Medico-legal Perspective Research Articles

B-290 Static Analytical Scopes and Lab Processes - An Existing Public Health Hazard

Abstract Background Most chromatographic-based procedures have defined analytical scopes. This allows for laboratories to include the most relevant analytes in test panels and for care providers to know exactly what is included and excluded in ordered tests. Analytical scopes can be developed based on drug trend data, consensus body recommendations, or mandatory guidelines. However, it is reasonable to conclude that strictly adhering to these scopes, or not having robust processes in place that permit for rapid scope changes, will result in the underreporting of drug use in a population or miss a relevant drug finding for a single patient. For example, SAMHSA’s minimum mandatory guidelines for urine workplace drug testing does not include fentanyl. While true the number of fentanyl positive cases that are missed in this population is speculative, a factual case in point is made by evaluating laboratory results for a major novel psychoactive substance (NPS) drug class - designer benzodiazepines (DB). We performed a retrospective review to study the frequency that designer benzodiazepines would have been missed in reporting without further intervention by laboratory staff. Methods Blood samples were screened by ELISA and LC-TOF/MS. Confirmation testing using two different LC-MS/MS panels was conducted on samples that screened presumptive positive for benzodiazepines. Analytical results were retrieved from the laboratory’s data management system using the following criteria: a) date range: Feb 2023 to Feb 2024, b) blood matrix, c) DUID testing cases where benzodiazepine screening was performed by ELISA and by LC-TOF/MS, and d) at least one DB was reported regardless of the presence of other drugs. Results Nine parent DB or their metabolites were identified in the 46 cases in this study: 8-aminoclonazolam (n=3), alpha-hydroxyetizolam (n=2), bromazolam (n=35), clonazolam (n=2), deschloroetizolam (n=1), etizolam (n=1), flubromazolam (n=7), flualprazolam (n=1), and pyrazolam (n=1). Benzodiazepine screening by ELISA and LC-TOF/MS was positive for 45 and 46 cases, respectively. In the 45 cases that screened positive by ELISA, 41 did not confirm positive for any classical benzodiazepine (CBZ) which included alprazolam, diazepam, lorazepam, clonazepam, temazepam, oxazepam, and the nordiazepam metabolite. Only 4 cases tested positive for both a DB and CBZ (alprazolam or clonazepam) simultaneously. Conclusions While it is understood that defined analytical scopes are a laboratory necessity, care providers, law enforcement, public policy decision makers, and communities at large need to understand the limitations and regulations surrounding analytical test procedures. For some testing, a laboratory is obligated to follow mandatory guidelines, but from a clinical or medicolegal perspective, the risk is two-fold. The first is that the causative drug producing any untoward effects goes unrecognized. The second is that symptoms displayed are attributed to the presence of other drugs. This work stresses the importance of sincere collaboration between laboratories and entities that are responsible for analytical scope development and providing funding to ensure the appropriateness of real-time drug surveillance and reporting efforts.

EP296 - Developing a computer based standardised consent form for laparoscopic cholecystectomy

Abstract Aims Laparoscopic cholecystectomy is a common general surgical procedure with approximately 65,000 procedures performed per year. The consent process is imperative as serious life changing and life-threatening risks must be discussed with the patient before surgery. At our trust, this is currently performed with a generic consent proforma which is filled in during each consent process. We aimed to streamline this process for clinicians and ensure all risks were discussed. Further, we aimed to ensure the process was more medico-legally sound with increased legibility by removing the handwritten aspect and ensure concordance with GMC and RCS informed consent guidance. Methods We produced a standard computerised consent form for laparoscopic cholecystectomy. This included a diagram to aid patient explanation and sections where all the key risks of the procedure could be checked off once discussed. Results The consent form has proven popular with clinicians and has streamlined the consent process. It has ensured legibility of the consent form for all involved and is therefore preferable from a medico-legal perspective. It also ensures consistency for all patients undergoing the same consent process. Conclusions Standardising the consent process using this procedure specific form has helped clinicians cover all the necessary areas with patients before surgery and should be considered for other common operations. Producing the consent form has also been an excellent educational opportunity for trainees, who can now consider all risks associated with laparoscopic cholecystectomy using a single document.

