Medico-legal autopsies after sunset: Ethical issues

From the British era, regular medico-legal autopsies have never been done in India after sunset, except for those specially permitted by the law enforcement agencies. The Ministry of Health and Family Welfare, Government of India, issued a notification on November 15, 2021, regarding the “Conduct of post-mortem in hospitals after sunset”. This has given rise to much debate on whether post-mortems can be conducted after sunset in an ethical manner. Here, we briefly discuss the various issues related to the carrying out of post-mortems after sunset in India.

Histopathological analysis of hysterectomy specimens

Background: Uterus is prone for various non-neoplastic and neoplastic lesions and also hysterectomy is the most common gynecological surgery indicated as a definitive treatment. Grossly unremarkable many specimens may reveal pathologies on histological examination. Hence, all hysterectomy specimens must undergo proper histopathological examination. In our study, hysterectomy specimens were studied and results compared with their clinical diagnosis. Aim and Objective: The objectives of the present study were to know the frequency and incidence of various lesions of the female genital tract and to compare findings of the present study with other studies. Materials and Methods: The study was a retrospective analysis of 250 hysterectomy specimens. All types of hysterectomies such as vaginal, abdominal, laparoscopic, and total abdominal hysterectomy without or with unilateral/bilateral salpingectomy/salpingo-oophorectomy were included in the study. Histopathological examination was done minimum by two faculty members. The results were noted and statistical analysis was done. Results: Total 250 hysterectomy specimens were studied. Vaginal hysterectomy was the most commonly performed type of hysterectomy which includes 187 cases (74.8%) out of 250 cases. Among the uterine pathologies, the most common lesion was leiomyoma (34.4%) followed by adenomyosis (26%). In our study during histopathological examination of cervix, the most frequent cervical lesion was found chronic cervicitis in 50.4% of cases. Conclusion: The present study highlights the wide spectrum of lesions of female genital tract and conveys that histopathology remains the primary modality for confirmation of diagnosis of lesions. We can conclude from the present study that many lesions had been diagnosed on microscopic examination though normal gross examination. Hysterectomy specimen should undergo proper histopathological examination, because it is the gold standard tool for final diagnosis.

Covid-19 vaccination for children in India: Queries and Clarifications regarding consent.

The Government of India initiated the COVID-19 vaccination for children in the age group of 15 -18 years on January 3 rd 2022. Although this was a much-awaited phase of vaccination, the parents, health care workers and the organizations dispensing the vaccines had many doubts and concerns regarding consent and liability for adverse effects, especially in this age group. There are no clear cut guidelines issued by the Ministry of Health & Family Welfare, Government of India on this subject. In this article, we elaborate on the various aspects of consent, particularly consent for vaccination, which is being followed in our country. By analyzing the related sections in the Indian Penal Code and prevalent practices in our country regarding consent, we endeavour to answer frequently encountered questions.

Knowledge, attitude and practice (KAP) of general population of Vadodara towards diabetes mellitus

Background: In today’s era lifestyle related diseases like diabetes mellitus, have emerged as a major public health problem. Diabetes mellitus, a common metabolic disorder, which accounts for a high incidence of morbidity leads to various events including micro and macro vascular complications. This study aims to assess the baseline levels of (KAP) knowledge, attitude and practices of general population of Vadodara. Materials and methods: The present cross sectional study was carried out on general population of Vadodara with the help of a suitably designed and validated KAP questionnaire. The questionnaire was pretested and verified for errors. The data was analyzed statistically. Results: Altogether, 60.12 % of respondents scored 100% in the questions related with knowledge. However 23.54% scored 100% in the attitude questions and12.80% scored 100% in practice questions. Conclusions: We can conclude that the responders had good knowledge but poor attitude and practice towards diabetes. We can overcome this by increasing quality of health education and improving applicability of scope of health education at all level.

