Medico Legal Research Articles

Correlation of Cause of Death Issued in Medico Legal Deaths in Hospitals and Cause of Death Found at Autopsy

Background:The death certificate is essential for legal investigations and public health planning. This study examines theaccuracy of causes of death reported by hospitals versus post-mortem findings and evaluates the completeness of deathcertificates.Method: A prospective, descriptive study was conducted in 99 cases, with hospital-issued death certificates, broughtfor medico-legal autopsy to the Department of Forensic Medicine, Institute of Medicine, Maharajgunj Medical Campus.Cases which were brought dead to the hospital but still were issued with death certificates and cases where the cause ofdeath remained undetermined even after autopsy were excluded. Data was recorded in a pro-forma and analyzed using theSPSS software Version 20.Result: The study involved individuals aged 13 to 30 years, mostly male. Private hospitals issued 66.7% of death certificates,with 55.6% by house officers. Only 62.6% met WHO standards. Autopsies were performed within 24 hours in 67.7% ofcases, revealing blunt force head injury as the leading cause of death (26.3%). There was a 67.7% discrepancy betweenhospital and autopsy causes of death, with house officers and government hospitals showing notable inconsistencies.Conclusion: Factors like the use of standard or non-standard death certificates, the designation of doctors, and the typeof hospital issuing the certificates influence the discrepancies between the causes of death listed by hospitals and thosedetermined after autopsies. This study aims to enhance the existing knowledge on the accuracy of death certificates and islikely the first systematic study of its kind in Nepal, laying the groundwork for future research.

A Retrospective overview of Medico Legal Study on poisoning death in Dhaka medical college

A Retrospective overview of Medico Legal Study on poisoning death in Dhaka medical college

Complementarity of odontology and anthropology in the identification of unknown bodies

The press regularly echoes disturbing disappearances of children and adults, suicides, victims of accidents, homeless, the often fortuitous discovery of bodies or human remains. The identification process of the person will be comparative when there is a presumption of identity and estimative in case of absence of presumed identity. In 2011, a retrospective study over 6 years at the Poincaré Hospital IML (Medico Legal Institute) in Garches states the surprising figure of over 1500 burials underX per year in France. This situation is the result of a series of dysfunctions. After having identified the causes, the identification in odontology and anthropology could contribute to solve this problem by adopting the following resolutions. Firstly, the creation of a single file for disappearances, grouping together the Ante-Mortem (AM) medical and odontological data files of persons reported missing, as well as the Post-Mortem (PM) odontological and anthropological data files collected on bodies under X during thanatological operations within the Medico Legal Institute. Secondly, the systematic collection of odontological evidence PM as well as an exhaustive anthropological analysis for any body under X without presumed identity, before burial.

Causes of Violent Deaths in Senegal during Medico Legal Autopsies

Causes of Violent Deaths in Senegal during Medico Legal Autopsies

Evaluation of Errors in Medico Legal Records in the Emergency Department of a Tertiary Care Hospital in North India, New Delhi

Medicolegal cases (MLC) are injuries or medical conditions which require additional input from law enforcement agencies to help in the diagnosis and determining the nature of injury sustained by the patient. Any incorrect input or incomplete documentation may lead to delay in the legal proceedings and thus, patient rights will be violated. In this article, we will enlist the errors in the medicolegal records over the period of 3 years in our institute and guide the doctors in the emergency department for proper documentation of the medicolegal cases.

Rare Medico Legal Cases of Pediatric Intensive Care Unit

Objective: While Multiple Life-threatening Conditions (MLCs) admitted to the Pediatric Intensive Care Unit represent a substantial healthcare burden, the risk factors, epidemiological data, and clinical manifestations of these cases have yet to be systematically and comprehensively documented. Material and Methods: This study was conducted in the Pediatric Intensive Care Unit at Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January 1, 2017, and January 1, 2022. The study included 31 males (35.4%) and 17 females (64.6%) with an average age of 4.7 ± 4.1 years. MLCs were classified into nine groups, including Foreign Body Aspiration (FBA), Blunt Trauma (BT), Asphyxia (ASP), Firearm Injury (FI), Sharp and Penetrating Object Injury (SPOI), Electric Injury (EI), Sports-Related Injury (SRI), Animal Bite Injury (ABI), and Home Accident (HA). Results: Foreign Body Aspiration (FBA) was the most prevalent type of MLC in this study (29.1%). The average hospital stay for FBA cases in the general ward was 3 days (range: 1-11 days), and in the Pediatric Intensive Care Unit was 2 days (range: 1-8 days). Blunt Trauma (BT) cases had an average hospital stay of 4 days (range: 1-12 days) in the general ward and 3 days (range: 1-10 days) in the Pediatric Intensive Care Unit. Surgical intervention was required for 29.1% of patients (n=14). The mean cost of treating a case in our study was calculated to be 5744 ₺ (approximately US$308.57). The majority of MLCs were attributed to FBA (n=14, 43%), followed by BT (n=9, 18%), and ASP (n=8, 16%). Conclusion: The predominance of Multiple Life-threatening Conditions (MLCs) in the Pediatric Intensive Care Unit, with Foreign Body Aspiration (FBA) being the most common cause, underscores the need for heightened awareness and prevention efforts. Understanding the risk factors, clinical presentations, and healthcare costs associated with these cases is essential for healthcare professionals and policymakers in their pursuit of reducing the incidence of MLCs.