A medico-legal perspective on postictal violence: A case study and systematic review of postictal delirium

Detailed descriptions of violent postictal episodes are rare. We provide evidence from an index case and from a systematic review of violent postictal episodes that demonstrates the encephalopathic features of some violent postictal behaviors. We discuss how these cases may fit in the legal framework of culpability. The data support the view that some episodes of violent postictal behavior are more accurately classified as a neurological delirium or encephalopathy rather than as a postictal psychosis. Current medical terminology may present unwarranted (and presumably unintended) barriers to exculpation for patients who exhibit post-ictal violence during an episode of delirium during which the patient was unaware of his or her violent conduct.

Home birth in Croatia - a medico-legal perspective today.

In Croatia, the model of obstetrics-midwifery management of childbirth in maternity hospitals is still in effect, and this is how > 99% of Croatian women give birth. However, in my view, midwives are still not sufficiently educated for completely independent work notwithstanding their university education. The Law on Midwifery defined the role of the midwife in home birth without, however, setting out other organisational-communication and professional provisions. Then it began with sporadic midwifery home births of a few per year, which grew quite rapidly, especially with the impact of the Covid-19 virus pandemic, to about 100 out of a total of about 38,000 births that are performed annually in the Republic of Croatia in maternity hospitals. Since the start of planned home births many bad perinatal outcomes have been recorded in hospital maternity wards who have admitted women after such deliveries. These include puerperal sepsis, protracted labour of several days, neglected protracted labour with perinatal asphyxia and aspiration of meconium amniotic fluid and resuscitation of the newborn (who later developed cerebral palsy), severe postpartum haemorrhage with obstetric shock and postpartum hysterectomy, episiotomy infection, and stillbirth at term pregnancy. Therefore, planned home birth in Croatia should now be regarded as an unsafe birth in extraordinary circumstances and the person who takes charge of it must be professionally prepared, educated and have numerous social skills. Most Croatian gynaecologists and obstetricians give support to midwives in their efforts to be professional and independent when at work, including the controlled and legal implementation of the planned home birth. We unreservedly support self-aware midwives to maintain their profession as highly ethical and professional as possible above the wishes of non-professionals who call for autonomy, so that we do not have to discuss such problems of malpractice of Croatian midwifery in the 21st century.

The Evolving Standard of Care for Autoimmune Neuropsychiatric Illness.

In recent decades, there has been increasing biomedical and public understanding of the role of autoimmunity in neuropsychiatric illness. Popular media have highlighted patients with psychiatric illnesses who were eventually diagnosed with autoimmune neuropsychiatric illnesses such as anti- N-methyl-D-aspartate receptor encephalitis. Coverage of these cases has often drawn attention to the effects of misdiagnosis or delayed diagnosis of such diseases in psychiatric patients. Autoimmune encephalitis can have varied presentations and often involves evaluation and management from multiple medical specialties. As a result, there remains considerable uncertainty regarding how courts might gauge the legal standard of care with regard to psychiatric workup of new-onset psychiatric symptoms, and the degree to which autoimmune encephalitis must be considered. In this article we provide a brief overview of autoimmune encephalitis and autoimmune psychosis, including current diagnostic approaches to these conditions. We review case law regarding the standard of care for psychiatric disorders caused by general medical conditions. Finally, we provide a medicolegal perspective on the responsibilities of psychiatrists and other mental health professionals in the evaluation of possible autoimmune encephalitis.

