Heat exertion precipitating shock and death in a case of previously undiagnosed sickle-cell disease.

Sickle cell disease (SCD) is an autosomal recessive genetic condition characterized by the presence of a mutated form of haemoglobin (HbS). HbS polymerises into long needle-like fibres under low oxygen conditions, leading to the erythrocytes forming sickle shaped red blood cells. With repeated sickling, the red blood cells become irreversibly sickled and trapped within the circulation, and this leads to vaso-occlusive crisis. The patient, a 25-year-old female, previously undiagnosed with SCD, presented with high grade fever, splenomegaly and succumbed due to heat exertion precipitating sickling crisis, multiorgan failure and shock.

Male genital self-mutilation due to tomophobia - case report and review of literature.

Self-mutilation is defined as a "deliberate destruction or alteration of body tissue without conscious suicidal intent". The prevalence of self-mutilation is about 1%, however the voluntary cutting of the genital organs remains extremely rare with fewer than 100 cases of genital self-mutilation reported in both sexes in the English literature to date. Genital self-mutilation is most often associated with psychiatric disorders, but it has also been reported in nonpsychotic individuals owing to various reasons. Here, we present the case of a 45-year-old man who was found deceased in his home in a pool of blood with a knife and a pair of scissors lying next to him. In addition to this, parts of the intestine were found next to the body. The patient was diagnosed with hydrocoele and had a known history of tomophobia which caused him to take matters into his own hands by incising his scrotum which led to his demise. Self-orchidectomy is an extremely rare phenomenon and is most often associated with psychiatric illness.

Violence against healthcare personnel in India: Covid-19 prompts stricter laws.

During the past 10 years, the "Prevention of Violence Against Medicare Persons and Institutions Act" has failed to achieve its object. With the advent of the pandemic, stricter measures were taken and on 22 April 2020, all acts of violence against healthcare personnel confronting the Covid-19 pandemic became "cognizable and non-bailable offences" by means of the Epidemic Diseases (Amendment) Ordinance, a direct statement from the Government of India that there would be zero tolerance for violence against its health care workers. The Amendment aims to fill gaps in the previous law which did not protect healthcare workers against occupational violence at the workplace and at home. The amendment of the Ordinance will have a positive impact on the medical community which is much needed, particularly during the pandemic.

New laws ban commercial surrogacy in India.

Surrogacy is a controversial issue and most particularly when well-known celebrities have used it. It is a boon for couples where normal pregnancy is not possible but can be used for commercial exploitation. The Government of India passed a law on surrogacy in December 2018, which introduced many changes to the pre-existing rules, in particular, it bans commercial surrogacy and curtails the freedom of foreigners to apply for surrogacy in India. This has dealt a major blow to the agencies who organised surrogacy for foreigners. A key reason for passing this law was the unjust treatment of the women who provided surrogacy services. They had poor living conditions and often failed to receive the money that was paid by the intended parents to the agency.2 There are some countries where commercial surrogacy is legal, including some states in the United States of America, Poland, Russia and many others.3 Some surrogate mothers suffer complications from the assisted reproductive technologies used; these mainly include ectopic pregnancy, psychological stress and ovarian hyper stimulation syndrome.4 Same sex couples, single parents and even infertile women should be encouraged to adopt children.

Abortion of Fetus with Down's Syndrome: India Joins the Worldwide Controversy Surrounding Abortion Laws.

Abortion continues to be a moral and ethical dilemma in medicine. While abortions in general have always faced social stigmas, the abortion of fetuses with Down's syndrome in particular remains the subject of debate across the globe. In India, under the Medical Termination of Pregnancy Act, abortion is legal under prescribed circumstances only till 20 weeks of gestation. Laws for abortion after 20 week of gestation are ill defined. In a recent ruling of the Supreme Court in India, a woman was denied the right to abortion of her 26 week old fetus. With this ruling, India has joined the rest of the world in the debate surrounding abortion laws and the ethics of abortion.

Sudden unexpected death due to strangulated inguinal hernia.

Sudden unwitnessed, unexpected deaths when the bodies are found in public places require a complete and meticulous medicolegal autopsy to ascertain the cause and manner of death to avoid further unnecessary investigations by the legal authorities. Such deaths attributed to gastrointestinal causes at autopsy are relatively uncommon. We report a case of sudden unexpected death due to strangulated inguinal hernia in a 60-year-old man. The body was discovered in a public area near a place of worship. The present case illustrates a potentially preventable sudden unexpected death due to a surgically correctable gastrointestinal condition. In the present case, the individual feared being hospitalised for treatment of his scrotal swelling with potential surgery and the eventual loss of daily income. In our opinion, such apprehensions may have delayed the potentially life-saving hospital surgical intervention in the individual.