Medico-Legal Cases: An Overview

A Medico-Legal Case can be defined as a case of injury or ailment in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the injury or ailment. Once the attending doctor decides to treat the case as Medico Legal Case, immediately he is required to inform the jurisdictional police as provided under Section 39 of Criminal Procedure Code, failure to do so, may result in a prosecution under Sections 176 or 202 of Indian Penal Code. Based on the report, police visits the patient to verify details mentioned in Medico-Legal Case. If there is subsequent death of patient or if the relatives wish to take a legal action against the offender, then based on the Medico-Legal Report, a First Information Report is registered under the relevant Indian Penal Code section. Medical practitioners share the responsibility of action against crime by supporting the justice system. The best way for a medical practitioner to achieve this is by proper examination of victims and/or perpetrators, and completing the legal documents meticulously. Medico-legal documentation is more than the compilation of a medico-legal report. Inappropriate completion of medico-legal documentation may necessitate the practitioner having to explain the documentation to make it understandable to the court.

Femicide: the georeferencing of cases in a brazilian capital and its metropolitan region

The aim of this research was to evaluate the spatial distribution of cases of femicides attended by the Instituto Medico Legal de São Luís/MA, between the years 2015 and 2021, according to the municipalities and neighborhoods of the occurrences. Cases referring to female victims were included in the research when it arrived for forensic examination and who presented in its Necropsy Requests and/or Police Report the classification of Qualified Homicide - Femicide. After registering the data in a spreadsheet editor, the addresses were punctuated in the Google Earth Program. The hot plots were produced by the ArcGIS Software. In the Kernel density map, there was a quantification of the relationships of the points within a radius of 5km, due to the low concentration of data. The total number of corpses analyzed at the IML was 9,301 cases, among which 1,111 were women, only 49 cases were classified as femicide, a prevalence of 4.41%. Femicide cases were observed in 14 different municipalities in Maranhão, with the city of São Luís with the highest number of registered cases. The subtypification of femicide is a serious problem due to the strict protocol in the search for traces that should be applied to all cases of violent death against women.

Rare Medico Legal Cases of Pediatric Intensive Care Unit

Objective: Although the MLCs who are admitted to the Pediatric Intensive Care Unit establish a crucial health burden, the risk factors, epidemiologic data and clinical signs of such cases have not been documented in a regular and comprehensive way.
 Methods: A retrospective patient review was made. This study was conducted in the PICU of Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between 01 January 2017 and 01 January 2022. This study enrolled 31 males (35.4%) and 17 females (64.6%) aged 4.7 ±4.1 years. We classified MLCs into nine groups as Foreign Body Aspiration (FBA), Blunt Trauma (BT), Asphyxia (ASP), Firearm Injury (FI), Sharp and Penetrating Object Injury (SPOI), Electric Injury (EI), Sports-Related Injury (SRI), Animal Bite Injury (ABI), Home Accident (HA).
 Results: FBA is the dominant type of MCL of this study (29,1%). The average hospital stay of FBA cases in the ward was 3 (1-11) days; in PICU was 2 (1-8) days. The average hospital stay of BT cases in the ward was 4 (1-12) days; in PICU was 3 (1-10) days. The average hospital stay of ASP cases in the ward was 2 (1-6) days; in PICU was 2 (1-7) days. 29,1 percent of the patients (n=14) required the surgery. In our study, we calculated that the mean voice of treatment of a case is 5744 ₺ (around US$308,57). The most significant proportion of the MLCs was caused by FBA (n=14, 43%), followed by BT (n=9, 18%) and ASP (n=8, 16%). 
 Conclusion: All parties which want to make decrease in the number of the MLCs, should draw attention to prevention efforts

