A Review on Medico legal and Ethical aspects of Orthopaedic Practice

Medico-legal issues in orthopaedic practice are increasing day by day. With the tremendous metamorphosis in the healthcare sector, incidents of lawsuits against orthopaedic surgeons and hospitals, in the name of medical negligence is on the rise. With every consumer redress forum being more inclined in protecting the consumers, it is imperative for practising Doctors to be more informed on the Medico-legal aspects of their field of practice. Most orthopaedic cases that lead to medico-legal cases result from trauma. Besides, these cases are seen in the Emergency Room, thereby resulting in critical and uncertain decisions. Unlike in other fields where the patient has an existing relationship before any complications occur, rapport-building has to begin much after the treatment has begun. Technological advances in the orthopaedic field, availability of online information on platforms like Google, lack of communication, cutthroat competition among orthopaedic surgeons, awareness about the consumer protection act, mob psychology, interference by anti-social elements and local politicians etc have brought orthopaedic practice at this stage. Following ethical aspects, keeping good repo with patients and society, keeping our documentation perfect and precise, and doing transparent and honest practice can save orthopaedic surgeons in long run. Having empathy towards patients and society, keeping workload in our control, helping each other in crisis, and no medical jousting are also important measures to do safe medical practice in the present era. Keeping in mind the mantra of coming together, working together, and working in harmony is of utmost importance for an orthopaedic practice in recent times.

Demographic Evaluation of Pediatric Medico-Legal Cases in Casualty

Introduction: Paediatric medico-legal cases are important public health problems in the paediatric casualty in India. These cases are among the leading causes of paediatric disabilities and deaths. We conducted a study to evaluate the demographic features of the medico-legal cases who presented to our paediatric casualty. Methodology: In a total of two-year study period, 120 patients were presented in casualty as medico-legal cases. Information about the patients was obtained from hospital records and analysed by us from casualty. Results: 70 male (58.3%) and 50 female (41.6%) patients were included in our study. The majority of the patients were between 10- 14 years of age (n=30; 25.0%). Fall from height was the major complaint (n= 60; 50%) of our patients. Winter was the most common season (n= 37; 30.6%) and January (n=13; 11%) was the most common month for medico-legal admissions. The majority of the patients (n=42; 35%) presented to our emergency room between 18-24 hours. 78 cases (65%) had health risks at the time of presentation. Conclusion: Developing effective & preventive strategies is essential to prevent child injuries. Majority of cases were males and adolescents. There is an urgent need to focus more on this vulnerable age group i.e., adolescent age group. There should be increased awareness among paediatricians about these medico legal cases and improving counselling skills to handle relatives of patients

Morphological Patterns of Traumatic Head Injury in Medicolegal Autopsies at Muhimbili National Hospital, Dar ESSalaam Tanzania

Introduction: Head injury is predicted to surpass many diseases as a major cause of death and disability by the year 2020. There is a limited documentations on morphological patterns of traumatic Head Injury and its prevalence specifically in Medical legal Autopsy in Tanzania population. The aim of this study was to determine the morphological patterns of Traumatic Head Injury (TBI) in Medical legal autopsies seen at Muhimbili National Hospital (MNH). Subjects and Methods : This was a hospital based cross -sectional study conducted at MNH mortuary. The postmortem examination was performed under Virchow method on 170 cases of TBI in which morphological patterns of TBI was recorded. Proportional of TBI frequencies on various morphological patterns in medical legal autopsies were recorded. Association between cause of death and etiology of TBI were established by Fisher - exact test.Results:The proportion of TBI among the medico - legal autopsy at MNH was 38.5%. All cases of TBI had scalp abrasion, and the majority had linear fra cture 67(39.3%) and the commonest the parietal bone was commonly affected 85(55.6%). In closed TBI, majority had subarachnoid hemorrhage130 (84.9%). All cases of T BI had brain edema, with one coincidental finding of metastatic adenocarcinoma. A total of 42 cases of TBI had brain herniation, 51 brain laceration and 52, had brain contusion. The association between etiology of injury, wearing helmets among motor cycle user and cause of death was statistically significance (p<0.05). Conclusion:The higher pro portion of TBI among medicolegal autopsies at MNH reflects the burden of head injury in our settings.

