Nut case in ER: ISTOLS Toxidromal Approach by Indian Society of Toxicology in managing botanical emergencies due to Areca Catechu - Betel Nuts

Prevention of medicolegal case by proving Patient’s contributory Negligence beforehand, by keeping betel nuts in mouth while sleeping, as bad habit documented in social history of patient, is better option, than fighting these allegations in the consumer courts, to prove our innocence as health care provider, filed mostly under Consumer Protection Act. We are presenting an interesting case reported in our Emergency, brought in critical state, rescued by logical approach in diagnosing, and recovered after bronchoscopic removal judiciously.

Mastery learning of toxicology life support skills by nurses and doctors, utilizing simulation technology in Nepal

Modern Medicine has been at the forefront in the use of patient simulation for research, training and performance assessment. With simulation, no patients are at risk for exposure to novice caregivers or unproven technologies. It becomes very important in field of toxicological emergencies, due to its acute onset of presentation, rapid progression of symptoms, and early deterioration of vitals and adverse outcomes in morbidity and mortality of patients in extremes of ages. Our observational study suggests that Emergency, Forensic Medicine and Toxicology (FMT) residents and Nurses have limited exposure to critically ill patients of trauma and toxicology and the budding forensic professionals lack the skills to manage them. Simulation has the potential to fill this educational void in managing clinical forensic and toxicological emergencies. The following review will attempt to answer this call by quantifying the effect of simulation-based educational interventions on retention of knowledge and clinical performance, as applied to acute care toxicology.

Role of Forensic Nurses in the mortuary and postmortem examination

Forensic nursing science is a developing at a fast pace in the developed countries of the world and the forensic nurses have gained valuable roles in the different departments. Mortuary services are often in a state of neglect in the developing countries especially the postmortem examination. Mainly this is due to lack of assistance to forensic physicians by educated and trained professionals. Forensic nurses can do a variety of roles to improve the functioning of the mortuaries. Role of forensic nurses in the postmortem examination and upkeep of the mortuaries is essential and it is emphasized that forensic nurses can play a very pivotal role in the functioning of the mortuaries.

Medical examination of sexual assault cases and related law

The criminal law amendment act 2012 has expanded the definition of sexual assault and recognised right to the treatment for all survivor/victims of sexual assault by the public and private health care facilities. The ministry of health and family welfare released uniform guideline for medico-legal care of victims of sexual violence. This paper highlights some of important provision of law and recent changes in examination of victim of sexual violence, which is applicable to all registered medical practitioner practicing either in public or private sector.

Risks, hazards and safety in mortuaries

Persons working in the mortuaries face numerous hazards and if proper precautions are not observed such persons can fall sick by the infectious agents. A review has been carried out to find out the various agents responsible for causing infection in the mortuaries. Practices in the mortuaries that can cause harm to the workers have also been reviewed. The various methods that can reduce or eliminate the chances of such infections and precautions to reduce the hazards in postmortem examination have also been reviewed.

Prediction methods for soft tissue structures in forensic facial reconstruction: A review for reconstruction of nose, eyes, mouth and ears

Facial reconstruction is an art and science in the field of forensics which involves construction of a recognizable face on unknown skull remains. It appears as a, metaphorically speaking “shining beacon of hope” after everything else fails for identification of the remains. Both, 2D and 3D methods of facial reconstruction have been developed for this process. The database of facial soft tissue thickness based on gender, ethnicity and age, at certain bilateral and unilateral anatomical points on skull bones, lay foundation to the process of reanimating the facial profile of a deceased. Several imaging modalities have been used for the collection of this data, in addition to the cadavers and various guidelines have been given for the reconstruction of the soft tissues, however, to construct soft tissue structures like nose, eyes, mouth and ears which take an important position in determination of the facial features is still a tedious task. This process is being researched since a century and multiple guidelines for reconstruction of the soft tissue structures are available. The face plays out based on the method used; hence selection of an appropriate method is vital. This review encompasses the various methods/guidelines derived for the reconstruction of the nose, eyes, mouth and ears of the face. In addition to the traditional methods given by Gerasimov, Krogman, Prokopec and Ubelaker, George, etc. other newer methods have been mentioned. This review also highlights assessment studies performed using the said methods in populations other than the ones they were derived from.