Deaths among women of reproductive age: a forensic autopsy study.

Unnatural deaths in women of reproductive age (range 12-49 years) have a serious psychological and social impact on the family and community. Deaths among women of reproductive age reported as medico-legal cases were investigated to see the trend in terms of cause and manner of death. The study group consisted of a series of 328 consecutive forensic autopsies on women in the reproductive age group, performed between 2009 and 2011 at the Government Wenlock District Hospital, Mangalore, India by qualified specialist forensic medicine experts. Unnatural deaths formed 93.6% of the cohort. The top three causes of death included burns, poisoning and hanging forming 69.5% of the cases. The manner of death was suicide in 45.4% cases, accident in 43.6% cases and homicide in 4.6% cases. The circumstances of death were related to alleged medical negligence in 2.4% cases. Death in 4% cases was natural mannered with a disease being the cause of death. Three-fourths of the victims were married. Married women formed 63.1% of the suicidal victims. Homicidal deaths were not reported among unmarried women. The preponderant method of suicide was by poisoning at 42.3% (63 cases), followed by hanging (34.9%), burns (11.4%) and drowning (9.4%). These four methods comprised 98% of the total suicidal deaths in this study cohort. Accidental deaths were predominantly caused by burns (62.2%) and road traffic accident (23.1%). Two-thirds of the homicidal deaths were due to assault caused by blunt-force trauma, ligature strangulation and sharp-force trauma. One-third of the homicidal victims died due to burns. With a clear understanding of the cause and manner of death, it may be possible to predict, and hopefully prevent, future cases of unnatural deaths in women of reproductive age who form a very important group of society.

Acanthosis Nigricansin PCOS Patients and Its Relation with Type 2 Diabetes Mellitus and Body Mass at a Tertiary Care Hospital in Southern India.

BACKGROUND: Acanthosis nigricansis was viewed recently as a possible marker of an increased risk for diabetes. Acanthosis Nigricans (AN) can help in identifying the patients with an increased risk for Type 2 Diabetes Mellitus (T2DM) among Polycystic Ovary Syndrome (PCOS) cases. Hence, this study was carried to know the prevalence of AN in PCOS and its correlation with diabetes mellitus and the body mass. METHODS: A prospective, longitudinal study in the patients with PCOS, who attended the Department of Medicine, Kasturba Medical College [KMC] Hospital, Attavar, Mangalore, Karnatka, India between December 2008 to April 2010, was carried out. A total of 119 patients with PCOS were included in the study. A complete history, along with the demographic data of the patients who were aged between 15-35 years, were considered for the analysis. RESULTS: AN was observed in 56% of the PCOS patients. The Body Mass Index (BMI) and the waist circumference were significantly higher in the PCOS patients with AN, as compared to those without AN. Among the 119 PCOS patients,77% were found to have BMI values which were above the normal. Among the obese PCOS patients, 58% had BMI values of more than 30kg/m(2) as compared to 19% of the patients who did not have AN. Type 2 DM was observed in 77% of the PCOS patients with AN, while none of the PCOS patients were found to be diabetic among those without AN. A family history of DM in the first degree relatives was present in all the patients with AN. The results were analyzed by the Mann Whitney U test for the continuous data and by the Chi square test for the categorical data. CONCLUSION: The PCOS patients who had a family history of diabetes and obesity with a body mass index of more than 30 kg/m(2) and a waist circumference of ≥ 90 cm were more likely to develop AN, which is a marker of hyperinsulinaemia and insulin resistance. Identifying such PCOS patients will stimulate the discussions of the lifestyle modifications in the primary care setting.

The Mangalore aircrash of 22 May 2010: practical problems related to identification of the dead in a populous developing country.

It was a sad and emotional moment for the citizens of Mangalore, India when the "Dubai to Mangalore" Air India Express Boeing 737-800 flight IX-812 crashed at the Mangalore International Airport on 22 May 2010, killing 158 people on board. Identification of the victims was difficult as most of the bodies were charred beyond easy recognition. The practical problems faced by the legal authorities in identifying the charred victims in a populous and developing country like India are discussed in this paper.

"Atypical Suicidal" cut throat injury--a case report.

Suicide is one of the leading causes of death in the world. The incidence and pattern of suicide vary from country to country. Cultural, religious and social value plays a vital role. Hanging, poisoning, drowning are the common methods of committing suicide. Suicide by incising one's own throat without hesitation marks remains a rare, and only few cases have been reported in the forensic literature. We present here an unusual and rare case of self-inflicted cut throat injury of a 45-year old ex-military man without tentative cuts over the neck, which has resulted from a curved sharp weapon.