Medicolegal analysis of physical violence toward physicians in Egypt

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

A medicolegal perspective on the issue of cyberbullying in Turkey: A retrospective descriptive study on medical specialization theses

In recent years, the issue of cyberbullying has attracted the attention of researchers from many different fields as well as medical professionals. The aim of this study is to discuss the descriptive variables of medical specialty theses written on cyberbullying in Turkey in terms of forensic medicine. In this study, using the keywords "cyberbullying" and "cyber violence", theses registered in the Thesis Documentation Center of the Council of Higher Education were scanned. As a result of the screening, among 179 theses, 15 medical specialty theses related to the subject were examined within the scope of the study. The distribution of the 15 theses examined according to specialty areas was n:7 (46.6%) psychiatry, n:4 (26.6%) family medicine, n:1 (6.6%) forensic medicine, n:1 (6.6%) child and adolescent mental health and diseases, n:2 (13.3%) pediatrics. The peak in the writing of specialty theses was in 2019 (n:4). The population of the theses consisted of individuals aged 12-18 years in n:10 (66.6%) and 10-18 years in n:3 (20.0%) and university students in n:2 (13.3%), respectively. It was determined that questionnaires were used as the instrument and method in all of the theses analyzed. Most of the theses analyzed were conducted on adolescents between the ages of 12-18. There were no thesis studies among adults without or not a university degree. In future studies, these populations should also be examined. Due to its effects on people, it was thought that there may be an increase in the number of patients exposed to cyberbullying in the fields of psychiatry and forensic medicine. Therefore, it is necessary to increase medical awareness and conduct more studies on the cyberbullying issue.

Is there such a thing as an indispensable skills profile to be a good doctor? "Life skills" as essential capabilities in the medicoforensic professions.

This writing aims to convey the essential nature and features of a cultural tool based on a set of skills and capabilities generally referred to as "life skills", which allow for the proper management (in the medical and medical-forensic professional realms) of daily situations in an effective and rewarding fashion. Such a process is based on individual tools such as communication, problem solving, stress management, self-control, the ability to make timely decisions, empathy, creativity and the opportunity to work in a multidisciplinary setting. Life skills include everything the professional should rely on in order to minimize the risks of a professional error, through the acquisition of knowledge and behavioral traits which constitute the fundamental, experience-based starting point. The chief objective of this commentary is to outline the scope of a straightforward discussion by specifically defining such skills; that in turn will make it possible to identify all the technical issues to address during the medical-diagnostic assessment, also from a medico-legal perspective, in order to frame the residual life skills and evaluate the possibilities of recovery and any disabilities, based on observation and interactions with each patient aimed at weighing their psychophysical performance.

Concussion, Persistent Concussion Symptoms (PCS) and ‘Pseudo-PCS’: A Neurosurgeon’s Medicolegal Perspective

Concussion, Persistent Concussion Symptoms (PCS) and ‘Pseudo-PCS’: A Neurosurgeon’s Medicolegal Perspective

Çocukluk Çağı Ev Kazalarının Adli Tıbbi Değerlendirmesi: 2 Yıllık Retrospektif Tek Merkezli Bir Çalışma

Background: Children are at a significant risk of domestic accidents due to their interest, curiosity, and lack of awareness of their surroundings. This study aims to evaluate domestic accidents from a medicolegal perspective and draw attention to the frequency and severity of such accidents in childhood.
 
 Materials and Methods: All ICD-10 codes related to domestic accidents and injuries were scanned and reviewed. A total of 1,835 cases in the age group of 0-18 years, who presented to our hospital with a history of domestic accidents, were identified between January 1st, 2015, and December 31st, 2016.
 
 Results: The mean age of the cases was found to be 45 months (min: 0, max: 215). It was observed that domestic accidents occurred predominantly in the 13-24 months age group, accounting for 494 (26.9%) cases. The majority of accidents occurred in the living room, constituting 672 (36.6%) cases, and the most common type of accident was falling, accounting for 960 (52.4%) cases. Only 451 (24.6%) of the study population were reported to judicial authorities.
 
 Conclusion: In cases of domestic accidents, especially if they are repeated, to avoid overlooking child abuse cases, it is recommended to seek opinions from experienced forensic medicine practitioners in this field, if possible. Establishing a national domestic accident database and conducting further studies on domestic accidents in children will enable us to comprehend the true extent of these accidents and develop new and diverse approaches to prevent them.

