Implementation of Competency-based Medical Education in Forensic Medicine and Toxicology in Indian Medical Education — A Viewpoint on Challenges and Way Forward

The changing disease burden, living conditions and anticipations of end-users in health care have resulted in the decision of regulatory bodies in the Indian medical education system to shift the MBBS curriculum from Traditional to Competency-Based Medical Education (CBME).The efforts taken by the National Medical Commission (NMC) erstwhile Medical Council of India (MCI) to successful implementation of the herculean task of shifting curriculum are praiseworthy. MCI initiated a National Faculty Development Programme (FDP) in 2009 in all medical colleges under its ambit.MCI started with five regional centres, which now expanded to 22 centres, out of which 12 are regional centres, and 10 are advanced nodal centres. Nearly 44932 faculties were trained till December 2018. Despite all the advantages of CBME & the efforts taken up by governing bodies, there are many challenges. Some are common for all subjects, but few are unique or specific to a subject. This article views the possible challenges and the way forward for the successful implementation of CBME in Forensic Medicine and Toxicology.

Laws Related to Environmental Protection vis-a-vis Hospital Induced Environmental Toxicity

Hospitals are reservoir of infected organisms and toxins. It is must to ensure minimum exposure to patients, public and staff to avoid spread of toxicity. Hospitals are also generating solid, liquid and gaseous waste which in turn produces environmental toxicity if not dealt with properly. To manage hospital and to avoid hospital induced environmental toxicity, it is necessary to know and follow various laws of environmental protection like The Environment Protection Act, 1986; The Environment (Protection) Rules, 1986; Bio-Medical Waste Management Rules, 2016; Manufacture, Storage and Import of Hazardous Chemical Rules, 1989; Municipal Solid Waste (management and handling) Rules, 2000; Environmentally Sound Management of Mercury Waste in Healthcare Facilities Rules, 2008; Water (Prevention and Control of Pollution) Act, 1974; The Air (Prevention and Control of Pollution) Act, 1981; Manufacture, use, import export and storage of hazardous microorganisms, genetically engineered microorganisms or cells rules, 1989; etc. Brief knowledge about above laws and consequences of violating such rules are important for every health sector like clinics, nursing homes, pathology laboratory, forensic laboratories, AYUSH hospitals, camps, research laboratories etc. In this review, we just touch upon various rules and its importance in relation to hospital set up. Green and clean environment is our necessity and health sector has to comply it.

Comparison of peripheral blood smear and automated cell counter in 100 cases of anemia

Background: Hemogram/ Complete Blood Count (CBC), performed on hematology analyzers, is one the most commonly ordered blood test in clinical practice especially in patients presenting with fever. The aim of the present study was to compare accuracy of RBC histograms shown by our 5 part cell counter to that of microscopy examination of blood film stain by field stain. Materials and methods: The present observational study was conducted during June 2020 - August 2020. Samples were run on 5 part hematology analyzer. Population of both anemic and healthy individuals in the age group 0-60 years were evaluated for the study. Total 100 patients in the age group of 0- 60 years were enrolled in this study. Hematological parameters were obtained by using 5 part automated hematology cell counter. The hemoglobin concentration and red blood cell (RBC) indices, encompassed mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) and erythrocyte count. Results: We studied 100 blood samples of patients. Among them 82 cases showed correlation between histogram to that of the peripheral blood smear examination.Conclusion: The result of the study shows that the automated hematology analyzer are appropriate for screening purposes because it increases the turnaround time and reduces the labor cost. But to diagnose and differentiate different types of anemia manual scan of peripheral smear is a method of choice.

Histopathological study of dermal granuloma

INTRODUCTION:The objectives of this study were to confirm the diagnosis of clinically suspected dermal granuloma- tous diseases by histopathological examination and by routine and special stains as well as to study the incidence of various types of dermal granulomas.MATERIALS AND METHODS:This study was conducted at the Department of Pathology in collaboration with De- partment of Skin and Venereal disease. A total of 90 cases from outdoor patient department of skin and venereal disease, which were clinically diagnosed as suspected dermal granulomatous diseases, were taken as the study population.RESULTS:In our study, we found that leprosy had the highest incidence (50%), followed by cutaneous tuberculosis (30%) among all dermal granulomatous diseases like syphilis, fungal, granuloma annulare, foreign body, actino- mycosis, and sarcoidosis. Dermal granulomas were most common in middle age between 21 and 40 years of age.CONCLUSION:Histopathology played an important role in the final diagnosis of dermal granulomatous lesions. Most common dermal granulomatous disease was leprosy, followed by cutaneous tuberculosis.

