Regional sources of NH3, SO2 and CO in the Third Pole.

The Third Pole (TP) is a high mountain region in the world, and is well-known for its pristine environment, but recent development activities in the region have degraded its air quality. Here, we investigate the spatial and temporal changes of the air pollutants ammonia (NH3), sulphur dioxide (SO2) and carbon monoxide (CO) in TP, and reveal their sources using satellite measurements and emission inventory. We observe a clear seasonal cycle of NH3 in TP, with high values in summer and low values in winter. The intense agriculture activities in the southern TP are the cause of high NH3 (6-8 × 1016 molec./cm2) there. Similarly, CO shows a distinct seasonal cycle with high values in spring in the southeast TP due to biomass burning. In addition, the eastern boundary of TP in the Sichuan and Qinghai provinces also show high values of CO (about 1.5 × 1018 mol/cm2), primarily owing to the industrial activities. There is no seasonal cycle found for SO2 distribution in TP, but relatively high values (8-10 mg/m2) are observed in its eastern boundary. The high-altitude pristine regions of inner TP are also getting polluted because of increased human activities in and around TP, as we estimate positive trends in CO (0.5-1.5 × 1016 mol/cm2/yr) there. In addition, positive trends are also found in NH3 (0.025 × 1016 molec./cm2/yr) during 2008-2020 in most regions of TP and SO2 (about 0.25-0.75 mg/m2/yr) in the Sichuan and Qinghai region during 2000-2020. As revealed by the emission inventory, there are high anthropogenic emissions of NH3, SO2 and CO within TP. There are emissions of pollutants from energy sectors, oil and refinery, agriculture waste burning and manure management within TP. These anthropogenic activities accelerate the ongoing development in TP, but severely erode its environment.

A gradual increase of aerosol pollution in the Third Pole during the past four decades: Implication for regional climate change.

We analyse the long-term (1980-2020) changes in aerosols over the Third Pole (TP) and assess the changes in radiative forcing (RF) using satellite, ground-based and reanalysis data. The annual mean aerosol optical depth (AOD) varies from 0.06 to 0.24, with the highest values of around 0.2 in the north and southwest TP, which are dominated by dust from Taklimakan and Thar deserts, respectively. However, Organic Carbon (OC), Black Carbon (BC) and sulphate aerosols have significant contributions to the total AOD in the south and east TP. High amounts of dust are observed in spring and summer, but BC in winter. Trajectory analysis reveals that the air mass originated from East and South Asia carries BC and OC, whereas the air from South Asia, Central Asia and Middle East brings dust to TP. Significant positive trends in AOD is found in TP, with high values of about 0.002/yr in the eastern and southern TP. There is a gradual increase in BC and OC concentrations during 1980-2020, but the change from 2000 is phenomenal. The RF at the top of the atmosphere varies from -10 to 2 W/m2 in TP, and high positive RF of about 2 W/m2 is estimated in Pamir, Karakoram and Nyainquentanglha mountains, where the massive glacier mass exists. The RF has increased in much of TP during recent decades (2001-2020) with respect to previous decades (1981-2000), which can be due to the rise in BC and dust during the latter period. Therefore, the positive trend in BC and its associated change in RF can amplify the regional warming, and thus, the melting of glaciers or ice in TP. This is a great concern as it is directly connected to the water security of many South Asian countries.

Multi-drug Resistant and Extended Spectrum ß-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples.