Long time consequences after STARR procedure: Report of 15 years experience and medico-legal perspective

IntroductionStapled transanal rectal resection is the most surgical procedure used for obstructed defecation syndrome, rectal prolapse, rectocele and rectal intussusception worldwide.The aim of this study is to report our experience and long time consequences and to offer a new medico-legal perspective. Materials and methodsWe retrospective review medical charts of patients treated between 2006 and 2021 ​b ​y the same team directed by the same senior surgeon. We consider major complications and long time sequelaeses as main object for the discussion. Inclusion and exclusion criteria were created. IRB approved the study. After revision a medico-legal perspective was done based on major complications. ResultsDuring the study period 1726 patients, ages between 18 and 71 years old, were treated with 1280 STARR procedures and 446 “Longo” [was stopped on 2012]; all procedures were performed by the senior surgeon and visited by the team at the same control visit at 7days, 30 days and 12 and 18 months after surgery. All patients had 100 ​% compliance at 30 days, while 85 ​% had long time visit (more than 18 months). During the study period 6 ​% (104 subjects) of patients had minor complications while 1 patient (42 ​yrs female) reported total fecal incontinence after 18 months (0,05 ​%). This patient had mental disorder treated with drugs unknown before surgery and long time mental disorder after surgery. We focused on this last case to discuss long time complication DiscussionThis survey reports some interesting clinical data; respect to standard complications minor complications such as pain, bleeding and anal discomfort represent less than 10 ​% of procedures that is a good results in this perineal surgery. For those working with rectal mucosal prolapse, obstructed defecation syndrome, rectocele or rectal intussusception is essential to distinguish these diagnosis to have a good counselling with patient before surgery (at least 1 month before). It is essential to check these patients with a close follow-up especially after surgery, to avoid any other mental discomfort related to fecal incontinence; long time fecal incontinence, without anatomical disorders as our case, could be associated and related to drugs consumption or mental disorder, or perineal insensitivity due to surgical procedure. In conclusion it is essential to have good clinical practice to suggest STARR procedure, having idea about different diseases, different surgical approaches and different long time complications.

Medicolegal knowledge and its practice among physiotherapists in Maharashtra

Background: Physiotherapy is a modern science and an independent profession. Physiotherapists are expected to conduct professional practice according to the existing laws and follow the guidelines of the respective state councils. Awareness about patients’ rights is increasing, as are malpractice cases and as professionals who are in constant contact with their clients, physiotherapists need to safeguard themselves from a medicolegal perspective. Having appropriate knowledge of medicolegal aspects and practicing accordingly will protect them against legal damages while maintaining professional integrity. This study aimed to find the level of medicolegal knowledge and its practice among physiotherapists in Maharashtra. Methods: An observational, cross-sectional study was conducted in Maharashtra, India. A self-made, validated questionnaire was distributed online and 100 physiotherapists across Maharashtra, accessed via the convenience sampling method, were surveyed. The collected data was analysed using descriptive statistics. Results: The average knowledge was 50.38%, but the average correct practice was 71.86%. These findings showed that the physiotherapists were practicing according to basic knowledge and they needed to improve their knowledge of aspects such as the Maharashtra Act II of 2004, documentation, applicable laws and professional indemnity to practice with unquestionable protection against legal proceedings. Conclusions: Physiotherapists in Maharashtra have basic knowledge of the governing body and of the legal aspects of their profession. With medical negligence cases on the rise, they need to update themselves about the details to conduct a safe and efficient practice. This will enhance their professional competence and provide legal and financial security.

Sex- and Gender-Specific Drug Abuse Dynamics: The Need for Tailored Therapeutic Approaches.

