Medicolegal Issues Research Articles

Relationship between chronological age and skeletal maturity of wrist joint and hand in a sample of Nepalese population: A radiographic study of wrist joint and hand in Nepalese population: A radiographic approach

Background: The human body grows and matures with age, especially in children and adolescents. Skeletal age is determined from the development stage of bones. Objectives: To determine the age of epiphyseal fusion of the lower end of radius and ulna in the Nepalese population which is important from a medicolegal point of view. Methods: An analytical cross-sectional study was conducted on patients undergoing X-rays of hand and wrist attending Manipal Teaching Hospital, Pokhara in a one-year period from January 1, 2019 to December 31, 2019. Total sample was 90 cases. The X-rays were assessed as appearance and not-appearance of epiphysis and different phases of skeletal maturity were graded according to McKern and Stewart classification. Results: Mean age was relatively higher in males in fusion of radius. Whereas in ulna, no difference was recorded in mean age in the fifth stage. In male the correlation coefficient for stage of fusion for radius and ulna with age (years) was 0.90 and 0.65 (p < 0.001), while for the females the correlation coefficient for stage of fusion of radius and ulna with age was 0.94 and 0.82 (p <0.001), both indicating a strong correlation. Conclusion: Estimation of age is not only important for identification of the deceased victim but also in medicolegal issues where there are many cases in courts which are undergoing age assessment by experts in absence of birth certificate or counterfeit documents.

Intellectual property and data ownership in the age of video recording in the operating room.

Recording intraoperative videos has become commonplace during surgery, with applications in video-based assessment, education and research. These videos can be both manually and automatically analyzed for performance analysis. A number of commercial entities providing video acquisition and processing has flourished over the recent years. As these companies expand, a number of medico-legal, licensing, intellectual property and data sharing related questions have been raised. We performed a qualitative survey of surgeons, hospital administrators, lawyers and commercial entities offering video recording capabilities for serious issues that the average surgeon who records their videos should consider. To address these concerns, we reviewed relevant legal precedent and currently available contracts. We identified several key medico-legal constraints, including data ownership and storage, FDA compliance, privacy and potential for use in litigation, present the legal background and potential solutions. Given the availability of surgical recordingand the future of video-basedperformance analysis, surgeons need to become comfortable with the medico-legal issues and the potential solutions available with national physician-led lobbying.

ASSOCIATION OF BLOOD GROUP SYSTEMS WITH BLOOD-BORNE INFECTIONS AND ITS IMPLICATION ON CADAVER SELECTION IN THE POST COVID ERA: A STUDY AMONG BLOOD DONORS OF KOLKATA

Introduction: Blood group antigens play a vital role in transfusion safety, understanding genetics, inheritance pattern, researching population migration patterns, as well as resolving certain medico-legal issues Aims & Objectives: The aim of this study was to investigate the prevalence of hepatitis B, Hepatitis C, HIV and Syphilis infections in blood donors referred to Blood Bank of Calcutta National Medical College and to determine any association between blood groups and blood borne infections and their impact on procurement and dissection of dead bodies. Methods: An observational study with cross sectional design of data collection was conducted in the Blood Bank of Calcutta Nation Medical College for a period of three months. All of the eligible donor serum samples were screened for HBV, HCV, HIV and syphilis. Test result of the collected blood was noted and tabulated in Microsoft Excel Sheet. Statistical analysis was carried out using SPSS 20 software. Chi-square test was performed for Qualitative comparison. Result:Total number of HIV, HbS Ag, Anti HCV, VDRL, MP positive cases were 16 (1.54%), 51(4.92%), 18(1.74%), 28(2.7%), 30(2.9%) respectively. 56.2% HIV positive cases were in the age group of 18-30 and 87.5% HIV positive cases were male.3.9% of HbS Ag positive cases, 10.7% VDRL positive cases, 3.3% MP positive cases were also HIV Positive. Signicant correlation was obtained HIV & VDRL and VDRL & anti HCV Conclusion: Hepatitis C was highest among the study population and signicant correlation was present between Syphilis and HIV or Hepatitis C. In the background of novel emergent diseases with spread via body uids, such information on blood borne infections may help us to formulate future guidelines on cadaver dissection.

