Comparative study of laparoscopic surgery and open surgery in regards to surgical-site infections.

Background: Surgical site infections (SSI) formerly termed surgical wound infection, are one of the most frequent post-operative infectious complication. Patients with SSI had longer and costlier hospitalization than patients who didn't have such infection. Laparoscopic surgery as a minimally invasive surgery have good outcome regarding SSI as compared to open procedure. Aims & Objective: To compare infection rate after laparoscopic versus open surgery. Material and Methods: A retrospective analysis of large number of cases in SMIMER Hospital was conducted. Patients who underwent laparoscopic (n=4500) or open (n=1500) appendicectomy, cholecystectomy, anti-reflux surgery, or gastric bypass from 2009 to 2012 were included in the analysis. The main outcome measure was inpatient diagnosis of SSI (Surgical Site Infection) after laparoscopic and open surgery. Results: During 36 month of study period total of 6000 patient underwent one of four selected procedure. Overall, the incidence of SSI was significantly lower in laparoscopic (100 of 4500, 2.0%) than in open (150 of 1500, 10%) surgery (P<0.01). Largely, laparoscopic techniques offer a protective effect against SSI. Patient treated with laparoscopy were 76% less likely to experience SSI. Odds Ratio (OR), 0.30; 95% Confidence Interval (CI), 0.28-0.34. Conclusion: Patient treated with laparoscopic procedure is less likely to experience SSI. After stratification by severity of illness, wound classification & admission status, laparoscopic techniques shows a protective effect against SSI.

Assessing the suitability of vitreous humor as a sample for toxicological analysis – A prospective study.

The incidence of poisoning and substance abuse have been steadily rising in India over the last few decades. Accurate diagnosis of poisoning is essential, both in the living as well as in the dead, for therapeutic and medicolegal purposes respectively. Poisons are generally detected in body fluids such as urine, blood, or gastric lavage during life, while they are detected in the contents of stomach, bowel and the viscera, besides urine and vomitus, after death. In a dead body, one of the better samples to complement blood is vitreous humor, because it is less likely to degrade quickly, and is fairly easy to collect at autopsy. In this study, an attempt has been made to assess the role of vitreous humor as a suitable sample for toxicological analysis in the detection of all kinds of poisoning after death. The study was done on alleged cases of poisoning subjected to medicolegal autopsy at the mortuary of Government Medical College and Hospital, Chandigarh. Attempt was also made to corelate the vitreous humor findings with that of the official report from the Chemical Examiner's Laboratory at the state or central level.

Teaching, training and practice of forensic medicine in India - An overview.

Forensic medicine & Toxicology, an important and integral part of medical education, has been a silent spectator to its ups and downs in the recent past. Having had its glory at times, playing pivotal role at places in aiding criminal justice, it has unfortunately failed to sustain the impetus and its importance. Furthermore, Medical Council of India (MCI) - the national medical supreme body, has come down heavily on this specialty in general and on its curriculum in particular at the undergraduate level, pushing it down to the cross roads. The increasing legal awareness among the masses, frequent unsavory remarks on the doctors by the judiciary, bringing medical profession under the purview of the Consumer Protection Act in contrast to the decreasing of importance of the subject in the medical curriculum coupled with casual approach to the subject both by the teacher and the taught have all culminated into a situation where fate of the subject befits the words of Sir Winston Churchill, "This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

Violation of children's rights: Can forensic medicine help.

"Today's child is tomorrow's citizen" so goes a popular saying, stressing the need for proper care and protection of the children. India has ratified the UN convention on the Rights of Child, which came into force on 2nd September 1990 and our own National Policy for Children was adopted way back in 1974. However, if we look at the outcome of all the measures that have been taken "on paper" the record is dismal. Child abuse goes unabated in our country, right in front of the eyes of the Law. The present study was undertaken to assess whether our specialty - Forensic Medicine - can bring to focus the atrocities perpetuated on children. During the 5-year period of the study, 155 cases were examined medicolegally in the Emergency department of the Govt. Medical College Hospital, Sector 32, Chandigarh; of which 6% were referred for medicolegal autopsy. Physical abuse accounted for 70% cases and sexual for 30%; the police brought 61% of the children to the hospital. Boys were more at risk in cases of physical abuse, however of the cases of sexual abuse, 23% were boys. Maximum cases of abuse - both physical and sexual occurred at the home/ eighborhood of the victim. It was concluded that the society as a whole, including the Govt. NGOs, Parents, teachers, elders etc. has the responsibility for the proper upbringing of the child and until and unless all of us shoulder the responsibility with sincerity, the children will continue to be abused.

Management of toxicological emergencies at different health care levels: A comparative study.

The proliferation of numerous poisonous substances due to rapid development in science and technology, coupled with the vast growth in industrial and agricultural sectors has substantially increased the incidence of poisoning in recent times. Today, a number of chemical substances, which were originally developed to protect agricultural products from rodents and pests, are at the forefront of suicidal ingestions. The aim of this retrospective comparative study is to analyze the characteristics of toxicological emergencies reporting at three different levels of health care centers-primary, secondary and tertiary - in order to find out the problems faced at each level with reference to their management, and to highlight the need to redress such problems to reduce the ever-increasing deaths due to poisoning.

Trauma score: A valuable tool for documentation of autopsy reports of trauma victims.

Trauma related morbidity and mortality is an age old reality, however, with the passage of time, advances in medical science and technology, man has succeeded to control / minimize the extent of damage caused by trauma. Vehicular accidents continue to be the commonest presentation of trauma related mortality and morbidity, the other causes being mechanical violence, industrial accidents, etc. According to the World Health Organization, accident is an event, independent of human will power, caused by an external force that acts rapidly and results in bodily or mental damage. Objective of the present study was to analyze the suitability of Anatomic Injury Scoring system particularly Injury Severity Score (ISS) on autopsy among the cases of road traffic accidents with the aim of improving the autopsy data in trauma related deaths, thus assisting policy planning for better trauma care systems.

Ligature mark on neck: How informative.

Many a times, a ligature mark may be the only evidence available in cases of asphyxial deaths due either to hanging or strangulation. A through examination of the ligature mark and analysis of the information provided by it, is therefore, a must to arrive at the most probable cause of death and differentiate between hanging and the ligature strangulation. A retrospective study was conducted at the Department of Forensic Medicine and Toxicology, Government Medical College & Hospital, Chandigarh, between 1997 to 2004 to assess the information provided by a ligature mark in such cases. We found that deaths due to hanging constituted 3.4% of the total unnatural deaths subjected to medicolegal autopsy; young adults, of the age group 21 to 25 years accounted for the maximum cases, 27%; and the male: female ratio was 2:1. Chunni was the most common ligature material used. Majority of the victims preferred multiple knots (61%) and fixed knots (58%) and a single loop (93%). The mark was obliquely placed (98% cases) above the larynx (85% cases). In all the cases of ligature strangulation, the mark was transverse, below the level of thyroid cartilage. Imprint over the groove when present, corresponded with the ligature material used in all the cases. It was concluded that a thorough, scientific examination of the ligature mark, though not conclusive, but is the most important part of the postmortem examination of deaths due to hanging and ligature strangulation.