Study of students perceptions regarding knowledge and attitude towards torture

Background: Torture and violence are associated with humans since beginning. Torture is one of the most extreme forms of human violence, resulting in both physical and psychological consequences. Materials and methods: Present study was conducted among total 113 students of 2nd MBBS after obtaining their informed written consent. All student participants were subjected to pre-tested and prevalidated questionnaire regarding torture which contained total 13 multiple choice type questions, out of which 8 questions were related to knowledge while 5 questions were related to attitude. Results: Age of participants was varied from 19 to 22 years with a mean of 21.25 years with male: female ratio of participants was 5.5:1. Among knowledge questions, 88% had given correct answer of meaning of term torture, 56% had given correct objectives of torture, 66% had given correct types of torture, 73% had given correct answer of commonest form of physical torture, 61% had given correct answer of commonest form of sexual torture, 59% had given correct answer of commonest form of psychological torture, 52% had given correct answer regarding laws related to torture and 79% had given correct role of National Human Right Commission in torture. Among attitude questions, 43% had agreed that beating in police custody to elicit confession is proper while 42% were undetermined, 88% had agreed that awareness of torture medicine by general medical practitioner is required, 79% had agreed that inclusion of torture medicine in undergraduate medical curriculum is required, 61% had agreed that teaching is torture medicine to paramedical branches is required and 69% had agreed that punishment of torture should be increased. Conclusion: Knowledge and attitude regarding torture among medical students give an idea for future planning of curriculum for betterment of subject.

Pattern of Lip Print among Undergraduate Students: A Forensic Anthropological Study

Background: Scientific study of lip prints as lines and fissures in form of wrinkles and grooves on labial mucosal surface of upper and lower lip which developed since sixth week of intra uterine life is called as Cheiloscopy. Materials and methods: The present study was done among total 121 2nd MBBS students after obtaining their informed written consent and ethical approval. Lip prints were collected, developed and analyzed with use of red/pink lipstick (Persona®: non-metallic, non-glossy, non-persistent), white paper, cellophane tape, scanner, hand magnifying glass, scissors, Adobe Photoshop CS5 Software etc. Results: Out of 73 male students, most common lip pattern was II (branched) in 45.21%, followed by I (long vertical) in 27.4%, IA (short vertical) in 15.6%. Out of 48 female students, most common lip pattern was II (branched) in 44.64%, followed by I (vertical) in 25.62%, IA (short vertical) in 13.22%. Out of total 121 students, most common lip pattern was II (branched) in 44.64% and least common was V (mixed indefinite) in 1.65%. Conclusion: It was found that type II (branched) was most common type of lip print observed among students while type V (mixed indefinite) was the least common among students.

Prevalence of anemia in patients with Type 2 Diabetes Mellitus at Gandhinagar, Gujarat, India

Introduction: Anemia is a common finding in diabetes. Number of factors contributes to an increased prevalence of anemia in diabetes. Aim: To determine the prevalence of anemia in our patients with diabetes. Material and methods: The present study was conducted at the Gayatri Hospital, Gandhinagar. The subjects for the study included 200 adult patients with age more than 30 years and having diabetes mellitus type 2, attending the outdoor patient department (OPD) or admitted in ward as indoor patient department (IPD) of Gayatri Hospital. Blood specimens were collected and processed for determination of blood glucose, serum creatinine, and hemoglobin, HbA1C. Results: Anemia was present in 18% patients of diabetes. The prevalence of anemia was almost similar between women (18.60%) and men (17.54%). 74% of anaemic patients had a serum creatinine <110 μmol/l and 72% of anaemic patients had a calculated creatinine clearance of >60 ml/min. Conclusion: Every fifth individual in a population of diabetes mellitus could be anemic. Identifying and treating anemia would make a great impact in managing various complications of diabetes mellitus.

Perceptions of patients towards euthanasia A medico-legal perspective

Background: Euthanasia is a matter of debate since its origin and till now. Few countries have proper legislation for the same while in India, the matter is always remain unnoticed. Present study was aimed to analyze perceptions of patients towards euthanasia. Materials and methods: A cross sectional study was conducted among 107 patients after obtaining their informed written consent for participation in the survey regarding euthanasia and its medicolegal perspectives. All patients were subjected to pre-tested and validated questionnaire (Likert type scale) related to euthanasia after obtaining their socio-demographic details. Results: Out of 107 responses, only 100 responses were considered for analysis and rest of 7 were discarded. Out of 100 patients, maximum (33%) were in between 31 to 40 years of age, 66% were male, 82% were Hindu, and 71% were married. 51% were agreed that person should be kept alive as long s possible regardless of his age, disease, disabilities and personal preferences. 40% believed that supporting death with dignity means supporting active and passive euthanasia. 61% suggested that freedom of choice also applicable to freedom of choice to live or die. 55% disagreed that some patients should be allowed to die instead of making heroic efforts to prolong their lives. 73% believed that demanding or helping in euthanasia is crime. 52% were unsure regarding legalization of euthanasia. 78% believed that legalization of euthanasia may create moral and ethical problems. Conclusion: Perceptions of patients were varied but conclusion can be drawn that many of them believed that legalization of euthanasia may create moral and ethical problems.