AN ANATOMICAL STUDY OF HUMAN MANDIBLE IN DETERMINATION OF SEX BY USING VARIOUS MORPHOLOGICAL AND MORPHOMETRIC PARAMETRES

Determination of sex from unknown human mandible has an important role in forensic eld in relevance with Medicolegal issues to trace victim. Aim: To determine the sex of human mandible by using various morphological & morphometric data. Materials and methods: The study was conducted on 82 dry human mandibles of unknown sex. Based on morphological features the mandibles are grouped into Male (50) and Female (32) bones and the following morphometric parameters are taken for further statistical analysis. 1) Symphyseal height 2) Ramus height (Rt) 3) Ramus height (Lt) 4) Bimental width 5) Inter premolar width 6) Inter molar width 7) Bicoronoid width. Results: There was a statistically signicant difference found in the height of ramus (right), with mean value of 54.84 ± 4.5mm for males and 50.56 ± 5.4mm for females (P < 0.05), height of ramus (left) with mean value of 53.24 ± 4.3mm in males and 49.81 ± 5.03mm in females (P < 0.05) and bimental width with mean value of 42.96 ± 2.6mm in males and 41.58 ± 1.8mm in females (P < 0.05), whereas no signicant difference was found in symphyseal height, bicoronoid width, inter premolar width and inter molar width of male and female mandibles. The parameters used in this study gave an overall 76.8% accuracy in determining the sex of the mandible. Conclusion: Out of 7 parameters taken into account the interesting observation is that 3 parameters are most reliable and dependable for determination of sex. Out of these, 2 parameters have given most sensitive data and high accuracy rate for the determination of the gender.

Trauma-Informed Acute Care of Patients With Violence-Related Injury.

Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.

Total Leukocyte Count Depicting the Degree of Inflammation in Acute Appendicitis.

IntroductionAcute appendicitis (AA) is the most common cause of acute abdomen in young adults. The diagnosis is usually made on various clinical findings. However, a missed case of acute appendicitis is a catastrophe as it later presents with life-threatening complications and results in medicolegal issues. Raised total leukocyte count (TLC) is a frequent finding in patients with acute appendicitis. As a convention, a normal leukocyte count usually rules out the differential diagnosis of acute appendicitis. Recent studies claimed that a substantial proportion of patients with normal TLC also had acute appendicitis and warranted a careful evaluation of such cases before sending them home. However, the reported frequency of acute appendicitis among TLC normal patients varied greatly among studies which necessitated the present study.AimOur aim was to determine the frequency of acute appendicitis in patients of normal TLC.Materials and methodsThis descriptive cross-sectional study was conducted at the Department of Surgery, KRL Hospital Islamabad. This study was carried out from 1 July 2019 to 31 December 2019. This study involved 238 patients of both genders aged between 12 and 70 years suspected of acute appendicitis on physical and ultrasound findings but with a normal TLC (4,500-11,000 WBCs/µL). The outcome variable was the frequency of acute appendicitis among such patients which was diagnosed upon surgery (inflamed appendix with free fluid) and histopathology of excised tissue (mucosal inflammation, neutrophil infiltrates, wall necrosis). Frequency of acute appendicitis was compared across various age and gender groups. Written informed consent was obtained from every patient.ResultsThe mean age of the patients was 27.4±15.5 years. Majority (n = 167, 70.2%) of the patients were aged ≤25 years, followed by 40 (16.8%) patients aged ≥46 years and 31 (13.0%) patients aged between 26 and 45 years. There were 135 (56.7%) male and 103 (43.3%) female patients with a male to female ratio of 1.3:1. All of the patients (100.0%) had pain in the right iliac fossa (RIF) while rebound tenderness, anorexia, nausea/vomiting, fever and dysuria were noted in 83.6%, 79.0%, 73.9%, 63.9% and 15.1% patients, respectively. The diagnosis of acute appendicitis was made in 198 (83.2%) patients with normal TLC and suspicion of acute appendicitis on physical findings and ultrasound. When stratified, there was no statistically significant difference in the frequency of acute appendicitis across various age (p-value = 0.988) and gender (p-value = 0.913) groups.ConclusionIn the present study, contrary to the routine impression that normal TLC rules out the differential diagnosis of acute appendicitis, a substantial proportion of patients with clinical and ultrasound suspicion of acute appendicitis but normal TLC had acute appendicitis which is worrisome as a missed case may later present with complications. The present study thus warrants cautious evaluation of clinically suspected cases with normal TLC count to avoid a missed appendicitis and improve the outcome in future surgical practice.