Study of Trend and Pattern of Death of Prisoners in Judicial Custody in the State of Bihar and its Medico Legal Aspect

Study of Trend and Pattern of Death of Prisoners in Judicial Custody in the State of Bihar and its Medico Legal Aspect

The electrocardiogram on the wrist: a frightening experience to the untrained consumer: a case report

BackgroundSmartwatches offering electrocardiogram recordings advertise the benefits of supporting an active and healthy lifestyle. More often, medical professionals are faced with privately acquired electrocardiogram data of undetermined quality recorded by smartwatches. This is boasted by results and suggestions for medical benefits, based on industry-sponsored trials and potentially biased case reports. Yet potential risks and adverse effects have been widely overlooked.Case presentationThis case report describes an emergency consultation of a 27-year-old Swiss–German man lacking known previous medical conditions who developed an episode of anxiety and panic due to pain in the left chest prompted by over-interpretation of unremarkable electrocardiogram readings of his smartwatch. Fearing acute coronary syndrome, he presented at the emergency department. His smartwatch electrocardiograms, as well as a 12-lead electrocardiogram, appeared normal. After extensive calming and reassuring, as well as symptomatic therapy with paracetamol and lorazepam, the patient was discharged with no indications for further treatment.ConclusionsThis case demonstrates the potential risks of anxiety from nonprofessional electrocardiogram recordings by smartwatches. Medico–legal and practical aspects of electrocardiogram recordings by smartwatches need to be further considered. The case shows the potential side effects of pseudo-medical recommendations for the untrained consumer, and may add to the discussion on the ethics of how to evaluate smartwatch electrocardiogram data as a medical professional.

Assessment of Sudden Natural Deaths in Medico-Legal Autopsies at Tertiary Care Teaching Hospital

Background and Aim: Sudden natural death that occurred apparently to a healthy individual sometimescreates suspicions of foul play, thus subjected to medicolegal (ML) examinations. The study aims to assess thesociodemographic profile of the sudden natural death cases brought for medicolegal autopsy and identify thecommonest accountable cause of sudden natural death.Material and Methods: The study was conducted in the Department of Forensic Medicine, at tertiary care teachinghospital, India for the duration of 1 year. During the study period total of 784 cases were brought for medicolegalautopsies to mortuary, out of which 50 cases were found to be sudden natural death constituting an overall burdenof 6.37%. All the cases of autopsy having the opinion of natural death as a cause of death and cases brought deadin casualty without evidence of unnatural cause were included. The distribution of the cases concerning varioussociodemographic variables was presented as frequencies and percentages.Results: Male predominance was observed among the sudden death cases as out of 50 cases, 40 cases (80%) weremale, and 10 cases were female with a sex ratio of 4:1. Most of the cases were reported from the adult age groupand the commonly involved age group was 31 to 40 years. Among the causes of sudden death, the most involvedorgan system was the cardiovascular system (44%), followed by the gastrointestinal system (22%), respiratorysystem (18%), central nervous system (14%) and genitourinary system (2%).Conclusion: Cardiac causes are the most common cause of sudden natural death among the adult population inthe study site. Increased frequency of sudden deaths among urban, married and adult male populations might bedue to sedentary lifestyles in urban areas and increased stress among married individuals due to workload andfamily responsibilities, indicating a physical and mental disequilibrium in modern times resulting in this type ofunexpected deaths.

IMPERÍCIA EM NECRÓPSIAS PÓS ESTRANGULAMENTO E ENFORCAMENTO EM IML DE ALAGOAS, BRASIL, EM 2018 E 2019

In this sense, we analyzed 86 autopsy reports of hanged and strangled individuals performed at the Medico Legal Institute (IML) Estácio de Lima, in Maceió, Alagoas, Brazil, between 2018 and 2019. We compared the necropsy techniques used in the IML with what the literature recommends, also reviewing the technical manuals for medical examiners in three states.