Background Emergence of antibiotic resistance among microbes contaminating the fresh meat products is a global public health concern as they can be easily transmitted to humans through their consumption and contact. Objective The current study was conducted to determine the distribution of antimicrobial resistance among Salmonella species isolated from fresh chicken liver samples with special emphasis on extended spectrum beta-lactamase (ESBL) production. Method A total of 200 fresh chicken liver samples were cultivated for the isolation of Salmonella and further subcultivated to detect extended spectrum beta-lactamase production among them. Antimicrobial susceptibility testing (AST) was done by disk diffusion method using a panel of 7 antimicrobials. Result Out of 200 samples analyzed, 61 (30.5%) samples harbored Salmonella species out of which 15 (7.5%) samples showed the presence of Salmonella Typhi. A significant association was noted in the incidence of Salmonella with various factors pertaining to the butchers, such as age, sex, literacy rate, practices of washing knives and chopping board, wearing aprons and gloves and type of water used (p < 0.05). Salmonella isolates were highly sensitive to amikacin (82.0%) and least sensitive to tetracycline (3.3%). All the isolates were resistant to colistin. Sixty (98.4%) isolates were identified as multi-drug resistant (MDR). The total number of extended spectrum betalactamase producers reported among Salmonella isolates was 29 (47.5%). Conclusion The results indicate that the fresh chicken liver samples sold in Bharatpur Metropolis are reservoirs of multi-drug resistant Salmonella, including extended spectrum betalactamase producers, that could potentially be transmitted to the humans by direct contact or through inadequate cooking.

Phacoemulsification surgery by a nationally-trained cataract surgeon of Nepal.

INTRODUCTION: A one month phacoemulsification training course had been implemented by the Nepal Netra Jyoti Sangh (NNJS) in collaboration with Association for Ophthalmic Cooperation to Asia, Japan (AOCA). OBJECTIVE: To evaluate the visual outcomes of phacoemulsification surgery by a nationally trained surgeon in Nepal. MATERIALS AND METHODS: A retrospective study of patients that underwent phacoemulsification with foldable intraocular lens implantation during a period of 18 months was carried out. Cases that had a six-week follow-up period were included. Effective phaco time (EPT), intra-operative and postoperative complications were noted. Uncorrected visual acuity (UCVA) at day 1 and best corrected visual acuity (BCVA) at week 6 were noted. The data were analyzed using SPSS 11.5. RESULTS: A total of172 patients that had completed a 6 week follow-up evaluation were included in the study. The mean age of patients was 57.12±10.19 years. The mean effective phaco time (EPT) was 9.74±7.41 seconds. Posterior capsule rupture (PCR) with vitreous loss occurred in 2 eyes (1.2%), Descemet's membrane detachment in 1 eye (0.6%), capsulorhexis extension in 1 eye (0.6%) and wound site thermal injury (WSTI) occurred in 3 eyes (1.7%). Postoperative complications were mild to moderate striate keratopathy (9/ 172), corneal edema (1/172), corneal epithelial defect (1/172) and uveitis (1/172). At 6 weeks post-operatively, 165 eyes (95.9%) had a BCVA better than 6/18 and 7 eyes (4.1%) had a BCVA of 6/18 to 6/60. CONCLUSION: Patients undergoing phacoemulsification had a good visual outcome as a result of the procedure performed by cataract surgeon trained from AOCA/NNJS national phacoemulsification training program of Nepal.

Role of reactive oxygen species in transforming growth factor-beta1-induced extracellular matrix accumulation in renal tubular epithelial cells.

Tubulointerstitial fibrosis, which is characterized by the progressive accumulation of extracellular matrix (ECM), is the main feature of chronic renal allograft dysfunction. Transforming growth factor-ß1 (TGF-ß1) is the key inducer of tubulointerstitial fibrosis. Plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of ECM degradation, is increasingly recognized to play an important role in renal fibrosis. ECM accumulation is the net result of ECM synthesis and degradation. We previously reported that reactive oxygen species (ROS) and subsequent activation of mitogen-activated protein kinase (MAPK) are required for the TGF-ß1-induced epithelial-to-mesenchymal transition in renal proximal tubular epithelial cells. In the present study, we examined the role of the ROS-MAPK pathways in TGF-ß1-induced fibronectin and PAI-1 up-regulation in renal tubular epithelial cells. Growth arrested, synchronized normal rat kidney epithelial (NRK-52E) cells were stimulated with TGF-ß1 (0.2-20 ng/mL) or H(2)O(2) (1-500 µmol/L) in the presence or absence of inhibitors of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (diphenyleneiodonium [DPI] and apocynin [Apo]) and MAPK (PD98059, an MEK inhibitor, or a p38 MAPK inhibitor) for up to 48 hours. Both TGF-ß1 and H(2)O(2) increased fibronectin and PAI-1 secretion in dose-dependent manners. Chemical inhibition of NADPH oxidase, extracellular signal-regulated kinase (ERK), or p38 MAPK all inhibited TGF-ß1-induced and H(2)O(2)-induced fibronectin and PAI-1 up-regulation. These results suggested that NADPH oxidase-mediated ROS and subsequent ERK and p38 MAPK activation play important roles in ECM accumulation in the renal tubulointerstitium.