Fatal Necrotizing Fasciitis as a Consequence of Blunt Trauma: A Case Report

Necrotizing fasciitis is an uncommon lethal bacterial infection that involves the subcutaneous tissue and fascia. It can be mono or polymicrobial infection. The diagnosis is mainly dependent on clinical signs and symptoms. Trauma is the commonest cause for it. The early signs and symptoms may mimic cellulitis. We present a case of necrotizing fasciitis following an assault. The patient was received in a state of shock. Despite all measures, the patient could not be saved. Early debridement and antibiotic therapy have a key role in the prognosis of the disease. Medicolegal issues can arise when the disease develops post-assault because of the vague and unpredictable nature of the disease and its challenging prognosis.

Concentrating in a Loud Crowd: Sonographer Perceptions of Policies to Limit Distractions in Obstetric Sonography Examinations

Objective The objective was to identify sonographer perceptions of distractions and policies for improving obstetric sonography examinations (OBUS). Materials and Methods A survey, with closed- and open-ended questions, was sent to OBUS practicing members of the Society of Diagnostic Medical Sonography (SDMS). Descriptive analyses, including frequency distributions overall and by various groups, were performed. Chi-square analyses were used to examine the relationships between categorical variables, including level of perceived distraction, and concordance with policies. Results Of the 3525 accessed e-mails, 807 responses were eligible for analysis. Over half (62%) of the respondents reported no observer policy. Sonographers reported strong agreement with observer policies and desired limits on observers. Policy disagreement themes included number of observers, children observers, patient satisfaction, and patient truthfulness. Most sonographers reported existence of (85%) and strong agreement (97%) with recording policies. Disagreements centered around the strictness of policies, policy enforcement and notification, distraction of recording, medico-legal issues, and finding anomalies while being recorded. Conclusion Discrepancies existed between policies regarding observers and recording in OBUS. Sonographers both desired and agreed with protocols to limit distractions. However, there were concerns regarding stringency, notification, and enforcement of policies. Further research is needed to determine if policies help limit distractions during OBUS.

Dying “from” or “with” COVID-19 during the Pandemic: Medico-Legal Issues According to a Population Perspective

There is still a lack of knowledge concerning the pathophysiology of death among COVID-19-deceased patients, and the question of whether a patient has died with or due to COVID-19 is still very much debated. In Italy, all deaths of patients who tested positive for SARS-CoV-2 are defined as COVID-19-related, without considering pre-existing diseases that may either contribute to or even cause death. Our study included nine subjects from two different nursing homes (Cases 1–4, Group A; Cases 5–9, Group B). The latter included patients who presumably died from CO poisoning due to a heating system malfunction. All subjects tested positive for COVID-19 both ante- and post-mortem and were examined using post-mortem computed tomography prior to autopsy. COVID-19 was determined to be a contributing cause in the deaths of four out of nine subjects (death due to COVID-19; i.e., pneumonia and sudden cardiac death). In the other five cases, for which CO poisoning was identified as the cause of death, the infection presumably had no role in exitus (death with COVID-19). In our attempt to classify our patients as dying with or due to COVID-19, we found the use of complete assessments (both histological analyses and computed tomography examination) fundamental.

Differentiation between Pleural Mesothelioma versus Pseudo-Mesothelioma Demonstrated in Eight Autopsy Cases

The pleural lobes are the origin of different pathologies, including malignant tumors, e.g., pleural mesothelioma. In some cases, clinical and macroscopic presentation point strongly to the diagnosis but often enough the patient has another underlying disease; malignant neoplasms of the lung as well as other organs (skin, pancreas, prostate or kidney) can mimic pleural mesothelioma and if so, are defined as ‘pseudo-mesothelioma’. We present eight cases that are clinically and macroscopically highly suspicious for pleural mesothelioma. All patients were autopsied due to medico-legal issues and work-related diseases. Six out of eight patients underwent autopsy to exclude possibility of asbestos-related malignancy and two out of eight due to exclusion of silicosis. From the eight cases, only three were real pleural mesotheliomas. Another three were adenocarcinomas of the lung mimicking pleural mesotheliomas. One had squamous cell carcinoma of the lung. Lastly, one patient had an extraordinary case of papillary renal cell carcinoma metastasizing universally in both pleura lobes. Due to striking morphological similarities, the exact final diagnosis was only possible after extended immunohistochemical analysis of the tissues. In summary, not only is it difficult to distinguish between real or pseudo pleural mesothelioma in patients having had contact with asbestos. Even patients with no evidence of asbestos contact can have clinical and pathological events strongly suggesting asbestosis and mesothelioma, without having it.