Histopathological differentiation of drowning in freshwater and saltwater in rats: forensic point of view / Diferenciación histopatológica de ahogamiento en agua dulce y agua salada en ratas: punto de vista forense

SUMMARY: The postmortem diagnosis of death by drowning is one of the most difficult issues in forensic pathology. We investigated possible evidence differentiating saltwater drowning from freshwater drowning by histopathological changes in brain, heart, lungs, liver, and kidneys tissues. A cross section descriptive study was carried out on eighteen 12-week-old male Wistar rats; they were divided equally into 3 groups. Group 1: control group; Group 2: death by drowning in freshwater; Group 3: death by drowning in saltwater. Immediately after death, all tested organs were removed and fixed for histopathological examination. The brain of freshwater group depicted degenerated neurocytes with dystrophic changes in the form of shrunken cell, pyknotic nuclei and deeply eosinophilic cytoplasm. The heart showed clear evidence of myocyte injuries in saltwater drowning compared to the control and freshwater groups. The kidneys of rats drown in saltwater revealed more glomerular destruction with no differences in tubulo-interstitial changes in comparison with those drown in freshwater. In the lungs, the changes in freshwater were restricted to the alveoli, and the bronchial changes were more distinctive in saltwater. No disturbed liver architecture was seen in both test groups, however hydropic degeneration, congested vessels, and sinusoids were more distinct in saltwater group. In conclusion, diagnostic differentiation between fresh and saltwater drowning was reliable in rats' lungs and heart with minimal differentiation in liver, kidneys, and brain. Further studies of drowning with different staining techniques will help to clarify the potential role of histopathological changes in body organs as indicator of drowning.

RESUMEN: El diagnóstico post mortem de muerte por ahogamiento es uno de los temas más difíciles de la patología forense. Investigamos la posible evidencia que diferencia el ahogamiento en agua salada del ahogamiento en agua dulce por cambios histopatológicos en los tejidos del cerebro, el corazón, los pulmones, el hígado y los riñones. Se realizó un estudio descriptivo de corte transversal en dieciocho ratas Wistar macho de 12 semanas de edad; se dividieron por igual en 3 grupos. Grupo 1: grupo control; Grupo 2: muerte por ahogamiento en agua dulce; Grupo 3: muerte por ahogamiento en agua salada. Inmediatamente después de la muerte, se extirparon todos los órganos analizados y se fijaron para el examen histopatológico. El cerebro del grupo de agua dulce mostró neurocitos degenerados con cambios distróficos en forma de células encogidas, núcleos picnóticos y citoplasma profundamente eosinofílico. El corazón mostró una clara evidencia de lesiones de miocitos en los ahogamientos en agua salada en comparación con los grupos de control y de agua dulce. Los riñones de ratas ahogadas en agua salada revelaron una mayor destrucción glomerular sin diferencias en los cambios túbulo-intersticiales en comparación con las ahogadas en agua dulce. En los pulmones, los cambios en agua dulce se restringieron a los alvéolos y los cambios bronquiales fueron más distintivos en agua salada. No se observó una arquitectura hepática alterada en ambos grupos de prueba, sin embargo, la degeneración hidrópica, los vasos congestionados y los sinusoides fueron más distintos en el grupo de agua salada. En conclusión, la diferenciación diagnóstica entre ahogamiento en agua dulce y salada fue confiable en los pulmones y el corazón de las ratas con una diferenciación mínima en el hígado, los riñones y el cerebro. Estudios adicionales de ahogamiento con diferentes técnicas de tinción ayudarán a aclarar el papel potencial de los cambios histopatológicos en los órganos del cuerpo como indicador de ahogamiento.

Telehealth in south africa: a guide for healthcare practitioners in primary care

The use of telehealth is becoming a prevalent feature in clinical practice worldwide, partly because of advances in medical and telecommunications technology. The coronavirus disease 2019 (COVID-19) pandemic has been a key driver in justifying the accelerated use of telehealth, leading to healthcare practitioners (HCPs) utilising virtual consultations more avidly. Although challenges remain, recent data have shown that remote consultations are feasible, safe and effective in South Africa (SA) and that HCPs should become proficient in conducting telehealth, virtual or remote consultations. These guidelines are based on the revised Health Professions Council of South Africa (HPCSA) General Ethical Guidelines for Good Practice in Telehealth (Booklet 10) and guidelines on remote or video consultations from the University of Oxford, the Royal Australian College of General Practitioners and the Royal College of Psychiatrists. These guidelines aim to equip HCPs with the basic knowledge and skills pertaining to medicolegal, communication and practical aspects of telehealth and how to practise telehealth safely and effectively in primary care settings in SA during the COVID-19 pandemic and beyond.Keywords: telehealth; virtual consultations; remote consultations; primary care; guidelines; ethics; medicolegal; communication.