Gross and Histopathological Study of Adrenal Glands from Routine Medico legal Autopsies

Background: Autopsies are important in clinical medicine as they can identify medical errors and assist incontinuous improvement. The role of a forensic pathologist is highly significant in determining the cause of deathas an undiagnosed case can contribute to the improvement of clinical or surgical management of such type ofpatients, and help prevent unexpected deaths in the future. In an era, where pathological autopsies are limited,the medico-legal autopsy will serve as supplement to document the incidental adrenal pathologies in the studypopulation.Material and Methods: The prospectivestudy was performed after getting proper approval from Institute ethicalcommittee. The adrenal glands were procured from medico-legal autopsies conducted from 2019 -2021, at themortuary of Govt. Medical College and Hospital, Aurangabad. All the necessary details were noted from thepolice requisition, Inquest panchnama and clinical papers provided. All the important findings were noted downin the predesigned case record form.Result: A total of 128 adrenal glands were examined for gross and histopathological changes. The number of malesand females studied comprised of 38 males (59 %) and 26 females (41%). Majority of lesions were observed onhistopathology as compared to gross examination. Maximum number of the lesions were observed in the age groupbetween 21 to 30 years (29%). Gross adrenal lesions were noted in 62% males and 38% females. Histopathologylesions were noted in 63% males and 37% females. The study showed more of unnatural cases than natural cases.Majority of the lesions are seen in unnatural deaths than natural deaths except enlarged adrenals are found innatural deaths. Majority of the adrenal histopathology lesions were found in unnatural deaths except adrenalitis,hypertrophy and atrophy which is common in natural deaths. Majority of the lesions are found in unnaturaldeaths both on gross 73% as well as histopathological 67% examination.Conclusion: This study emphasizes the importance of Gross as well as Histopathological examination in medicolegalautopsies. In cases of negative autopsies, this necessitates to examine the adrenal glands, histopathologically whichmay give a clue about the cause of death.

Medico – Legal Profile among the Unnatural Deaths in Paediatric Age Group at SMS Hospital, Jaipur

Background: Childhood begins after birth and continues into adolescence; according to the Children’s Bill ofRights, childhood is defined as the life up to 18 years after birth. Childhood mortality is a reliable indicator ofhealth care facilities of a country and its development.Aims & Objective: Assessment of medico–legal profile among the unnatural deaths in paediatric age group atSMS Hospital, JaipurMaterial & Methodology: A cross sectional observational prospective study that used inclusion and exclusioncriteria was conducted. 65 autopsies of medico-legal paediatric unnatural death were taken in the study. Thepresent study had been conducted in the Mortuary, Department of Forensic Medicine & Toxicology, SMS Hospital,Jaipur during the period from 15 June 2021 to 14 June 2022.Result & Observation: In this study total 65 pediatric victims studied. Male children account for 61.54 % (40victims) while female account for 38.46 % (25 victims), unintentional pattern of death was present in 49 subjectwith accidental manner of death in all. Intentional pattern of death was present in 16 subject with homicidalmanner of death in 6.15 % and suicidal manner of death in 18.45 %, In present study 23 subject (35.38 %) died dueto Road Traffic Accident, followed by Fall From Height in 12 subject (18.45 %).Conclusion: From the study we concluded that there is an immense responsibility for the parents and caregiversin supervising their children. If the incident cannot be prevented, the victim should receive immediate care rightaway in order to save their life.

Impact of COVID 19 lockdown on Medico Legal Cases in a Tertiary Care Hospital in North Kerala

Background: The consequence of Covid 19 lockdown on medicolegal cases was variable throughout the world.Methodology: A descriptive cross sectional study was conducted in a tertiary care hospital setting and otherpublic health institutions in the same district with the objective of comparing thetotal number of medico legalcases, any increase or decrease in the unnatural (accidental, suicidal and homicidal) versus natural deaths and alsowhether any increase or decrease of coronary artery disease among the brought dead natural cases during pre andthe lock down period.Results: Among the total number of medicolegal cases came for autopsy (237), 65.8% were during pre lock downperiod and 34.2% were during lockdown period. This indicates a significant reduction in the number of casesduring lockdown compared to pre lockdown in both type of institutions. This reduction in number of cases wereobserved in all the type of cases as indicated by reduction in unnatural deaths (30.2%versus 69.8%), small reductionin natural deaths (46.3% versus 53.7%), accidental deaths (26% versus 74%), suicidal deaths (36.2% versus 63.8%),reduction in Road traffic accidents(26.3%versus 73.7%), deaths following coronary artery disease (42.9%versus57.1%). The age distribution of deaths due to coronary artery disease during the pre lockdown period was in arange of 28 – 85 years and during lockdown period was 33- 78 years with a median of 48 years in both groups.Conclusion: Regardless of the type of, there is reduction in the number of medicolegal cases during lockdowncompared to pre lockdown in both the types of institutions.