Assessment of Knowledge and Awareness about Medico Legal Issues among Interns and Post GraduateStudents in Rajahmundry, Andhra Pradesh

In recent times there has been increased number of complaints and lawsuits against doctors. Thereforehaving knowledge about Medico Legal issues is as important to the practice of medicine as clinical skills.The present study was conducted to evaluate Awareness and Knowledge about Medico Legal issues amongInterns and Post Graduate Students. Total 140 interns and 110 Post Graduate students participated in thestudy. Post graduate students had more knowledge about Medico Legal issues and consent than internsbut there was deficit of knowledge about Injury and Death certificates. About Consumers protection act(COPRA)there is little awarenessbut regarding Human organ transplantation Act (HOTA) and Hospitalindemnity Insurance awareness should be increased. Our study conveys that action should be taken to coverthe lack of awareness and knowledge for doctors as well as patientssafety.

Stature Prediction and Formulation of Regression Equation from Hand and Foot Anthropometry

Background: Estimation of stature is a key feature of personal identification. Evaluation of stature fromincomplete skeletal and decomposing human remains is particularly important in personal identification forforensic experts and anthropologists.Methods: The data was collected from 1000 asymptomatic, healthy adults (500 males and 500 females)belonging to border areas of Punjab region of age group ranged between 18-50 years.Results: The comparison of each parameter of the study shows that all parameters have higher valuesin males than in females. It is also observed that in males highest correlation is exhibited by Right footlength(r= .418) and in females it is exhibited by Left Foot Length (r= .354). The calculated linear regressionformulae show good reliability and applicability for stature estimation.Conclusion: In all parameters the foot length and hand length are better predictors of stature in both sex.Using regression formulae the height of subject can be easily determined and this will be used as researchtool in anthropological and medicolegal issues.

Burnout in gastrenterologists: a national-level analysis

Introduction The term burn-out or burnout, means ‘burn to exhaustion’, this term was first used by Herbert Freundenberg. According to Freundenberg, burnout is a ‘state of physical and mental exhaustion conditioned by the individual's professional activity’. That is manifested through a set of signs and symptoms associated with physical and emotional breakdown that result from total energy exhaustion and the lack of resources or forces to ‘help’ others. Objectives Assess the occurrence of burnout in Portuguese gastroenterologists and understand how certain sociodemographic and professional variables might be associated with burnout manifestations. Material and Methods Observational descriptive, prospective and multicenter study, with analyzed data related to a sample of 52 national gastroenterologists, during the time between 5 February 2019 and 13 April 2019. An estimate of the burnout levels was carried out by the Copenhagen Burnout Inventory (CBI) questionnaire validated for the Portuguese population - CBI-PT. Possible interconnection between sociodemographic and socio-professional variables were analyzed. Results More than half of the gastroenterologists surveyed did not experience burnout in all subscales of the CBI. On a personal level, there were 13 gastroenterologists with moderate burnout and 11 with high burnout. Regarding the work extent, 18 gastroenterologists with moderate burnout and 7 with high burnout were identified. When considering patient level, it was possible to determine 21 gastroenterologists with moderate burnout and 3 with high burnout. There were no cases of severe burnout. Physicians who developed burnout were significantly younger (p < .001), had less service time (p = .007) and less leisure time (p = .024). Doctors in internship had a higher prevalence of burnout, which might be significantly related to a higher level of professional stress (p = .016). The performance of certain examinations (varicose ligation and endoscopic capsule), working during the weekend and the involvement in medico-legal issues had revealed an association with a higher prevalence of burnout. Discussion and Conclusion A higher prevalence of burnout was identified in young gastroenterologists, doctors in the internship, those performing high amounts of techniques (upper gastrointestinal endoscopy and colonoscopy), as well as doctors working during the weekend or involvement in legal-medical issues. Therefore, it is possible to conclude that if these young doctors do not acquire tools that will allow them to deal with this problem, it is expected that this pathology will reach critical levels within gastroenterologists, and consequently have a negative impact on healthcare.