Embolismo graso fulminante por lipoinyección glútea. Reporte de un caso con enfoque Médico Legal / Fulminant fat embolism due to gluteal lipoinjection. Report of a case with a Medical Legal approach

Resumen La liposucción es uno de los procedimientos estéticos que se realizan con mayor frecuencia a nivel mundial, con una baja incidencia de complicaciones y una mortalidad de 20 por cada 100 000 procedimientos y cuando se realiza en conjunto con una lipoinyección glútea la principal causa de muerte el embolismo graso. Se presenta el caso de una femenina de 32 años, sin patologías crónicas conocidas, la cual se asistió a un centro médico para que le realizaran una liposucción con lipoinyección glútea y falleció casi al finalizar la cirugía; en la autopsia Médico Legal se observó la presencia de material de aspecto adiposo en el tronco principal de la arteria pulmonar y en sus ramificaciones, en las cuales se obstruía por completo el lumen, mediante un estudio histopatológico se confirmó el diagnostico de embolismo graso, el cual se estableció como causa de muerte. Se realizó una revisión de la literatura sobre embolismo graso asociado a liposucción con lipoinyección glútea.

Abstract Liposuction is one of the most frequently performed cosmetic procedures worldwide, with a low incidence of complications and a mortality of 20 per 100 000 procedures, and when it is performed in conjunction with gluteal lipoinjection, the main cause of death is fat embolism. This article presents a case of a 32-year-old female, with no known chronic pathologies, who was attended at a medical center to undergo liposuction with gluteal lipoinjection and died almost at the end of the surgery; In the Medico-Legal autopsy, the presence of adipose-like material was observed in the main trunk of the pulmonary artery and in its ramifications, in which the lumen was completely obstructed, a histopathological study confirmed the diagnosis of fat embolism, which was established as the cause of death. A review of the literature about fat embolism associated with liposuction with gluteal lipoinjection was made.

Suicidio con cloruro de potasio: Reporte de un caso / Suicide with potassium chloride: Case report

Resumen El suicidio es el uso deliberado de violencia externa con la intención de quitarse la vida, y el uso de medicamentos es una forma en la que esta se puede consumar, el cloruro de potasio es uno de los medicamentos que en concentraciones elevadas tienen efectos letales, por lo que el objetivo de este artículo científico es detallar características farmacológicas del cloruro de potasio, y los elementos a considerar en el estudio postmorten de cadáveres cuando se sospecha de una intoxicación por cloruro de potasio con manera de muerte suicida; con la metodología de estudio de artículos científicos, exposición de un caso clínico y discusión de la importancia del análisis de los elementos aportados y solicitados durante la investigación médico legal, también la especial y delicada importancia de una correcta recolección de muestras biológicas y continentes de medicamentos para el estudio toxicológico y químicoanalítico; de esta manera se concluye que el Cloruro de potasio es un fármaco con efectos colaterales dañinos en la función eléctrica cardiaca, la determinación de la manera de muerte es un trabajo complejo para el médico forense en este tipo de casos, y los resultados de la pericias complementarias a la autopsia tienen mucha importancia para el análisis de este tipo de casos.

Abstract Suicide is the deliberate use of external violence with the intention of taking one's life, and the use of medications is one way in which this can be consumed, potassium chloride is one of the medications that in high concentrations have lethal effects, Therefore, the objective of this scientific article is to detail the pharmacological characteristics of potassium chloride, and the elements to be considered in the postmortem study of corpses when potassium chloride poisoning is suspected as a suicidal death; with the methodology of study of scientific articles, presentation of a clinical case and discussion of the importance of the analysis of the elements provided and requested during the medical-legal research, also the special and delicate importance of a correct collection of biological samples and drug containers for toxicological and chemical analysis; In this way, it is concluded that potassium chloride is a drug with harmful collateral effects on cardiac electrical function, determining the manner of death is a complex job for the forensic doctor in this type of case, and the results of the expertise complementary to the autopsy are very important for the analysis of this type of case.

Muerte súbita por miocarditis aguda asociada al virus influenza tipo B. Reporte de un caso / Sudden death due to acute myocarditis associated with influenza type B virus. Case report

Resumen La miocarditis es una inflamación del miocardio causada principalmente por infecciones virales, dentro de las cuales se encuentra el virus Influenza tipo B. Su presentación clínica varía desde individuos asintomáticos o con síntomas leves e inespecíficos a una miocarditis fulminante e incluso muerte súbita. La principal consecuencia a largo plazo es una miocardiopatía dilatada con insuficiencia cardiaca. Se presenta el caso de una femenina de 17 años, sin patologías crónicas conocidas, la cual presentó un cuadro viral de dos días de evolución y luego falleció de manera súbita; en la autopsia médico legal se documentó mediante estudios histopatológicos una miocarditis linfocítica aguda y por medio de la técnica de reacción en cadena de la polimerasa (PCR) de un frotis traqueal se evidenció la presencia del virus influenza tipo B. Se realizó una revisión de la literatura sobre miocarditis principalmente miocarditis viral causada por el virus Influenza B.