A profile of eye-lid conditions requiring reconstruction among the patients attending an oculoplasty clinic in mid-western region of Nepal.

INTRODUCTION: Some eyelid defects require reconstruction. OBJECTIVE: To study the eyelid conditions requiring reconstruction among the patients attending an oculoplasty clinic of a tertiary level eye institute. MATERIALS AND METHODS: All the cases of eyelid reconstruction surgery of two years were retrospectively included in this study. The parameters studied were causes of eyelid defects, age and gender of the patients and the reconstructive surgical procedures. RESULTS: Of 43 cases that required eyelid reconstructive surgery 17 (39.53 %) had ocular tumors and 16 (37.2%) had trauma. The mean age of presentation was 42 years ± 13.89 (4- 84 years. Of the eyelid tumors, benign lesions were found in 7 (41.1%) followed by basal cell carcinoma in 5 (29%). The surgical procedures carried out were direct closure of defects in 15 (35%), excision of cicatrized tissue with skin graft in 7 (16%), reconstruction with rotational flap in 6 (14%), blepharoplasty in 4 (9%), gold weight in 4 (9%), lid sharing procedure (Cutler-Beard procedure) in 3(7%), lateral tarsorraphy in 2 (5%) and canalicular repair with silastic tube intubation in 2 (5%). CONCLUSION: Ocular tumors are the most frequent conditions requiring eyelid reconstructive surgery. The common reconstructive procedures are direct closure followed by excision of cicatrized tissue with skin graft.

Surgical outcome of pars plana vitrectomy: a retrospective study in a peripheral tertiary eye care centre of Nepal.

BACKGROUND: Trans-pars plana vitrectomy (TPPV) is an effective surgical procedure to retain the useful vision in vitreoretinal diseases. OBJECTIVE: To evaluate the surgical outcome of pars plana vitreoretinal surgery. STUDY DESIGN: Retrospective non-comparative interventional case series. MATERIALS AND METHODS: A hospital-based retrospective interventional study of series of cases was carried out in retina clinic of Lumbini Eye Institute, Nepal, over a period of one-and-a-half years. Records of 64 patients who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. OUTCOME MEASUREMENT: The parameters studied were post-operative visual acuity and complications. RESULTS: Of 64 patients, 61% presented 2 months after the onset of symptoms. Preoperatively, 65.5% had visual acuity of hand motions to 3/60 followed by perception of light only in 26.6%. The main indication for TPPV was vitreous haemorrhage (VH), in 53%. The visual acuity improved to better than 6/60 in patients with VH (68%), whereas, overall, in 72% of the subjects, it improved by 2 lines postoperatively. The commonest intra-operative complications were iatrogenic retinal break (5, 7.8%) at the sclerostomy site. CONCLUSION: The main indication for TPPV is vitreous haemorrhage. Useful vision can be restored by pars plana vitrectomy in the majority of the patients. Retinal break is the commonest complication of TPPV.

Outcome of cluster endophthalmitis in western plain region of Nepal.