Medicolegal Issues: Perception, Awareness, and Behavioral Changes Among Italian Neurosurgical Community: Survey-Based Analysis

Despite the rising trend of medicolegal challenges in Italy, there is a significant lack of literature on this topic. To provide better understanding of awareness toward medicolegal aspects, defensive behavior, consent-taking practice, and general perceptions of Italian neurosurgeons on this issue, a cross-sectional survey was conducted. A questionnaire covering various aspects of medicolegal issues, in an anonymous online form, was sent to neurosurgeons practicing in Italy via e-mail-through a national mailing list-and social media platforms. The data collection period was November 1, 2020 to December 31,2020. A total of 64 single responses were included. We assessed 1) awareness of Italian neurosurgeons about a legal framework: a low level of knowledge has been reported-87.5% were unaware of the terms and conditions outlined by the contract with the institution, 75.6% of respondents stated they didn't know the main body of law that governed the medical community; and 2) perception toward defensive medicine: 92.2% believed that they were not trained to face possible medicolegal issues, but only a few tried to acquire more knowledge about medical legal issues, such as learning how to obtain a proper informed consent for a surgical procedure (34.4%). This study marks the first survey to identify the perceptions among Italian neurosurgeons of medical legal issues and related "defensive medicine" practices: This is of relevance given its exorbitant cost in terms of public expenditure, psychologic burden, and its relevant impact on health care delivery.

KNOWLEDGE AND ATTITUDES REGARDING ETHICAL AND MEDICOLEGAL ISSUES IN HANDLING THE COVID-19 PANDEMIC AMONG RESIDENT DOCTORS AT ZAINOEL ABIDIN HOSPITAL, ACEH, INDONESIA

Background: Coronavirus Disease 2019 (COVID-19) has spread throughout the world to become a pandemic, making the entire health sector overwhelmed. Hospitals as health service facilities continuously strive to provide optimal service to patients with the confirmed COVID-19 infection. Resident doctors usually handle COVID-19 patients at the Zainoel Abidin Hospital (ZAH). As the front liner in handling the COVID-19 pandemic, these resident doctors must have adequate knowledge and good attitudes in dealing with COVID-19 patients, especially regarding ethical and medicolegal. Aim: This study aims at finding out the level of knowledge and attitudes of resident doctors in dealing with the COVID-19 pandemic at the ZAH, Aceh. Methods: This was a cross sectional study conducted among resident doctors (n=80) in the ZAH during November-December 2020 with a self-administered online questionnaire. It had been tested for validity by experts with a Content Validity Ratio / CVR of 0.738 and reliability of 0.732. The data were analyzed using the frequency distribution test (univariate) and the Chi square correlation test (bivariate). Results and Discussion: The results show that the majority of respondents had inadequate knowledge of ethical and medicolegal issues in handling the COVID-19 pandemic (70.0%); however, they had a positive attitude in overcoming ethical and medicolegal issues, i.e.77.5%. The chi square statistical test result shows no correlation between knowledge and attitude with a p-value of 0.077 (p-value &gt;0.05). Conclusions: Therefore, it can be concluded that the theoretical knowledge of doctors was not sufficient to identify ethical and medicolegal issues, but the attitude in dealing with ethical and medicolegal issues was satisfactory. This result offers a new opportunity and challenge to increase the awareness of doctors in applying their knowledge and attitudes towards handling the COVID-19 pandemic.

Different medico legal issues in deaths due to entrapment with animal electric traps; a study on selection of cases from the Southern Province, Sri Lanka

Introduction: Deaths due to electrocution involve both low and high voltage current and the manner of death is almost always accidental. Deliberate electrocution of wild animals by an unsafe extension of an electric line is made by drawing an electric connection from the low voltage utility bare lines. The entrapment of humans in these electric traps is observed in several geographical areas in Sri Lanka. The study intends to raise different medico legal issues pertaining to these deaths in a selected sample. Methods: A descriptive, retrospective study was carried out on 13 outdoor electrocution deaths due to contact with animal electric traps. The medico legal autopsies were carried out by the researchers and the data were collected from the autopsy and scene visit findings, police reports and the inquirers’ reports. Results: All the victims were adult males. The electric entry mark which is the hallmark of forensic diagnosis of electrocution was observed in all 13 dead bodies. It was characterised by a groove with charring at the base in 12 deaths. The macroscopic and microscopic features of electrocution were observed even in severely decomposed bodies. The cause of death was in all cases was determined as electrocution and the manner of death was determined as accidental. The trappers in 9 incidences were identified but none of them were prosecuted for breaching the laws of the Electricity Act or the Fauna and Flora Protection Ordinance of SriLanka. Conclusions: The scene visit examination was helpful to determine the manner of death and was determined as accidental which may be debatable according to the law of the country.