Abstract Myocarditis is an inflammatory disease of the heart muscle. Viral infections are the most frequent cause of myocarditis, incluided Influenza B virus. The clinical presentation of acute miocarditis is highly variable, ranging from subclinical disease to fulminant heart failure and sometimes with sudden death. The major long term consequence is dilated cardiomyopathy with chronic heart failure. We present a case of a 17 years old woman who presented with viral symptoms for two days and then died suddenly; in the medico-legal autopsy, an acute lymphocytic myocarditis was documented through histopathological studies and the presence of influenza type B virus was evidenced by means of the polymerase chain reaction (PCR) technique of a tracheal smear. A review of the literature on myocarditis, mainly viral miocarditis caused by the Influenza B virus, was made.

Métodos para Valoración del Perjuicio Estético Causado Por Cicatrices Faciales

RESUMEN: Dentro del daño estético, las cicatrices son las secuelas más frecuentes. Al momento de su valoración médicolegal, hay que considerar las distintas formas en que se pueden presentar, además de su visibilidad a distancia. El objetivo de esta revisión es conocer los distintos métodos existentes usados para la valoración del perjuicio estético causado por cicatrices faciales. Se realizó una búsqueda bibliográfica en PubMed y Scielo, obteniéndose cuatro artículos atingentes al tema. Llama la atención la escasez de métodos estandarizados para su valoración, advirtiendo, además, que los pocos baremos existentes son para valorar el daño en el ámbito civil o laboral. Para estandarizar los criterios clínicos y medicolega les es recomendable el uso de métodos cuantitativos. Finalmente, al momento de evaluar las secuelas de las lesiones, es importante considerar no sólo el compromiso estético y funcional, sino también las implicancias biopsicosociales en la vida del individuo.

ABSTRACT: In relating to facial aesthetic damage, scars are the most frequently observed. When these scars are assessed for medico-legal purpose, it is necessary to consider the different ways in which they can be presented, and their visibility from distance. This review has as objective to evaluate the different existing methods used for the assessment of cosmetic damage caused by facial scars. The bibliographic search was carried out in PubMed and Scielo, where four articles related to the topic were found. The shortage of standardized methods for their assessment is striking, in addition, draws attention that the few existing scales are used to assess the damage in civil and labour affairs. To standardize clinical and medico-legal criteria, the use of quantitative methods is recommended. Finally, to evaluate the result of the injuries, it is important to consider not only the aesthetic and functional consequences, but also the biopsychosocial implications in the life of an individual.

Aspectos médico legales en mastología. Demora en el diagnóstico de cáncer de mama como motivo de conflicto legal. / Medical legal aspects in mastology. Delay in the diagnosis of breast cancer as a reason for legal conflict.

Pocas situaciones generan mayor angustia en el profesional médico como la de recibir una demanda por mala praxis. Los reclamos medico legales en cáncer de mama están centrados, de acuerdo a la mayor parte de la bibliografía internacional, en el retraso en el diagnóstico de cáncer de mama, si bien existen reclamos legales en el ámbito del tratamiento, estos son menos frecuentes. En EEUU la primera causa de juicios por mala praxis son los daños obstétricos, y la segunda causa es el retraso en el diagnóstico de la patología oncológica, estando en primer lugar el cáncer de mama; el riesgo de reclamo médico legal se calcula en 1/1000 canceres de mama; no hay estadísticas fiables en nuestro país pero extrapolando estos resultados seria esperable unas 20 demandas anuales. El perfil de riesgo es una paciente joven, premenopausica, con una masa autopercibida que es subestimada en la consulta clínica y/o por los estudios por imágenes. Una buena relación médico-paciente y una correcta documentación de la historia clínica es la mejor prevención, trabajando en forma normatizada y de acuerdo a guías nacionales e internacionales. Fomentar el trabajo en equipo y la formación de Unidades de Mastología en las instituciones es una forma de trabajo multidisciplinario que resulta en beneficio tanto de la paciente como de los profesionales.

