarded as the most accurate indicator of the sex [Macaluso PJ et al., 2014] but when these bones are missing; [1] recent findings have suggested that sternum and manubrium can act as valuable specimens [Dwight T-1881& Osunwoke EA et al. -2010 Manubriosternum is a flat bone that takes part in the formation of the thoracic cage. [2,3] Dwight T-1881 Suggested that the male sternum is considerably longer than the female sternum. He also confirmed that the combined length of manubrium and mesosternum, and the total sternal length provide useful guide to the height of an individual. Similarly, [Torwalt et al., 2005] studied the sex differentiation in human sternum by studying its various morphometric measurements in various populations. [4] In India, various researchers have presented their work on the sternum regarding sex determination. [5,6] [Singh et al., & Dahiphale VP et al., 2002] Identification is recognition of an individual by means of various physical features and biological parameters, which are unique to each individual. Since the bone resists putrefaction and destruction by animals, they can be used for identification and can lead to a reliable determination of age, sex, race [Camps FE et al., 1976] stature of the individual. [7] Sex determination from unknown human skeletal remains or decomposed bodies is an important initial step in forensic investigation. Accurate determination of skeletal sex is a critical requirement in medico legal cases. Sternum is highly useful for determination of sex of an individual apart from determination of racial characters. Studies on sternum have been reported in both sexes of American, African and European population and also in different zones of Indian population like North Indian, Maharashtra and Guajarati population but they are scanty. This study has been planned to verify the existrnal data and establish them in reference to population in and around Lucknow. Since the study was conducted in the people of Lucknow, and subjects were selected only from in and around the Lucknow as the race and built may affect the dimensions of the sternum. By this study we evaluated the growth and size of sternum in living male and female children and also find out the relation between the size of In the present study, an effort has been made to estimate sex through the measurement of sternums bone in living male and female children requited from department of medicine as well as pediatrics, obstetrics & gynecology and Department of Anatomy, King George's Medical University, U.P., Lucknow.

Subjects and Methods
This study has been conducted on the total 100 subjects, 50 female (0-15 yrs) and 50 male (0-15yrs) of healthy people (Living children) from general population of north India as well as in and around the Lucknow. After obtaining ethical clearance and informed consent form, the living subjects have been recruited from the healthy staff members of OPD, department of medicine, pediatrics and Obstetrics & gynecology at King George's Medical University, U P, Lucknow. All the living subjects have been well informed about the nature of study. To prevent discrimination, living subjects have recruited for our study fulfilling inclusion criteria (male and female, age 0 to 15 years, BMI less than 25 and no history of chronic disease, at least 1 years tenure, no use of medication other than analgesics during the month preceding data collection). The living subjects have been explained the procedure of study. For the morphometry of the sternum, following measurements have been taken in to consideration:

Length of manubrium:
It has been measured from the centre of suprasternal notch to the centre of the manubrio-sternal junction in mid sagittal plane.

Length of mesosternum:
It has been measured from the centre of manubrio-sternal junction to the centre of sterno-xiphoid junction in the mid sagittal plane.

Total length of sternum:
It has been measured from the centre of jugular notch to xiphoid process in the mid sagittal plane.The above mentioned measurements have been further use to calculate various sternal dimensions and indices according to the technique described by Ashley. Each linear measurement has been taken thrice on the anatomical position of the sternum using Mitutoyo-digital vernier calipers to the nearest millimeter with precision of 0.01 mm, according to definitions presented in and their average was recorded. [10]

Basic characteristics:
The present study deals evaluation of sex determination through measurement of human sternum in Lucknow city of Uttar Pradesh (U.P.). The primary outcome measures of the study were length of manubrium, length of mesosternum and length of sternum measured in millimeter (mm). Besides that actual age (yrs), height (cm), weight (kg), chest circumference (cm), waist circumference and hip circumference (cm) were also noted.

I. Female 2-15 yrs:
The basic characteristics of 2-15 yrs females are summarized in

Comparison between Female vs. Male-02-15 yrs:
The comparison of mean length of manubrium, mesosternum and sternum between 2 to 15 yrs female and male is summarized in Table 3 and also depicted in Fig. 1

Discussion
The aim of the present study was to evaluate the gender through measurement of children (M/F) sternum in Lucknow city of Uttar Pradesh, India. Results from our study revealed that body weight, BMI, and abdominal circumference were in normal range. The findings suggest that osteometric evaluation of the sternum can be an effective method for identification of sex in the Lucknow population as well as Uttar Pradesh.

Comparison between Female vs. Male-02-15 yrs:
The comparison of mean length of manubrium, mesosternum and sternum between 2 to 15 yrs female and male was Comparing the mean length of manubrium, mesosternum and sternum between two groups, Student's t test showed significantly different and higher length of manubrium ( [Fernandez ED et al., 2007] the male length of mesosternum was 106.79 mm and 93.90 mm for females respectively. [6] His findings were supported by, [7,11]

Conclusion
On the basis of observations and results of my present study, evaluation of Sex in male and female children, through measurement of sternum in Lucknow city of Uttar Pradesh was concluded that -The basic characteristics of 02-15 yrs in males and female like age, height, weight, chest circumference, waist circumference and hip circumference and BMI was in normal range respectively. The comparison of mean length of manubrium, mesosternum and sternum between 2 to 15 yrs, female and male sternum between two groups, significantly different and higher length of manubrium, mesosternum and sternum in males as compared to females children. Thus the present results in my study was provide full support, study done by [12][Ashley GT-1956b] formulated the 149 rule, according to which a male sternum exceeded 149mm in length whereas the female sternum was less than 149mm.

Statistical analysis:
Data were summarized as Mean ± SD (standard deviation), range (min to max) and median. Groups were compared by independent Student's t test. Pearson correlation was done to assess association between variables. A two-tailed (α=2) p<0.05 was considered statistically significant. Analyses were performed on SPSS software (windows version 21.0). The statistical analysis has been done by Dr M.P. Negi, from Central Drug Research Institute (CDRI) Lucknow.