Sex and gender have been gaining ever greater attention due to their associated risks, dynamics, patterns and protective factors underlying substance abuse and addiction. Such differentiations and the clarification of complexities thereof take on even greater relevance in light of drug abuse scope worldwide. According to the 2022 World Drug Report released by the United Nations Office on Drugs and Crime (UNODC), in 2020 an estimated 284 million people worldwide aged 15-64 had used a drug within the last 12 months. The authors have set out to shed a light on determinants and contributing factors of drug abuse based on sex and gender and outline policy and medicolegal remarks aimed at delineating sex- and gender-based approaches towards drug abuse therapeutic interventions that are both therapeutically and ethically/legally viable and grounded in an evidence-based set of standards. Neurobiological data suggest that estrogen may facilitate drug taking by interacting with reward- and stress-related systems. In animal research, the administration of estrogen increases drug taking and facilitates the acquisition, escalation, and reinstatement of cocaine-seeking behavior. From a medicolegal perspective, it is of utmost importance to take into account the whole picture constituting each patient profile, which certainly includes gender factors and contributors, when outlining a therapeutic approach. Failure to do so could lead to negligence-based malpractice allegations, in light of the scientific findings representing best practices with which clinicians need to comply when caring for SUD patients.

Torture and Maltreatment in Prison: A Medico-Legal Perspective

The maltreatment and torture of prisoners constitute a global problem. Methods of maltreatment are classified as the psychological and the physical, and physical methods inevitably lead to psychological sequelae. Our review offers an analysis from the medico-legal perspective of the literature on the torture and physical and sexual abuse experienced by prisoners and their psychological sequelae and aims to investigate the medico-legal issues of investigating maltreatment in prison so as to suggest methodologies and updated approaches for dealing with such cases in a forensic context. We performed a comprehensive literature search of peer-reviewed publications (articles and reviews), research reports, case studies, books, service models, protocols, and institutional documents available online using key electronic databases (Scopus, PubMed) and search engines (Google Scholar) with the following keywords: physical violence, psychological violence, torture, maltreatment, physical abuse, psychological abuse AND prison OR prisoner OR jail OR custody. In the medical literature, most of the publications on torture are based on retrospective studies of torture among survivors and often refer to asylum seekers. Forensic evaluation is crucial for assessing the determinant elements of torture and maltreatment. A multidisciplinary approach and standardized and updated methodologies are needed to support policymakers, national institutions, and public health system initiatives in this field.

The choice of Caesarean section between clinical indication and patient autonomy: The physician between rock and hard place.

Caesarean delivery carries a higher risk of short- and long-term complications for both mother and baby than vaginal delivery. However, over the past two decades, data show a considerable increase in requests for Caesarean sections. This manuscript analyses the case of Caesarean Section on maternal request without a clinical indication from a medico-legal and ethical perspective. Medical associations and bodies databases were searched for published guidelines and recommendations on the use of caesarean sections on maternal requests. As derived from the literature, medical risks, attitudes, and reasons for this choice have also been summarized. International guidelines and medical associations recommend strengthening the doctor-patient relationship by setting up an information process to make the pregnant woman understand the danger of Caesarean delivery without clinical indications and to make her consider whether she can survive natural childbirth. Caesarean section on maternal request and without clinical indications is an emblematic case of how the physician could be between two opposing interests. Our analysis shows that if the woman's rejection of natural birth persists and clinical indications for Caesarean delivery are lacking, the physician must respect the patient's choice.

Which caval diameter? Clarification manufacturer's instructions for inferior vena cava filter use and implications for practice

To clarify manufacturer's instructions for inferior vena cava (IVC) filter use and implications for practice. Three vendors of IVC filters were contacted for clarification, with all stating that caval diameter limits are to be true maximum and true minimum cross-sectional diameters. To determine the implications of this, measurements were performed on 302 abdominal computed tomography studies in four transaxial dimensions perpendicular to the long axis including true maximum and minimum diameters, and measurements reflecting those typically taken on fluoroscopic cavography. Based on the true maximum and true minimum caval diameter limits as clarified by vendors, 22% of patients who would typically be considered suitable for IVC filter insertion based on frontal and lateral fluoroscopic cavography would be contraindicated, and 40% of patients who would typically be considered suitable for IVC filter insertion based on only frontal fluoroscopic cavography (as lateral projection is often not performed) would be contraindicated. There is a marked discordance between the vendor-clarified caval diameter limits of three common IVC filter devices and real-world caval geometry. Given the rarity of complications, this suggests a pressing need for revision of manufacturers' instructions for use statements to better reflect current safe routine clinical use, particularly from a medicolegal perspective.