“There’s got to be a better way”: Global Perspectives of Medicolegal Environment and Neurosurgical Socioeconomics

Neurosurgery is considered to have one of the greatest risks of medical malpractice claims. However, medicolegal issues in neurosurgery are often disregarded and underrated worldwide. Medical errors in the neurosurgical field can be attributed to multiple factors, including highly morbid pathologies, the technical difficulty of neurosurgical procedures, and the involvement and interaction of a multidisciplinary team in the care of neurosurgical patients. Health care providers worldwide are at risk of lawsuits, sometimes even when no deviation from the standard of care had occurred in a given case. Often, governments use additional tactics to decrease the burden on compensators and extrajudicial institutions and to decrease the court's flow of irrational litigation. Continuous amendments to health care acts and newer reforms to address these issues have materialized worldwide. In the present narrative review, we have reviewed the global perspectives of medicolegal issues, with a focus on neurosurgical discipline.

Defence of Insanity: Its Scope and Application in English law

English Law of Insanity proceeds in making assessments of the legal wrongfulness of an accused by fitting the circumstances within four slots established in line with M’Naghten case.During this process, the judges’ role becomes more robust than the jury as technical and medico legal issues are beyond the grasp of lay jury members.So we offered a critical appraisal of the approach adopted in English Law to fit the psychological science' in legal moulds through vast discretion vested in judges to deal with the defense of insanity. For this purpose, the authors extracted various pieces of information from case laws, books, law commission reports, Acts, statutes, and research articles published related to the subject matter and developed a synthesis to reach a conclusion. Our findings suggest the trial judge decides the extent and types of evidence to be induced for resolving the issues in contention regarding insanity and to be decided by the jury. Some issues pertaining to insanity are too difficult for the trial judge to decide, which requires expert evidence. The application of defense of insanity rests with the evaluation to see whether the judge's discretion has proved a right mechanism to plug medico legal gaps in this process or not.

Dental Age Assessment Using Demirjian’s Method in Patients Visiting A Dental School in Uttrakhand

Background: Age estimation forms one of the most important sub-disciplines of forensic sciences and is of paramount importance in medico-legal issues. Material and Methods: The study comprised 200 subjects aged 14 to 24 years. By purposive sampling method the study subjects were divided into 10 groups starting from 14 years to 24 years with a class interval of 1 year ( e.g. Group I:- 14.01- 14.99 years, Group II:- 15.01- 15.99 years…… Group X: - 23.01- 23.99 years). Each age group consisted of 20 subjects with equal distribution of 10 subjects in both genders. Chaillet and Demirjian’s method with Acharya’s formula was used to compare the chronological and the estimated dental age. Results: The study showed a significant p-value (p< 0.005) in all the age groups in both the genders except for group v (18.01-18.99) in males and group III (16.01-16.99) and group V (18.01-18.99) in females. Also, the difference in the estimated dental age varied between + 4.18 years and – 2.02 years for males and +4.08 years and – 0.20 years in females. The results depicted an overall underestimation of the dental age by 0.60 years in males and 1.26 years in females. Conclusion: we concluded that Chaillet and Demirjian’s radiographic method with Acharya’s formula can be a reliable method in the assessment of dental age in the mentioned study group consisting of the Uttarakhand population.

Facilitating the practice of dermatology in Kerala – Recommendations by an expert panel of Kerala State Branch of The Indian Association of Dermatologists, Venereologists, and Leprologists

Dermatology is a rapidly growing specialty. Dermatology practice has become increasingly complex. The average dermatology practitioner is faced with an explosion of scientific knowledge and would also have to deal with diverse issues such as finance, medicolegal issues, taxation, marketing, and regulatory acts. Updating knowledge and micromanaging clinic-related issues are major concerns for a practicing dermatologist. Kerala state branch of the Indian Association of Dermatologists, Venereologists, and Leprologists can serve the interests of this group of members by helping out in training, faculty development, and research. This document presents a road map for such an initiative.