Study of ocular manifestation of snake bite at tertiary care hospital, Valsad

Introduction: All over the world, cases of snake bite via poisonous snakes are common and as India is a tropical country great variety of snakes are present. Almost 60,000 people are bitten by snakes every year in India with a mortality rate of almost 25%. Various ocular manifestations like angle closure glaucoma, optic neuritis, external ophthalmoplegia and vitreous hemorrhage following snake bite may result in blindness. The present study was conducted with an aim to study various ocular manifestations of snake bite among cases came to tertiary care hospital, Valsad. Materials and methods: Total 100 cases were included with history of snake bite with ocular manifestations over a period of 2 years from January 2015 to December 2017 from records at tertiary care hospital, Valsad. Detail history and complete ophthalmologic examination findings of every case were taken for study. Results: Out of 100 cases, 78 were male and 22 were female. Maximum cases (26%) were in age group of 41-50 years while least cases (4%) were in age group of < 10 years. Most common snake was viper (71%) unknown (17%) followed by cobra (12%). Most common ocular manifestation was subconjunctival hemorrhage (70%), followed by acute anterior unveitis (32%). Least common finding was external ophthalmoplegia (12%). Conclusion: Subconjunctival hemorrhage is the most common finding in snake bite case with ocular manifestation. Male are more prone to snake bite and cases are common in age group of 41-50 years.

Pattern of ocular injuries at tertiary care hospital, Valsad

Background: Ocular injury is the most common cause for visual morbidity and blindness and should not be neglected at all. Materials and methods: A retrospective study was conducted at GMERS Medical College, Valsad on patients who came to Ophthalmology Department from January 2015 to December 2016 for period of 2 years. Outdoor as well as indoor patients were included in the study with history of ocular injury. Data were collected from clinical records and analyzed to study pattern of ocular injuries. Results: Total 100 cases were studied, out of which 74 were male and 26 were female with history of ocular injury. Maximum numbers of patients were in age group of 21 to 30 years. Road traffic accidents were the most common cause of ocular trauma among all patients. Conjunctival hemorrhage and scleral hemorrhage were more common among all. Conclusion: This study showed that road traffic accidents were the commonest causes of ocular injuries and conjunctival hemorrhage was the most common type of ocular injury.

Reconstruction of crime – A review.

Reconstruction of crime is very much essential to solve any mystery for police and investigative agencies. Correlation of victim, accused, weapon of offence, scene of crime, human behaviour, environmental evidences etc. are very important for the same. A crime reconstruction must require keen observation, understanding of science, recognition of evidences, and application of critical thinking with logic.

Lessons in medical ethics from ancient Indian teachers.

Age of medicine is as old as the age of human on the earth. The doctor today is a scientist, technologist and healer at the same time. The ethics germane to the medical profession can’t be simple and uniform. Nor is the ethics simply a matter between the doctor and the patient; the society with its entire economic and political dimension is involved in much bigger way. Certain basic traditional thoughts given by ancient Indian teachers like Hippocrates, Charaka, Sushrutha and Vagbhata are still become relevant. Medical ethics in the medical curriculum, must be included not as a normative discipline but as a practical course with its own problems and considerations. As per Indian outlook, the role of ethics is certainly vast and varied, from treating a common cold, to the controversy on euthanasia, from the simple obligations of a family doctor, to the specialist services in the high cost, high technology five star nursing homes.

Demographic profile of Aluminium phosphide poisoning in Gandhinagar, Gujarat.

Background: Poisoning is an important cause of unnatural death, next to road traffic accidents in India even today. Incidence of aluminium phosphide poisoning is increasing day by day in western region of India including Gujarat. Demographic profile of aluminium phosphide poisoning cases is very helpful to be aware of current scenario and to implement preventive steps for betterment of health services. Objectives: The present study was undertaken to know the demographic profile of aluminium phosphide poisoning cases received as indoor or outdoor patient department of Gayatri Hospital, Gandhinagar, Gujarat, India. Material and methods: History taking, complete examination and necessary investigations of all cases of aluminium phosphide poisoning cases is very helpful to be aware of current scenario and to implement preventive steps for betterment of health services. Objectives: The present study was undertaken to know the demographic profile of aluminium phosphide poisoning cases received as indoor or outdoor patient department of Gayatri Hospital, Gandhinagar, Gujarat, India. Material and methods: History taking, complete examination and necessary investigations of all cases of aluminium phosphide poisoning was done, during the period of two years from 01-01-2012 prevalence of age and sex, socio-economic status, marital status, religion, literacy status, occupational status, time of consumption, manner of poisoning, reasons for suicidal consumption etc. Results: During the study period, 40 cases were diagnosed as of aluminium phosphide poisoning. Majority of the victims were in the age group of 41-50 years (25%), 70% were married, 80% were Hindu, 65% were of lower socio economical class and 57.5% belonged to rural area. Occurrence of aluminium phosphide poisoning was more common in evening time between 5 pm to 11 pm (45%) and among housewives (27.5%). Suicidal cases (82.5%) were more common compared to others. Conclusion: Based on these finding, preventive measures like restriction of sale and availability of aluminium phosphide, good availability of investigation and treatment, promoting poison information centre etc have been put forward.