Journey of unidentified bodies towards DNA identification: A social, medico-legal and forensic perspective from New Delhi in India

IntroductionAccording to studies undertaken in numerous nations, alarming increase in the number of unidentified bodies is a global concern. The population worldwide is increasing, and so is the population of the developing Indian subcontinent. Interestingly, a portion of this population is made up of individuals who have flocked from different states in search of employment, etc. Such people die under unfortunate circumstances, and under a police inquest, the process of their identification begins with an autopsy surgeon and a forensic scientist playing a larger role in it. DNA profiling provides an efficient tool in identification of such unidentified bodies. In addition, the authors have attempted to put together a background narrative of the ill-fated individuals; divulging into their standing in the urban society. Materials & methodsA total of 100 case files related to unidentified bodies were selected from total cases received between 2017 and 2021 at Regional Forensic Science Laboratory. The various parameters were reviewed, followed by DNA profiling of all exhibits. An attempt was made to correlate the said parameters with respect to DNA profiles and vice-versa to comprehend how these parameters, coupled with DNA profiling, help in identification of unidentified bodies. ResultsThe majority of the unknown deceased were males in the age range of 3–90 years old. The unknown deceased died of natural or unnatural causes, with majority dying of injury or trauma. The approximate time since death ranged from same day up to 6 months. Exhibits like dried blood gauzes, liquid blood samples in EDTA vials, teeth, and bones were able to generate DNA profiles in most of the cases for identity of deceased. Blood gauze was the most common source of exhibits submitted at the laboratory. ConclusionThe study’s findings revealed that besides age, sex or cause and manner of death of decedent, the type of exhibit (blood gauze, tooth, etc.) for DNA examination, the appropriate exhibit, if collected and preserved properly, can play a vital role in identification. A systematised action plan is required by law enforcement agencies in order to minimise the social and legal burden of unidentified dead bodies. In such a plan, medical experts must note down all possible findings at the time of post-mortem and collect suitable exhibits for DNA profiling. Further DNA profiling of the exhibits by forensic DNA experts should be done to preserve the unaltered identity of the deceased for a longer term in a DNA database.

Caution in workplace drug testing: Controlled drugs

Increasing substance abuse in the world, affects many areas of life, and this situation in workplaces causes exceptionally low work performance and even occupational accidents, resulting in problems that can create high costs for employers. In this context, workplace drug testing (WDT) programs are designed to detect the status of alcohol, illegal substances, or certain abused prescription drugs. These drug tests are a deterrent and preventive application of substance use in the workplace. The increase in the non-medical use and misuse of prescription drugs such as pregabalin (PGB) is a serious public issue in most countries such as Turkey. PGB was included controlled drug list in 2019. In the routine practice of WDT, classical substances are analyzed and PGB is not. In this study it's aimed to Evaluate the toxicological data obtained via a comprehensive retrospective investigation of urine samples of cases from a medico-legal aspect by creating a wide perspective for investigating psychoactive substances susceptible to abuse in Turkey. Furthermore, the study aimed to raise awareness on the subject by conducting a more comprehensive retrospective scan to determine the status of abused drugs, particularly the status of prescription/controlled ones. Forty-seven cases were admitted to Ege University Addiction Toxicology Laboratory between 2017 and 2021 due to special WDT requests. Thirty-one samples of the cases, of which there was a witness sample, were included in the study. The cases consisted of current employees or the ones who applied to work in companies from different transportation sectors and those who were asked for a drug test to be able to travel abroad. During the pre-interview of the cases by the physician, sociodemographic information, data on drug use, and urine samples were collected following the safety chain procedures. Urine samples were first subjected to screening analysis by immunoassay (Biochip). Confirmation analysis was performed with GC-MS of positive samples. All samples were subjected to a general toxicological screening in terms of 147 parameters with LC-MS/MS. Among the cases, 61.3% ( n = 19) were male, and the ages varied between 22 and 56. There were cases declaring drug use in the last 72 hours for the treatment of analgesic, cardiac, hypertension, osteoporosis problems etc. In case No. 1, cannabis (THC) and ATS were detected in the screening analysis and confirmed by GC-MS. In the analysis with LC-MS/MS, PGB, which was not included in the analysis scale in GC-MS, was detected in this case. He stated no drug/substance use. Case No. 1 was also reported to have attempted to forge the identity card upon identifying the personnel performing identity verification during the workplace drug test. PGB was found positive for case No. 29 with LC-MS/MS, while he also was noted to have been referred for toxicological analysis as the employer noticed the decrease in work performance. Employer-reported data overlapped with clinical signs of PGB use and a positive laboratory PGB result. Additionally, there was no drug containing PGB among the cold medicine and analgesic drugs (Voltaren) declared. The increase in the non-medical use and misuse of prescription drugs is a serious public issue in most countries such as Turkey. Most of the abusers have perceptions that the prescribed drugs are more reliable, and healthier than illegal substances, in addition, it is much more easy access. It is remarkable that we detected pregabalin, one of the controlled/prescription drugs in 2 cases in our study. In addition to conventional substance screening included in the international WDT guideline, the study's findings demonstrated, from a medico-legal perspective, the importance of meticulous investigation with clinical awareness of the prescripted substances susceptible to abuse such as PGB due to their increasing abuse potential.