There are few situations can generate distress for medical professionals like receiving a malpractice lawsuit. Medico legal issues in breast cancer are focused, according to the most international bibliography, on the delay in diagnosis of breast cancer. Even though legal claims exist concerning about treatment, those are less frequent. In USA, obstetric damages are the first cause of malpractice lawsuit and the second one is the delay in diagnosis of oncological pathology being the breast cancer at the first place. The risk of legal medical claim is calculated at 1/1000 breast cancers. There are no reliable statistic in our country but extrapolating these results, it would be expected around 20 demands per year. The risk profile is a young premenopausal patient with a breast mass self-perceived which is underrated by the doctor or imaging studies. A good doctor patient relationship and an accurate report in medical records is the best prevention, working in a standarized way according to international and national guides. We must persuit to encourage teamwork and Mastology Units organisation over all institutions is a multidisciplinary way of working toreach the patients benefit as well as professionals.

Maltreatment and non-infant maltreatment, relevance of forensic clinical anatomy, presentation of a case / Maltrato y no maltrato infantil: relevancia de la anatomía clínica forense: presentación de un caso

In a recently published article, Andrea Porzionato et al, they expose the relevance of Forensic Clinical Anatomy as a tool in judicial strata when there are medical-legal implications for suspected child abuse and the presence of anatomical variants and traumatic injuries that at any given time are difficult to differentiate. A case is reported where the careful dissection of a minor's body reveals a congenital malformation of the genital-urinary tract that causes repeated urinary tract infections resulting in sepsis and death, based on this description and the context of death is determined that death is associated with child abuse from lack of medical attention.

En un artículo de reciente publicación, Andrea Porzionato et al, exponen la relevancia de la Anatomía Clínica Forense como herramienta en estratos judiciales cuando existen implicaciones médico-legales por sospecha de maltrato infantil y la presencia de variantes anatómicas y lesiones traumáticas que en un momento dado son difíciles de diferenciar. Se reporta un caso donde la cuidadosa disección del cuerpo de un menor revela una malformación congénita del tracto genital-urinario que ocasiona infecciones repetidas del tracto urinario resultando en sepsis y muerte, con base en esta descripción y se determina el contexto de muerte la cual está asociada con abuso infantil por falta de atención médica.

Métodos histoquímicos e inmunohistoquímicos para la estimación del Intervalo postmortem en tejidos humanos: una revisión / Histochemical and immunohistochemical methods for the postmortem interval estimation in human tissues: a review

El intervalo postmortem (IPM) es un importante desafío a resolver en patología forense, y consiste en poder determinar el tiempo transcurrido desde la muerte hasta el momento de la autopsia. Dada la poca confiablidad de algunos métodos por la gran influencia de factores externos, la Histoquímica (HQ) y la Inmunohistoquímica (IHQ), entre otros, han recibido considerable atención por sus niveles de objetividad en la investigación forense. Se presenta una revisión con búsqueda sistemática de estudios experimentales que apliquen métodos HQs e IHQs para la estimación del IPM sobre material cadavérico humano. Se identificaron 1053 artículos de los cuales 12 cumplieron con los criterios, a los que se agregaron 4 mediante una búsqueda manual (n=16 artículos). Alemania fue el país con más publicaciones destacando con 8 artículos. Las técnicas HQs de AgNORs, TRAP y PAS fueron utilizadas en 5 estudios (glándulas sudoríparas, piel, hígado, médula ósea y mucosa labial), mientras que las IHQs fueron empleadas con diferentes grupos antigénicos en 12 estudios (páncreas, cerebro, pulmón, tiroides, hígado, glándulas pituitarias, glándulas sudoríparas y mucosa gingival). Las estimaciones del IPM fueron posibles con márgenes entre 2-3 h. hasta los 20 días dependiendo de la técnica. El análisis de tejidos provenientes de cavidad oral asegura una vía no invasiva, de fácil acceso y bajo resguardo natural a la influencia de factores ambientales. Si bien no existe un método único que permita de manera confiable estas estimaciones, la introducción de nuevas técnicas permitiría evitar la producción de errores.

The postmortem interval (IPM) is an important challenge to be solved in forensic pathology, and it consists in determine the time elapsed since death until the autopsy. Given the low reliability of some methods due to the great influence of external factors, Histochemistry (HQ) and Immunohistochemistry (IHQ), among others, have received considerable attention for their levels of objectivity in forensic investigation. A scoping review of experimental studies that apply HQs and IHQs methods to estimate the MPI on human cadaveric material is presented. We identified 1053 articles, of which 12 met the criteria; we added 4 articles through a manual search (n = 16 articles). Germany was the most productive country, with 8 articles. HQ techniques of AgNORs, TRAP and PAS were used in 5 studies (on sweat glands, skin, liver, bone marrow and labial mucosa), while IHQs techniques were used with different antigenic groups in 12 studies (on pancreas, brain, lung, thyroid, liver, pituitary glands, sweat glands and gingival mucosa). IPM estimates were possible with margins between 2-3 hours up to 20 days depending on the technique. The analysis of oral tissues ensures a non-invasive route, easily accessible and under natural protection to the influence of environmental factors. Although there is no single method that reliably allows these estimates, the introduction of new techniques would prevent the production of errors.