BACKGROUND: Post-operative endophthalmitis remains one of the most visually devastating complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. Excessive inflammation, particularly in the early post-operative phase, should be regarded as infective endophthalmitis. Early diagnosis and immediate intervention in such case, lead to salvage of eye as well as better visual outcome. OBJECTIVE: To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis in high volume cataract surgical centre. MATERIALS AND METHODS: Retrospective, interventional case series of 19 patients with acute post-operative endophthalmitis after manual small incision cataract surgery in a single day, underwent vitreous tap and received intravitreal Vancomycin, amikacin and Dexamethasone. Subconjunctival vancomycin was given at the end of the procedure. Vitreous samples were stained using Grams stain, Giemsa stain and KOH mount. Samples were sent to the hospital's microbiology laboratory for culture and sensitivity testing. All patients received intravenous ciprofloxacin for 3 days and oral ciprofloxacin for 7 days. Topical Prednisolone acetate, Ofloxacin, Gentamycin and atropine were given to all patients. Patients were followed up till 6 weeks. RESULTS: 10 eyes had vitreous tap culture negative (52.6%) where as 9 eyes (47.4%) had bacterial culture growth. The culture reports showed 4 cases (21%) of Staphylococcus epidermidis, 3 cases (15.8%) of Staphylococcus aureus and 2 cases (10.5%) of mixed growth. 48 hours after the intervention, 15 patients improved clinically. On sixth week follow up, 7 eyes (37%) had visual acuity better than 6/18, 7 eyes had 6/18 to 6/60 and 5 eyes had visual acuity between 1/60 to 5/60. CONCLUSION: Intravitreal antibiotics and steroid, along with systemic ciprofloxacin and subconjunctival vancomycin has good visual outcome for post operative cluster endophthalmitis.

Forensic considerations of pregnancy-related maternal deaths: an overview.

During the 20th century, risks to women associated with childbirth in developed countries have been dramatically reduced on account of many factors that include technological advancements in obstetrical care, greater access to health services and fewer births occurring at the extremes of women's reproductive age span. However, pregnancy-related maternal deaths continue to be a major health concern in developing countries. In the year 2005, an estimated 536,000 women died of maternal causes worldwide of which 86% occurred in sub-Saharan Africa and South Asia and less than 1% in more developed countries. The large regional differences in maternal deaths demonstrate that most of these deaths are preventable. It is nevertheless important to monitor patterns of pregnancy-related mortality and serious morbidity and to be sensitive to what observed patterns or changes may tell us in order to continue to safeguard women during this critical period and the monitoring process must begin with ascertainment of the accuracy of routine reporting of deaths associated with pregnancy and childbirth. We examine the pregnancy-related maternal deaths with a forensic view point.

Preliminary experiences with limbal relaxing incision for treatment of astigmatism during phacoemulslfication.

INTRODUCTION: this small study relates our early experiences with the Limbal Relaxing Incision (LRI) for management of astigmatism in patients undergoing cataract surgery. AIMS: to evaluate the efficacy of LRI in the management of primary astigmatism when combined with phacoemulsification. SUBJECTS AND METHODS: limbal relaxing incisions were performed to correct primary astigmatism in 12 eyes of 12 cataract patients who underwent phacoemulsification as the primary procedure. The length and number of incisions were determined using the AMO LRI calculator software programme using Donnenfield and NAPA nomograms. Keratometric astigmatism was measured preoperatively and postoperatively on day 1 and after 3 weeks or more. Surgically-induced astigmatism (SIA) and the intended angle of error were evaluated by the vector analysis method. Preoperative and postoperative uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity (BSCVA) were evaluated in each visit. RESULTS: The mean age of patients was 52.92 +/- 10.91 years. There were 75 % male and 25 % female patients. The mean keratometric preoperative astigmatism was 2.08 +/- 1.05 diopter. The mean 1st postoperative day keratometric astigmatism was 1.74 +/- 1.32 diopter and the mean final keratometric astigmatism at 3 weeks postoperatively was 1.05 +/- 0.68 diopter. The mean SIA on the 1st postoperative day was 2.97 +/- 1.72 diopter at 103.25 +/- 56.57 degree with intended angle of error 6.53 +/- 9.61 degree. The mean SIA on the 3rd postoperative week was 2.26 +/- 0.87 Diopter at 107.08 +/- 49.96 degrees with intended angle of error 2.90 +/- 7.87 degrees. CONCLUSION: limbal relaxing incisions are effective method to reduce postoperative astigmatism with good predictability of intended angle.

Road traffic injuries: a major global public health crisis.

Evidence suggests that the present and projected global burden of road traffic injuries is borne disproportionately by countries that can least afford to meet the health service, economic and societal challenges. Although the evidence base on which these estimates are made remains somewhat precarious in view of the limited data systems in most low- and middle-income countries, these projections highlight the essential need to address road traffic injuries as a public health priority. Most well-evaluated effective interventions do not focus directly on efforts to protect vulnerable road users, such as motorcyclists and pedestrians. However, these groups comprise the majority of road traffic victims in low- and middle-income countries, and consequently the majority of road traffic victims globally. Responding appropriately to the disparities in available evidence and prevention efforts is necessary in order to address this global public health crisis comprehensively.