Pressure Ulcers from the Medico-Legal Perspective: A Case Report and Literature Review.

Introduction: The identification of professional liability profiles related to the development of pressure injuries is a very thorny issue from a medico-legal perspective. This is because no matter how strict the applied prevention protocols applied may be, the development of such injuries is largely dependent on endogenous factors. This paper aims to investigate the medico-legal issues related to this topic through the exposition of one case of medico-legal litigation and a traditional review of the literature. Methods: We performed a literature search using three databases (Pubmed, Scopus, and Web Of Science), restricting the search to the period between 2001 and 2021. We used “pressure ulcers” and “jurisprudence” as the main keywords. From an initial library of 236 articles, our selection resulted in 12 articles, which were included in the review. Results: We identified the ever-increasing expectations of patients and the concept of automatic attribution of responsibility when a pressure ulcer develops as the primary reasons for the increase in litigation over the past 20 years. The related corrective measures are numerous: a strict adherence to guidelines, an adequate documentation of preventive measures, a risk assessment, family involvement, and a successful collaboration between physicians and government institutions. Conclusions: The biological complexity of the pathogenetic development of pressure ulcers makes the subject very delicate from the medico-legal point of view. In principle, it is possible to state that a very large proportion of such injuries are preventable, but that there remains a percentage of them that cannot be prevented. In such cases, only a proper documentary demonstration of the adequacy of preventive measures can exclude liability profiles.

Prevalence and Severity of Injuries in Patients Following Road Traffic Accidents: A Medicolegal Aspect

Background: Around the world, road traffic accidents (RTAs) are the leading cause of morbidity and mortality, with the incidence being high in both developed and developing nations. This study was conducted with the goal of determining the pattern and degree of injuries following an RTA from a medical and legal standpoint. Study Design: Retrospective analytical study. Place and Duration of Study: Peoples University of Medical & Health Sciences for Women, Nawabshah from 1st October 2020 to 30th September 2021. Methodology: Two hundred and ten patients of road traffic accident presenting in the emergency department were enrolled. Results: Patients with road traffic accident were more likely to be motorcycle or scooter riders 59.2% or pillion riders 13.3 %. The most prevalent age group was 20-29 years old, according to the results 39.5 %. Most of the 210 patients had no internal injuries, and the few cases of polytrauma with internal injuries were quite rare 6.1 %. Majority of males were involved in road traffic accident. Conclusion: Men, bike/scooter drivers, and those between the ages of 22 and 29 are more likely to be involved in a traffic collision. According to the medicolegal perspective, patients who have been involved in road traffic accidents are more likely to sustain serious and life-threatening injuries. Keywords: Prevalence, Severity, Injury, Road traffic accident