Medico-legal Examination Research Articles

Medicolegal Findings of Rape Victims: A Retrospective Study of 69 cases at a Tertiary Care Hospital in Dhaka City

Background: Proof of rape depends not only in the physical findings of the victims but also to the subjective intentions of the assailants.Objective: The purpose of the present study was to find out the medicolegal findings of rape victims in order to point out the visible loopholes of the procedure.Methodology: This was a cross sectional descriptive type of study which was done in the Dept. of Forensic Medicine, Dhaka Medical College, Dhaka, Bangladesh from January to December 2016 with maintaining ethical issues. Rape cases from 23 police stations of Dhaka Metropolitan area were sent for medicolegal examination and victims who ultimately agreed to do medicolegal examinations were examined and opinions were given regarding the issues.Results: A total number of 69 cases from 23 police stations of Dhaka Metropolitan area were studied. In this study, majority (70.0%) of the victims was within 11 to 20 years of age and 65.0% of the victims were unmarried. Almost 68.0% of the victims were examined within 7 days followed by 32.0% of the victims after 7 days to beyond one month after rape; however, 48.0% of the victims showed sign of recent hymeneal tear with bruise and abrasion followed by 52.0% showed sign of old hymeneal tear. Spermatozoa were not found in any of the specimen of high vaginal swab.Conclusion: In conclusion, teenage unmarried girl are the most common victim of rape cases.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 106-109

Medicolegal Aspects and Examination Techniques in Exhumation Cases with Alleged Human Rights Violation

Medicolegal Aspects and Examination Techniques in Exhumation Cases with Alleged Human Rights Violation

Організаційні основи проведення судово-медичної експертизи живих осіб

Організаційні основи проведення судово-медичної експертизи живих осіб

Medico-legal aspects of disabilities due to orthopedic injuries and compensations in Egypt

Disability is a complex problem that results in detrimental effects on the victim. The number of disabled has increased considerably. The development constitutes a good reason for paying more specific attention to society's growing number of disabled. The physician's duties are not only to describe the anatomic and physiological defects present in the injured individual, but also to answer questions regarding the patient ability to perform specific economic or social function. This study aimed to clear up some of the problems or difficulties that may face the medico-legal physician or any personal that may be concerned with the process of evaluation. In the other words the aim of work is to design a new strategy for evaluating the degree of permanent infirmities and their compensation. The study investigates the pattern of disability in cases referred for medico-legal examination in department of Cairo and the chief's office of medico-legal administration in ministry of justice. The study included 200 cases of disabled. Male gender was more predominate than female gender (were male 78% - female 22%) and the working group (18–60) were the most frequent age group identified as victims of traumatic injuries. It was recommended the overall development plans of the country should have a positive role in prevention and decrease this problem.

Practice of community-service doctors in the assessment and medico-legal documentation of common physical assault cases

Background: In South Africa, allegations of physical assault are managed primarily at the primary healthcare level, where they are attended to by medical officers or community service doctors (CSDs). However, reports that the knowledge and skills provided at undergraduate level are not sufficient to equip these CSDs to deal with evidence in medico-legal examinations in various settings, including in cases of patients who allege being the victims of common physical assault or assault with intent to inflict grievous bodily harm, have been documented in the literature. This study investigates the practice of CSDs in relation to the assessment and medico-legal documentation of allegations of common assault, with a view to identifying gaps in their knowledge of clinical forensic medicine.
 
 Method: The study was a cross-sectional descriptive study. A questionnaire with quantitative sections that used an adapted Likert scale was used to gather data. An electronic survey tool was employed to target 150 CSDs countrywide. Percentages are used to display results.
 
 Results: A response rate of 59.3% was achieved and results indicate that clinical forensic training in the undergraduate medical programme does not prepare CSDs sufficiently for the task of managing the medico-legal examination and documentation of allegations of assault by patients.
 
 Conclusions: The courts rely heavily on medico-legal documentation for success in criminal prosecution. Any substantial flaw in the documentation, including inadequate observations and/or notes made by a medical practitioner, may make proving guilt very difficult. This study revealed an important gap in the knowledge and practice of clinical forensic medicine by CSDs and suggests that the current curriculum should be adapted to allow adequate training of undergraduate medical students in the area of clinical forensic medicine. Appropriate undergraduate training will ensure that medico-legal documentation is completed accurately and that medical practitioners help ensure the administration of justice.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2018; DOI: 10.1080/20786190.2017.1364014

Medico-legal documentation of rape or sexual assault: are community-service doctors equipped for the task?

Background: Following upon two-year internship, community-service doctors make mistakes when they deal with evidence of medico-legal examinations in various settings. These mistakes result in alleged perpetrators being released by courts. This study investigated undergraduate clinical forensic medicine training, based on experiences and opinions of community-service doctors. This article focuses on incidents of alleged rape cases only. 
 
 Methods: The study was a quantitative retrospective cohort study that made use of a questionnaire with an adapted Likert scale. An electronic survey tool was employed to target 150 community-service doctors throughout South Africa. Percentages are used to display results.
 