Disaster management following explosion.

Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making.

Injuries to neck structures in deaths due to constriction of neck, with a special reference to hanging.

This prospective study aimed at examining various injuries to the neck structures in deaths due to constriction of neck. Neck dissection technique, as advocated by Prinsloo and Gordon was undertaken to study the injuries to the thyro-hyoid complex, strap muscles, carotid vessels, etc. Of the 1746 medico-legal autopsies, conducted during the study period, 5% were deaths due asphyxia of which 82% were those of constriction of neck. The 21-30 years age group accounted for the maximum number of cases (57%). Male:female ratio was 2:1. Hanging (69%) outnumbered other asphyxial deaths--ligature and/or manual strangulation, smothering, etc. Injury to the sternocleido-mastoid muscle (54%) was the commonest injury to the neck structures. The hyoid bone was fractured in 21% cases, while the thyroid cartilage was fractured in 17% cases. Complete hanging was noted in 68% of cases while the hanging was atypical in 88%. Fixed knot was found to have been used in 71%. A single loop round the neck was observed in 80% of the cases and it was above the level of thyroid in 58% cases. Most cases of the fracture of the laryngo-hyoid complex were in the 41-60 year age group, 72% and the fracture was on the same side as the knot in 52% cases. Majority used soft daily wear articles of clothing like a sari (32%) or chunni (24%). Asphyxial deaths due to constriction of neck being common in all parts of the world, prospective studies in different setups to examine the profile of neck structure injuries are needed so as to differentiate the suicidal or homicidal nature of such deaths with a greater certainty.

Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy.

AIMS AND OBJECTIVES: To compare the success rates of non endoscopic endonasal dacryocystorhinostomy and conventional external dacryocystorhinostomy for the surgical management of primary acquired nasolacrimal duct obstruction. MATERIAL AND METHODS: A retrospective, nonrandomized, comparative interventional case series of 302 patients who underwent either endonasal or external dacryocystorhinostomy over a period of 2 years. All surgeries were performed by a single surgeon and patients with primary nasolacrimal duct obstruction with a minimum of 6 months post operative follow up were included in the study. While external dacryocystorhinostomy was performed using traditional technique, endonasal dacryocystorhinostomy was performed using direct method of nonendoscopic visualization. RESULTS: Of the 302 cases included in the study 165 patients had endonasal dacryocystorhinostomy whereas 137 underwent external dacryocystorhinostomy. Success was defined by resolution of symptoms of tearing, a negative fluorescein dye disappearance test and patency of the canalicular system on lacrimal irrigation. In the external dacryocystorhinostomy group 124 (90.5%) patients had surgical success whereas 146 (88.5%) of the endonasal dacryocystorhinostomy patients had successful outcome. The overall success rate was 89.4%, and the difference of surgical success between the two groups was not statistically significant ( P=0.57). CONCLUSION: Non endoscopic endonasal dacryocystorhinostomy gives surgical results comparable to those of external dacryocystorhinostomy and is a viable alternative where dacryocystorhinostomy is indicated for primary acquired nasolacrimal duct obstruction.

Infection in patients with severe burns: causes and prevention thereof.

The better understanding of burn pathophysiology has resulted in effective fluid resuscitation in the acute stage, but the morbidity and mortality of burn patients are mostly linked to the burn wound consequences. Once the initial acute phase is over, the burn wound becomes the source of virtually all ill effects, local and systemic. The dysfunction of the immune system, a large cutaneous bacterial load, the possibility of gastrointestinal bacterial translocation, prolonged hospitalization, and invasive diagnostic and therapeutic procedures all contribute to infectious complications. Wound infection may lead to septicemia that may not only consume additional resources but is associated with significant morbidity and mortality despite the advances in burn care.

Misuse of prenatal diagnostic technology for sex-selected abortions and its consequences in India.