Consent in medical practice Perceptions of patients towards legal aspects of informed consent.

Background: Informed consent is way of providing necessary information to the patients and helping them for decision making. All the pros and cons of procedure must be explained to the patients in the language he or she can understand. Just taking signature of patient on consent form without proper explanation and understanding of him is violating entire process of informed consent. Materials and methods: A cross sectional, observational study was conducted over 121 patients aged 18 years and above who came to Gayatri Hospital, Gandhinagar after obtaining their informed written consent for participation in survey regarding informed consent. All participants were subjected to pretested and validated questionnaire (Likert type scale) regarding legal aspects of informed consent. Results: Out of 121 participants, only 100 participants’ responses were included for analysis. Among 100 participants 73 were male and 27 were female. 78% agreed that informed consent is must for any procedure. 61% agreed that signing consent form is just a formality. 91% believed that informed consent is protective shield for doctors. 88% believed that informed consent is legally necessary. Only 52% agree that consent form is meant to protect patients’ rights. 77% felt that signing consent form Parmar P, Rathod GB, Rathod S, Parikh A. Consent in medical practice – Perceptions of patients towards legal aspects of informed consent. IAIM, 2016; 3(4): 105-110. Page 106 eliminate patients’ right to compensation. 82% wanted to know everything but letting decision left on doctor. Conclusion: The study concluded that there is a vide gap between actual concept of informed consent and perceptions of patients for the same. Patient awareness programs must be conducted by appropriate authority with help of media and television to improve their knowledge and preserve their rights.

Study of innovative teaching methods to enhance teaching and learning in Forensic Medicine.

Background: Didactic lecture is the current method of choice but it is not effective way of teaching. Interactive lecture with various innovative teaching methods is the best proven way for teaching and learning. Material and methods: Cross sectional study was conducted in Department of Forensic Medicine for period of 1 year by voluntary participation of 100 students 2nd MBBS. Three topics of Forensic Medicine were taught by jigsaw, think-pair-share and team project to three equal number groups of students and they were subjected to pre and post intervention questionnaire. Results: There was significance increase in mean post test score for all the innovative teaching methods for all topics. There was no significance difference in mean post test scores of all three innovative teaching methods which indicated that all three innovative teaching methods were effective and good to practice. Conclusion: Instead of didactic lecture, interactive lecture with innovative methods like think-pair-share, team project , and jigsaw is a very helpful and essential for effective teaching and learning.

Is ultrasonography essential before surgery in eyes with advanced cataracts?

BACKGROUND: Ultrasonography is an important tool for evaluating the posterior segment in eyes with opaque media. AIM: To study the incidence of posterior segment pathology in eyes with advanced cataract and to see whether certain features could be used as predictors for an abnormal posterior segment on ultrasound. SETTING: Tertiary care hospital in South India. METHODS AND MATERIALS: In this prospective study conducted over a 6-month period, all eyes with dense cataracts precluding visualization of fundus underwent assessment with ultrasound. Presence of certain patient and ocular "risk" factors believed to be associated with a higher incidence of abnormal posterior segment on ultrasound were looked for and the odds ratio (OR) for posterior segment pathology in these eyes was calculated. RESULTS: Of the 418 eyes assessed, 36 eyes (8.6%) had evidence of posterior segment pathology on ultrasound. Retinal detachment (17 eyes; 4.1%) was the most frequent abnormality detected. Among patient features, diabetes mellitus (OR= 4.9, P= 0.003) and age below 50 years (OR= 15.4, P= 0.001) were associated with a high incidence of abnormal ultrasound scans. In ocular features, posterior synechiae (OR= 20.2, P= 0.000), iris coloboma (OR= 34.6, P= 0.000), inaccurate projection of rays (OR= 15.1, P= 0.002), elevated intraocular pressure (OR= 15.1, P= 0.004) and keratic precipitates (OR= 22.4, P= 0.004) were associated with high incidence of posterior segment pathology. Only four eyes (1.5%) without these features had abnormal posterior segment on ultrasonography. CONCLUSIONS: Certain patient and ocular features are indicative of a high risk for posterior segment pathology and such patients should be evaluated by ultrasonography prior to cataract surgery. In the absence of these risk factors, the likelihood of detecting abnormalities on preoperative ultrasonography in eyes with advanced cataracts is miniscule.