Medico-legal autopsies of homicidal deaths: A five-year retrospective study in Hospital Sungai Bul

@#Introduction: Homicide is the act of killing one human being by another, encompassing death as a result of criminal act including justifiable homicide such as judicial killing and self-defence. This study aimed to ascertain the epidemiology and patterns of injury of homicide victims. Materials and Methods: We reviewed records of medico-legal autopsy cases performed at the Department of Forensic Medicine, Hospital Sungai Buloh, for a period of five years, from January 2012 until December 2016. Subjects’ demographic data such as age, gender, nationality, ethnicity and cause of death were recorded. Results: A total of 122 homicide cases were documented. 90% of the victims were 18 to 65 years old. Males contributed 80% of the subjects. An alarming 42% of the subjects comprised of non-Malaysians. Indonesian subjects contributed one-third of the non-citizen category, followed by Bangladeshis at 20.4%. Other nationalities were Burmese, Nepalese, Pakistani, Vietnamese and unspecified. Among Malaysians, 50% of the subjects were Indians, followed by Malay (31.5%) and Chinese (17.8%). Sharp and blunt force traumas were the most common injuries found, contributing 33% and 32% respectively. Asphyxiation and firearm injuries recorded an almost similar frequency, contributing 25% in combination. Other patterns included combined sharp and blunt objects (4.9%) and burns (3%). Conclusions: A large number of immigrants in the country have significantly increased the forensic casework. Sharp and blunt objects continue to be the weapon of choice due to its easy accessibility. As domestic violence including fatal spousal and child abuse continue to rise, in-depth study in the area is warranted. Keywords: h

Anthropometric and Histologic Study of Liver and Kidney of Foetuses and Their Correlation With Gestational Age

@#Introduction: It is very important to accurately estimate the age of foetus for various medicolegal cases. This study is an attempt to establish a relationship between anthropometric measurements and histologic analysis of liver and kidney to identify gestational age of the foetus. Methods: The study was carried on 30 fetuses. Their anthropometric measurements were done using Vernier calipers. The data was statistically analyzed by computation to find out its normative value. Histologic analysis was done by preparing hematoxylin and eosin stained slides and looking under light microscope. The relationship between gestational age and data thus obtained was determined. Results: Size of liver and kidneys increased with every trimester. The kidney showed immature duct system and clustered glomeruli with lack of differentiation into cortex and medulla in first trimester. Tubular differentiation started in second trimester which finished in third trimester with formation of juxtaglomerular apparatus. Size of glomerulus was, however, maximum during second trimester, followed by first and third trimester. In liver, haemopoeisis was observed in first trimester which decreased with subsequent trimesters. Lobular differentiation increased with each trimester. However, full term liver did not have the classic lobular pattern. Size of sinusoids decreased with every trimester. Abundant fibrous tissue was observed around portal triad. Conclusion: There is a relationship between the gestational age and anthropometric measurements and histologic features of liver and kidney of the foetus. This will help in identifying foetal age as well as any congenital kidney and liver diseases.

Challenges faced in handling the medico-legal cases in a selected teaching hospital

Background: Doctor comes across certain ‘Medico-Legal’ problems at one time or the other during the practice of his/her profession. Reporting a medico legal case (MLC) is one of the legal responsibilities of all doctors to ensure that immediate action is taken by the police and maximum evidence is collected by them. This study was undertaken to assess the knowledge and attitude of the staff in dealing medico-legal case in tertiary care hospital and to find the challenges faced by them while handling the medico-legal cases.Methods: A cross sectional Study was conducted at Yenepoya Medical College Hospital, Mangalore among the Staff working in Accident and Emergency Department during the study period of 6 months.Results: The study was conducted among 116 study participants, most 108 (93.1%) were in the age group of 20-29 years and 77 (66.4%) were females. It was seen that only 3 (2.6%) of them correctly answered 17-20 questions out of 20 questions that were asked. Knowledge regarding MLC case was much high among CMO compared to others which was statistically significant with p value <0.0001. Challenges faced by the study participants were patients or the patient party not willing for MLC, delayed treatment due to the confusion, answering the court, handling the police and the violent public in few cases.Conclusions: Knowledge on dealing with MLC and a proper counseling session for patients of MLC cases can help to overcome various challenges faced while dealing with any MLC case.