 Results: A response rate of 59.3% was achieved. Although 80% of the participants reported that they had undergraduate training on how to manage alleged rape or sexual assault cases, only 11.4% of the participants had hands-on exposure to an alleged rape case during their undergraduate training. In addition, the majority of the participants (77.1%) never had undergraduate training on how to complete the J88 form. These findings indicate that clinical forensic training in the undergraduate medical programme does not adequately prepare community-service doctors to meet the challenges of clinical forensic practice. The current curriculum should be adapted to address these shortcomings.
 
 Conclusions: Perpetrators cannot be convicted if evidence collected cannot stand up in court. Proper training of undergraduate medical students prior to their community-service posting will ensure that medico-legal documentation is completed correctly, leading to the presentation of credible evidence in a court of law in order to ensure successful conviction of alleged perpetrators.
 
 Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2018; DOI: 10.1080/20786190.2017.1348046

Guidelines examination of victims of sexual assault harmonization of forensic and medico-legal examination of persons.

Sexual assault is a complex situation with medical, psychological, and legal aspects. Forensic experts play a major role in terms of forensic and gynecological medical examination and evidence collection in order to maintain the chain of custody. Victims should be examined by a specially trained medico-legal examiner in order to avoid multiple examinations in the surroundings that do not meet minimum health standards. The evolution and treatment of sexual assault victims are time-intensive and should optimally be provided by a team that includes a forensic medical doctor. These guidelines will be of interest to forensic medical doctors who will have responsibility for the examination and assessment of victims of sexual violence and can be used as a day-to-day service document and/or a guide to develop health service for victims of sexual violence.

Study of early postmortem changes in skin for estimation of postmortem interval at pims, loni

The primary task of medico-legal death examination is the reliable estimation of the time since death, on the basis of postmortem changes, under influence of different factors. Elasticity, transparency, softness, luster, moistness were the features of skin tested in study. In all the 66 cases, skin did not show luster, elasticity, transparency, moistness or softness after death, between 3 to 24 hours of postmortem interval, in relation to age, sex, body mass index, built, season, minimum to maximum temperature, humidity, cause, mode and manner of death factor. The dead body showed loss of elasticity and transparency, dullness, lusterless, hardness and dryness of skin between 3 to 24 hours postmortem interval in relation to various external and internal factors.

A study of cephalic index of Bengali subjects of Tripura for determination of race

Background: There has been a common belief among the people of Tripura that the racial origin of the Bengali subjects is from Aryans. Aims: The aim of this study was to determine the cephalic index of Bengali population of Tripura, for determination of their racial origin. Setting and Design: A data-based study carried out in a tertiary care teaching institute, Agartala. Materials and Methods: After obtaining ethical clearance from the Institutional Ethics Committee, this study was conducted on the cadavers of Bengali subjects of Tripura brought for medicolegal postmortem examination in a tertiary care teaching hospital in Tripura. A total number of 411 cases were selected at random for the study during April 2015–March 2016. Using a slide caliper (Martin's type), the maximum length and breadth of skull with and without soft tissue were measured and individual's cephalic index was calculated. Statistical Analysis Used: Data collected were analyzed using the Statistical Package for Social Science (SPSS Inc., Chicago, IL, USA) Windows based version 21.0. Results: The study comprised 282 (68.6%) males and 129 (31.4%) females. Two hundred and twenty-one numbers of subjects (53.77%) were found to be mesaticephalic, while 184 subjects (44.76%) and 6 subjects (1.45%) were brachycephalic and dolichocephalic, respectively. In case of cephalic index without soft tissue, 233 subjects (56.69%) were mesaticephalic and 178 subjects (43.31%) were brachycephalic, whereas none was found to be dolichocephalic. Conclusion: Among 411 numbers of subjects, when cephalic index was calculated with soft tissue, 221 numbers of subjects (53.77%) were found to be mesaticephalic, while 184 subjects (44.76%) and 6 subjects (1.45%) were brachycephalic and dolichocephalic, respectively. In case of cephalic index without soft tissue, 233 subjects (56.69%) were mesaticephalic and 178 subjects (43.31%) were brachycephalic, whereas none was found to be dolichocephalic.

Pattern of Sexual Assault in Gharbia Governorate during the Period between 2011-2014: Retrospective and Cross Section Study

Background: Sexual assault is a special type of violence with great effects on the victims. In Egypt, there are no accurate statistical data about sexual assault. Objective: The aim of this work was to study the pattern of sexual assault in Gharbia Governorate, Egypt. Subjects and methods: This study was conducted in Tanta Department of Forensic Institute of Ministry of Justice, Egypt. It included collection of retrospective data during the period from the start of January 2011 to the end of June 2014.Cross section study of sexual assault cases was also done from the start of July 2014 to the end of December 2014.Complete history taking as well as full general and local examination was done for the studied cases. Results and conclusion: Total number of sexual assault cases was 229 over the studied period. The median age of victims was 16 years with interquartile range of 10-21 ranging from 3 to 63 years. Most cases (63.3%) were less than 18 years, 76% of the cases were females, and came from urban areas (63.3%). Unmarried cases constituted 83%. Rape was the most frequent type of assault (41%). Most of the assailants were outside the familial relations to the victims (91.3%), and a single assailant was responsible in 78.6% of the cases. The most common type of physical injury was abrasion (46.75%), whereas the least were bites (1.29%). Most cases (68.6%) were examined within 10 days after the assault; hymnal tear was the commonest injury on vulvovaginal examination (88.4%). Anal examination revealed chronic habit of anal sex in 18.52% of cases. The present study concluded that unmarried females under the age of 18years from urban areas constituted the major victims of sexual assault in Gharbia Governorate. Rape was the commonest reported assault in this study. Logistic regression analysis revealed that age, gender and marital status were good predictors of type of sexual assault. Recommendations: Medico legal examination of sexual assaults should be done as early as possible for the value of collecting evidence. Medical education for the children and their family about methods of protection against sexual assault should be considered