During 1800, the British Government found that there were no daughters in a village in the Eastern Uttar Pradesh region of India. According to the 2001 Census, there were less than 93 women for every 100 men in the Indian population. The prevailing concept that the birth of a female child can signal the beginning of financial ruin and extreme hardship for a poor Indian family is understandable. What is surprising is that even high-income families do not want a female child. The Government of India in its 10th Plan recognized the rights of the female child to equal opportunity, to be free from hunger, illiteracy, ignorance and exploitation. In the National Policy for the Empowerment of Women 2001, a policy framework was laid down for the elimination of discrimination against, and violation of, the rights of the female child. However, the situation continues to worsen, and studies have revealed that sex-selected abortions are practised among all communities despite enactment of laws prohibiting prenatal sex determination. In this paper, we examine the functioning and consequences of the misuse of this technology.

Gender identity disorder and its medico-legal considerations.

The general belief among behavioural scientists and physicians is that gender identity disorder or transsexualism is an identifiable and incapacitating disease which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients. Although many advances have been made in the reassignment surgery techniques, phalloplasty still remains a major challenge; to date, no ideal technique has been developed. The new gender created by the reassignment surgery has, in turn, led to many legal complications for post-operative transsexuals because, in many developed and the developing countries, transsexuals are not given a legal identity, thereby adding to their agonies and miseries. This article examines the historical perspective, genesis and management of gender identity disorder, or transsexualism, and draws attention to the medico-legal considerations.

Sudden infant death syndrome: a subject of medicolegal research.

During the last decade, much attention has been paid to the risk factors of sudden infant death syndrome (SIDS). Many researchers have demonstrated that infant-care practices are linked to the risk of SIDS. Prone sleeping, bed sharing, maternal substance abuse, and cigarette smoking have been reported to be significant potentially modifiable risk factors for SIDS. Despite the reports that the incidence of SIDS has decreased by 38% in the United States, it remains the leading cause of death in the first year of life. Deaths resulting from child abuse or neglect inflicted or permitted by their caretakers being second only to SIDS in infant mortalities and some recommendations regarding the differentiation of SIDS and child abuse have generated speculation that some cases of infanticide were misdiagnosed as SIDS. To reach a proper conclusion as to the cause and manner of death of an infant who died suddenly and unexpectedly, investigation must be thorough and professional.

Forensic considerations of missed diagnoses in trauma deaths.

Injuries missed at initial diagnoses or operations have the potential to cause disastrous complications in trauma patients. Understanding the etiology of unrecognized injuries is essential in minimizing its occurrence. For this purpose, we scrutinized the treatment and the autopsy records of the trauma deaths from 2000 to 2004 to determine the frequency, body regions, severity and causes of injuries that escaped recognition during the initial assessment, primary, secondary and tertiary surveys by the clinical team in patients who died of trauma. We also examined the accuracy of the cause of death as recorded on death certificates. The frequency of unrecognized injuries was found to be 11% in all trauma deaths. Abdomen (40%) and head (29%) were the more common regions of the body where injuries were frequently missed. System related errors (68%) and patient related factors (32%) were responsible for the injury remaining unrecognized. It was concluded that the injuries may be missed at any stage of the management of patients with major trauma and repeated assessments both clinical and radiological are mandatory not only to diminish the problem but to avoid litigation as well.

Death during or following surgical procedure and the allegation of medical negligence: an overview.

A great variety of mishaps can occur during or following the administration of anesthesia and operative or investigational procedures that do not necessarily convey an error of judgment or negligence on the part of the surgeon or the anesthetist. However, all deaths occurring during the course of anesthesia and surgery or within a reasonable period thereafter (commonly referred to as peri-operative period) have to be reported to the police as these deaths cannot be regarded as natural. Despite the death occurring due to some preexisting disease or some co-existent condition, there may be a tendency on the part of the relatives of the deceased to impute negligence on the part of the anesthetist and/or the surgeon merely because of the fact that the death was closely associated with the anesthesia and surgical intervention. As such, any death suspected to be caused, or contributed to, by any of these procedures needs to be adequately investigated both from the point of view of the relatives of the deceased as well as instituting future safety measures. This paper examines the medical, ethical and legal aspects of such deaths with reference to the allegations of medical negligence in these cases.