Study on acute poisoning cases brought for Medico Legal Autopsy in Gandhi Medical College, Secunderabad

Background: Regular epidemiological investigations are essential for gaining insights into the incidence ofpoisoning in various geographical areas. The purpose of this study was to assess the characteristics and trendsof deaths due to poisoning in Gandhi Medical College, Secunderabad.Methods: Hospital records, inquest reports, post-mortem reports and toxicological analysis reports were analysedamong various age groups, sex, type and manner of poisoning. Snake bite poisoning cases were excluded.Results: Out of 318 cases, we got positive toxicological analysis report for 287 (90.2%) cases. In our studypredominance of male cases 259(81.45%) compared to female cases 59(18.55%) reported. In the age group mostinvolved was 21-30 yrs 107 cases (34%) followed by 31-40 yrs 82 (26%), 41-50 yrs 49 (15%). Organophosphatepoisoning reported in high number of cases 189(65.85%) followed by paraquat poisoning 44(15.33%), tabletpoisoning 23(2.01%), Sulphuric acid poisoning 22(7.67%) and others 9 (3.14%) (Rodenticide, phenol, pyrethroid,nitrite). In manner of death suicidal cases 311(97.80%) reported more followed by accidental cases 7 (2.20%). Insuicidal cases, economic constraints as a reason were outnumbered 209 cases (67.20%) followed by health issues52(16.72%), academic failure 35(11.25%), love failure 15(4.82%). In region wise, rural areas reported more cases244(76.73%) when compared to urban area 74 (23.27%). In season wise, more cases reported in April to July 148cases (46.50%) followed by December to March 97 cases (30.5%), August to November 73 (23%). Zero homicidalpoisoning noted.Conclusion: Organophosphate poisoning in active male population of rural areas with economic constraintswere reported to be predominant.

A Review on Medico legal and Ethical aspects of Orthopaedic Practice

A Review on Medico legal and Ethical aspects of Orthopaedic Practice

Sexual Assault in the Mahdia Region: Medico Legal Aspects

IntroductionDespite recent legislative changes through the enactment of 2017-58 law on the elimination of violence against women and children, sexual violence remains fairly frequent and is often underestimated.Objectivesto describe the epidemiological peculiarities of victims of sexual assault in the Mahdia region and to discuss their medico legal implications.Methodsthis is retrospective study of 110 cases of victims of sexual assault examined at the legal medicine department of the TAHER SFAR University Hospital in Mahdia. This work was carried out over the period from January 2016 to August 2018.Resultsthe majority of victims were female (80%) and the main vulnerability factor was an age under 15 (26%). The perpetrator was generally unique (74%). Sexual assault by penetration was mostly reported (51% of cases), and was almost exclusively penile (98,2 of cases). The gynecological examination revealed a torn hymn in 43 victims, a compliant hymen without traumatic lesions in 7 victims (8%) and recent vulvar traumatic lesions without hymenal crossing in 5 victims (5,6%). Recent anal penetration was diagnosed in 6 male victims (6,8%). Among female victims, recent anal penetration was diagnosed in 5 victims (22,7%). One in four victims reported a market psychological impact with female predominance in 85% of cases. Complications of the most reported sexual assaults were pregnancy in 7% of cases. In total, only 57,3% of the certificates issued made it possible to conclude that the injuries.ConclusionsThe care of victims of sexual assault requires a multi- disciplinary approach; medical, psychiatric, social and legal.DisclosureNo significant relationships.

Analysis of Pattern of Medico Legal Cases Registered in the Casualty Department of a Teaching Hospital, Karimnagar, Telangana

context: A medicolegal case is any medical case with legal implications. These medico-legal cases differ among regions based on socio-economic status, cultural diversities, capability of law enforcing agencies and the prevailing standards of health care services available in the community. aim: This study was aimed to know the pattern and magnitude of medico legal cases. material & methods: It is a record based analytical cross sectional study in which all the MLC cases registered in MLC record book of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar between January to June 2017 were included. Cases found non medico-legal were excluded. Variables considered were gender, age, time of arrival. Findings were expressed in numbers and percentages. results: Total cases were 464, of which 355 (76.50%) were males and 109 (23.50%) were females. Maximum cases were from the age group of 21-40 years i.e., 206 (44.39%). Most of the medico-legal cases registered were due to Road Traffic Accidents (53.67%) followed by machinery (factory) injuries (20.25%), poisoning (8.84%), fall from height (6.26%), assault (4.52%), thermal injuries (4.52%), injuries by animals (0.86%), self-inflicted injuries (0.64%), injuries due to violent asphyxia (0.22%), railway injuries (0.22%). conclusions: Most of the victims were males, young adults. Most common cases reported as medico legal cases were road traffic accidents followed by machinery injuries and poisoning cases, etc.