Current Scenario of Euthanasia in India

Euthanasia is a recently talked topic now a days in India. Few societies like Jainism etc. practicing santhara/ salekhana/ ichhamaran as of now embodied in passive euthanasia permitted by Supreme Court of India on 3rd March, 2018 to a person who is above the age of 18 years. Various types of euthanasia are there but only Passive euthanasia will be permitted as per law to terminally ill patients who give advance medical directives to treating doctor to end his life in a dignified manner. Advance medical directions given by the patient should clearly mention under which circumstances passive euthanasia (removing life support from patient but palliative care may be continued) should be administered by following legal formalities.

An overview of sexual assault cases in Bangladesh

Sexual assault is defined as any sexual act performed by one (or more) person(s) on another without consent. It may include the use of threat or force. In some cases, the person cannot give consent to sex because he/she is unconscious or otherwise incapacitated. A person may be raped by a stranger, an acquaintance or date or a family member. The purpose of the present study was to find out the medicolegal findings of rape victims in order to point out the visible loopholes of the procedure. This was a cross sectional descriptive type of study which was done in the Dept. of Forensic Medicine, Sir Salimullah Medical College and Mitford Hospital, Dhaka , Bangladesh from January to December 2015 with maintaining ethical issues. Rape cases were sent for medicolegal examination and victims who ultimately agreed to do medicolegal examinations were examined and opinions were given regarding the issues. In this study, majority (70.0%) of the victims was within 11 to 20 years of age and 65.0% of the victims were unmarried. Almost 68.0% of the victims were examined within 7 days followed by 32.0% of the victims after 7 days to beyond one month after rape; however, 48.0% of the victims showed sign of recent hymeneal tear with bruise and abrasion followed by 52.0% showed sign of old hymeneal tear. Spermatozoa were not found in any of the specimen of high vaginal swab. Young adults remain the most vulnerable group, so education related to sex, morality, humanity and different life skills training should be provided to these groups from their school years itself. The benefits of early intervention and comprehensive care of survivors with the use of standardized protocols along with shorter and lesser traumatic period of court processing to the survivors of these cases should be encouraged.

Suicide note in the ligature material- a case report

Suicide is a leading cause of death among young adults. About a million suicides occur annually throughout the world. A suicide note is often found at the scene. It has been reported that a note was left in 5%-43% of the suicides (1). The content of a suicide note includesapology, shame, guilt, love for those left behind and instruction regarding practical affairs (2). It is an important tool for medico-legal investigation on the manner and circumstances surrounding the death. The victim generally writes them on a paper, notebook, wall, or mirror by means of pen or marker (3). We present a case where asuicide note was recovered from the ligature itself. This method of keeping a suicide note in the ligature is unique and rarely found in the literature.

Retrospective study of accused and survivors of sexual offences in Karnal, Haryana

Sexuality is a crucial part of people’s health, general well-being and quality of life and enjoying a healthy sexuality is well thought-out as a human right. But it is counted as sexual assault or rape if it is without her consent or against her will or when it is obtained by unlawful manners such as fraud, putting her in fear of death or hurt, drugging or impersonation. Sexual offences are traumatic at the time of occurrence and may also leave a very bad and negative impact on her physical and mental health. A retrospective study was performed after collecting Medico-legal reports done on survivors and accused in Government Hospital Karnal from January 2012 to April 2016. In the present study, Total 69 cases of alleged history of sexual assault were taken, out of which 38 cases of male accused and 31 cases of female survivors’ medico-legal reports were studied. The highest percentage of female survivors was among age group between 11-20 years (64.5 %). The highest percentage of male accused was among age group between 21-30 years (55.3 %). During examination it was found that 2 female survivors (6.5%) out of 31 cases had alleged h/o sexual assault at the same time. There were 3 cases (7.9%) of gang rape. Out of these three cases of gang rape, in two cases (66.7%), two each accused persons were involved and in one case (33.3%) four accused were involved. In rest of the cases single male accused was involved. It is seen that younger aged females are at maximum risk for sexual assault threat and young adult males are active in these sexual assault activities. So it is important to give sex education to our young generation and make them aware.