Responsabilidad Médica en Chile: Fallos de la Corte Suprema de Justicia 2017 / Medical Malpractice in Chile: Rulings of the Supreme Court of Justice 2017

RESUMEN: El objetivo de este trabajo fue analizar los datos epidemiológicos y jurídicos de los casos por responsabilidad médica fallados por la Corte Suprema de Justicia chilena (CSJ) el año 2017, para relevar los escenarios de alto riesgo, aportando a su prevención. Se realizó un estudio retrospectivo, revisando los fallos de la CSJ en la base de datos electrónica del Poder Judicial chileno. Se seleccionaron y analizaron los fallos por responsabilidad médica. Se detectó un total de 61 casos por responsabilidad médica que alcanzaron la CSJ en 2017. Todos correspondieron a causas civiles. La duración promedio de los juicios fue 41,9 meses. La especialidad más demandada y condenada fue ginecología. La mayoría de las demandas y condenas afectó al Sistema Público de salud. Los casos que dan origen a las demandas son, en su mayoría, de atención de urgencias por sobre las programadas, y de tratamiento por sobre procedimientos quirúrgicos. El 54,8 % de los casos resultaron en la muerte del paciente. La mitad de los fallos condenatorios involucraba el fallecimiento del usuario afectado. Se deben investigar los factores de riesgo no sólo de la ocurrencia de mal-praxis, si no de la judicialización de los conflictos médico-paciente, especialmente en el área gineco-obstétrica, incluyendo los casos de instancias anteriores a la CSJ. Se debe investigar así mismo los factores de riesgo para la mayor propensión de los profesionales de sexo masculino de ser demandados y condenados por malpraxis médica.

ABSTRACT: The objective of the present study is to characterize the epidemiologic and juridical data for medical malpractice cases ruled by the Chilean Supreme Court (CSC) in 2017, to highlight the high risk scenarios, as a contribution to their prevention. A search of the CSC electronic database was conducted to identify and analyze CSC rulings for medical malpractice cases. In this study 61 malpractice cases ruled by CSC were identified. The CSC received only civil cases of medical malpractices during the studied period. The average duration of the trial was 41.9 months. Gynecologists faced suits and received sentences more frequently than any other type of specialist. The majority of prosecuted cases and convictions were associated with the public health system. A greater number of claims were related to emergency care than with scheduled procedures. Likewise, more claims were associated with non-surgical treatment than with surgical procedures. 54.8 % of all cases resulted in the patient's death. Half of the cases that lead to conviction, were related to the death of a patient. Risk factors should be investigated, not only of the occurrence of malpractice, but also of the judicial process of doctor-patient conflicts, especially in the obstetrics and gynecology area, including the analysis of cases of prior judicial instances. The risk factors for the higher propensity of male professionals to be prosecuted and convicted for medical malpractice should also be investigated.

Gross and Histopathological Findings in Fatalities Caused by Pulmonary Disease: An Autopsy Study

Respiratory pathologies are some of the common causes of deaths and it has been reported that in almost 1/3rd cases of sudden deaths the primary pathology may be attributable to pulmonary pathology. One of the important aspect of respiratory pathologies is that they can progress rapidly over a short period of time and in many cases these pathologies may prove to be fatal. In such cases gross and histopathological examination of lung tissue can give valuable insights into the cause of death. We conducted this prospective study to study the pathological findings in the lungs of such cases. Methods: The present study was conducted in the department of forensic medicine and toxicology of a tertiary care medical college situated in an urban area. The duration of study was 2 years. All cases of natural deaths brought for medico-legal autopsy were included in this study on the basis of a predefined inclusion and exclusion criteria. Virchow’s technique for dissection was followed in all the cases. The demographic details, gross and histopathological examination of lungs was done and findings were noted. Statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: The study consisted of a total 54 patients out of which there were 34 males and 20 females with a M:F ratio of 1:0.58. The most common affected age group was found to be between 30-40 years (22.22%). The mean age of males and females were found to be comparable with no statistically significant difference (P>0.05). Most people died within 3-7 days from time of admission (25.92%). Pneumonia was found to be leading cause of deaths in lung pathology which contributed to 74.7% cases. On gross pathology consolidation and pulmonary edema were most common findings whereas on gross as well as histopathological examination. Conclusion: Gross and histopathological examination of lung tissue in individuals dying due to natural causes can give valuable insights into the cause of death.