Study of various cardiac arrhythmias in patients of acute myocardial infarction.

Background: Myocardial infarction is one of the major causes of sudden death in present era and cardiac arrhythmias are common complications of it. Material and methods: Present study was conducted at intensive coronary care unit (I.C.C.U) of tertiary care hospital, Ahmedabad on 100 cases of acute myocardial infarction to study the incidence of arrhythmia and their nature in relation with the site of infarction and to evaluate prognostic value of arrhythmias in Acute Myocardial Infraction (AMI). Results: Incidence of various arrhythmias was 76% in present study. S. tachycardia was more common (68%) than S. bradycardia (19%). S. tachycardia and tachyarrhythmia occurred more commonly with anterior wall myocardial infarction, while S. bradycardia and bradyarrhythmia with inferior wall myocardial infarction. Conclusion: Study of incidence of various cardiac arrhythmias, their nature and relation to site of infarction as well as prognostic value in patients of acute myocardial infarction proper treatment.

Nature helps to solve the crime â Diatoms study in case of drowning death.

Nature is everywhere surrounding us in different form. It includes single cell structure to extremely complex, living or non living, substance or creature. One of the important part of nature is diatom - submersion of body into water is known since ages. Diatoms study in case of drowing death is very useful for forensic investigators. It is one of the best example in which nature helps to solve the crime. In present article, we discussed about diatoms, diagnosis of drowning death and length of submersion of body in water with help of diatoms, collection, identification and preservation of diatoms for forensic analysis.

Forensic onychology: An essential entity against crime.

Forensic Onychology (Greek word, Onuks = nail, Logia = study of) is the subject which deals with study of fingernails and toenails for better administration of justice in the court of law. Identification means determination of individuality of a person. Nails are important tissues for human identification. One of the major advantages of utilizing nail is that, in comparison with other tissues, sample size and sampling process can be considered relatively non invasive and non destructive and yet each nail retains a discrete record of detailed information on genetic inheritance, drug use, pathology, diet and location history as well as exposure to explosives residues or other pollutants. In contrast to soft tissues, nails survive relatively well in the decomposition environment. Furthermore, in contrast to other long lasting tissues (such as bone and teeth) nails are easy to decontaminate from external sources of DNA. Thus examination of nail is very useful in many ways against crime. In this paper, we discussed about structure and method of analysis of nail, utility of examination, drug use and nails and detection of DNA from nails.

Fine needle aspiration cytology of swellings of head and neck region.

Head and neck mass lesions are frequently found in clinical practice. A spectrum of pathological lesions ranging from simple benign lesion to highly malignant manifestation is observed. Objectives: To make clinicopathological correlation of head and neck lesions and to assess the frequency of incidences of different sites, age groups, sex, and distribution among inflammation and neoplastic lesion. Materials and Methods: A retrospective study was conducted from January 2011 to April 2012. Fine-needle aspiration diagnosis was correlated with details of relevant clinical findings and investigations. Patients aged between 1 and 70 years were included in the study. A total of 200 patients with the swellings of head and neck underwent fine-needle aspiration cytology (FNAC). Results: Out of 200 fine-needle aspiration procedures, 52% were of thyroid, 28.50% were of lymph node, 11% from salivary gland, and 4% from soft tissue and miscellaneous swellings. There were 4.5% cases in which diagnosis was not possible. In inflammatory swelling (33%), tuberculous lymph node (42.12%) involvement is common than all other sites with male preponderance (55%). Conclusion: FNAC is a simple, quick, inexpensive, and minimally invasive technique to diagnose different types of head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.

Voice fingerprinting: A very important tool against crime.

In the recent world of technology, there are many methods to determine the individuality of a person. One of them is the voice – unique individual characteristic. Each person‘s voice is different because the anatomy of the vocal cords, vocal cavity, oral and nasal cavities is specific to the individual. Comparison of two recorded speech by means of spectrogram or voice prints for the purpose of identification is called as Voice fingerprinting. Forensic voice analysis has been used in a wide range of criminal cases such as murder, rape, drug dealing, bomb threats and terrorism. Investigator has two complementary ways of making identification through voice analysis. First, he or she will listen to the evidence sample and the sample taken from the suspect, comparing accent, speech habits, breath patterns and inflections. Then a comparison of the corresponding voiceprints is made. In this paper we discussed about the history of sound spectrogram, basic method of recording the voice & comparison, its utility in the solution of crime & admissibility in the court of law.