Ground sections of teeth: histopathological study modality

Ground sections of teeth or bone are considered best solutions for the study of any hard tissues in the study of histopathology. Various studies have been performed like progression of dental caries, enamel studies, dentin studies, cementum annulation studies, bone morphologies, age determinaton studies, etc. It is important study part in any forensic studies where mass disasters occurring as natural phenomenon of cyclonic events, earth quakes, floods and volcanic explosions and airplane accidents, industrial accidents and terror related acts. Forensic dentistry has played a vital role and many medico-legal cases are solved by studying the teeth. Ground sections study is important in any part of research. For a dentist this phenomenon is less understood, and this article brings in limelight various methods and study pattern of ground sections of teeth. With this knowledge an understanding and performing ground sections of teeth becomes a well start for dental graduates. Various other modalities in histopathology are decalcification studies, histopathological staining procedures, special stains procedures, immunohistochemistry. All the histopathological modalities have their own importance and are used appropriately in the study of oral pathology.

Abuso sexual en el paciente pediátrico / Sexual abuse in the pediatric patient

Resumen El abuso sexual infantil es la causa específica más común de violencia intrafamiliar en menores de 18 años en Costa Rica. Entre los factores de riesgo se encuentran el pertenecer a una familia disfuncional, el uso de la violencia como método de educación, la falta de educación sexual y los menores de edad con discapacidades cognitivas o trastornos del desarrollo. Los menores de edad tienden a ser víctimas abusadas crónicamente y que su reporte es tardío por lo que la valoración debe iniciarse desde que se tiene la mínima sospecha. El abordaje debe ser integral, realizando una detallada historia clínica y examen físico, así como una valoración legal y recolección de evidencia. Un sinnúmero de consecuencias sufren las víctima de abuso sexual infantil, entre ellos se encuentran los trastornos de personalidad, el trastorno de género, las enfermedades de transmisión sexual y la depresión. Si bien Costa Rica está a la vanguardia a nivel internacional en temas de derechos humanos, la incidencia de casos reportados de abuso sexual infantil ha incrementado en los últimos años por lo que es un tema que involucra a todos los actores de la sociedad para su abordaje.

Abstract Child sexual abuse is the most common specific cause of intrafamilial violence in children under 18 years old in Costa Rica. Among the risk factors are belonging to a dysfunctional family, the use of violence as a method of education, lack of sexual education, and children with cognitive disabilities or developmental disorders. Minors tend to be chronically abused victims and that their report is delayed, so the assessment should start from the moment of the slightest suspicion. The approach must be comprehensive, performing a detailed clinical history and physical examination, as well as a legal assessment and evidence collection. Countless consequences suffer the victims of child sexual abuse, among them are personality disorders, gender disorder, sexually transmitted diseases, and depression. Although Costa Rica is at the forefront of international human rights issues, the incidence of reported cases of child sexual abuse has increased in recent years, which is why it is an issue that involves all actors in society to address it.

Study of Medicolegal Aspects of Unknown Cases in P.M.C.H., Patna

Introduction: When people die and their bodies are found withno identifying documentation, it is very difficult for the police toestablish their identities. These bodies are labelled as‘unknown/unidentified dead bodies’ (UIDB). The body ispreserved in the mortuary for 72 hours, from the time it isreceived in the mortuary. If no one claims the body after 72hours the police are legally authorized to dispose of the body.The aim of study is to find incidence of unnatural deaths inrelation to the age, sex, pattern of injuries and other parameterof the unknown victims and to ascertain the root cause of alltypes of deaths.Materials and Methods: This prospective study wasconducted in the Department of Forensic Medicine andToxicology, Patna Medical College, Patna, Bihar, Indiabetween August 2012 to September 2014. All the medico legalautopsies of unknown/unidentified bodies during this periodwere included in the study. Information regarding unclaimedbodies with regard to age, sex, cause of death and manner ofdeath was sourced from the autopsy reports and the inquestpapers of the investigating officers.Results: Out of total of 5103 autopsies done 401(7.85%) wereunknown/unidentified dead persons. 342 cases (85.28%) wereof male. Incidence of unknown/unidentified death was mainly inmiddle age group (30-50yrs) (42.64%). 225 (56.10%) deathswere due to accident/injury. Major cause of death due toinjuries were polytrauma. Highest cases were seen in winterseason and lowest in Autumn. 279 cases were untreated and122 hospitalized or treated cases in total unknown cases.Conclusion: Most of the literature available were on theindividual body identification or identification of victims of massdisasters. Unknown bodies comprised 7.85% of the totalautopsy load of the department. The age group 21-40 yearswas responsible for 44.85% of total cases. Accident is animportant cause of morbidity and mortality in the study area.Males are the most affected population; the common agegroup affected is 21–40 years. However, more studies arerecommended to find the actual cause of accidents andprevalence of homelessness and its health-related effects onmorbidity and mortality, which will help in providing health carefacilities to the needy.