Reasons of female children for elope with boyfriends in Anuradhapura district of Sri Lanka

Since Anuradhapura is a common district for elope of girl children with boyfriends, all medico legal examination forms of such cases examined by the author during last two years, were perused in order to find the reason for elope and about the awareness of legal age limit for the marriage. During the year 2015 and 2016, ninety-eight girls below the age of 18 who participated with elope had been examined by the author for medico legal purposes. They were within the age limit of 12 to 17 years. Forty two (42.8%) girls were not aware about the legal age for marriage. Commonest reason for elope was the disapproval of love affair by parents in 54 cases (56%). Other causes were; girls could not live at home in 17 cases (17%), no special reason in 16 cases (16%), issues related to sexual activities in 5 cases (5%) and miscellaneous reasons in 6 cases (6%).To minimize the elopement, psychosocial management of above five broad causes will be important. Research on reasons for elope from families and boyfriends will provide all groups of reasons for elopement in underage girls in the district.

A case of chronic subdural haemorrhage and its medico-legal implication

Subdural haemorrhage is almost always traumatic and rarely natural. Traumatic Subdural haemorrhage (SDH) occurs following break of the parasagittal bridging vessels due to shearing movement of the head. Clinical features appear in 3 days in acute SDH, in 3 days to 3 weeks in sub-acute SDH and after 3 weeks in chronic SDH. SDHs are aged macroscopically and histopathologically. A 42 years old female knocked down by a bus was admitted to a base hospital. She was unconscious on admission and had nausea, vomiting and headache. By the next day, almost all symptoms were settled except headache and was discharged. Fifteen days later, she developed sudden onset bilateral lower limb weakness and was re-admitted. She was transferred to a tertiary care hospital immediately. The pre-op CT scan showed left frontal chronic subdural hemorrhage (SDH) and the patient was subjected to a burr hole surgery. She was transferred back to the base hospital and according to the medico-legal examination performed 21 days after the incident, the category of hurt was “fatal in the ordinary course of nature”. In the remarks column, it was mentioned that it is not clear whether this SDH is due to the fall from the bus or any other incident after that. This chronic SDH also could be following a separate “new incident” that took place after the traffic accident. Therefore, without dating the chronic SDH accurately, it is not safe to identify the real causative circumstance.

Pediatric medicolegal autopsy in France: A forensic histopathological approach

The aim of postmortem medicolegal examination in pediatric death is primarily to establish the circumstances and causes of death and to exclude child abuse. In France, pediatric death is systematically documented by medicolegal or medical autopsy. In case of medicolegal autopsy, the complementary examinations, requested and financed by justice, are rarely limited to a histopathological examination. However in medical autopsies other tools are available to the pathologist as toxicology, biochemistry and molecular biology. The purpose of this article is to evaluate the efficacy of forensic histopathology in pediatric forensic autopsies. We analyze the main causes of pediatric death in a forensic context. Between 2004 and 2015, 157 infant deaths were identified in Marseille university hospital. The forensic histopathology and autopsy reports of all 157 cases were available for systematic review. Medical or surgical causes represented 41,3% of deaths in our center, accidental causes 8.1% and child abuse 28,8%. The definitive diagnosis was made at autopsy in 30% of cases and at histopathological examination in 70% highlighting that forensic histopathology is an indispensable tool in pediatric medicolegal autopsies. Significant histological abnormalities may be detected in selected organs such as the brain, lungs, heart, liver, adrenal glands and kidneys in spite of macroscopically normal appearances. This justifies systematic sampling of all organs. Despite the implementation of the French sudden infant death protocol which recommends medical autopsies, too many pediatric autopsies are carried out in a medicolegal context. 30% of the cases remain without diagnosis at the end of the autopsy and histological examination. This number could be reduced by the contribution of others laboratory investigation.

The Psychological Effects of Road Traffic Accidents (RTAs): An Exploration of a United Kingdom Medico-Legal Examiner's Career of RTA Assessments

Around 20 to 50 million people are injured as a result of a road traffic accident (RTA) each year throughout the world. In the United Kingdom there have been considerable efforts made to review the assessment of whiplash claimants following RTAs due to the perceived level of fraud. However, very little has been done with regards to assessments for mental disorder; this article seeks to investigate how such assessments are undertaken. Data originating from one clinical forensic psychologist's practice (N = 305) are examined to provide an insight into the assessment of mental disorder in the medico-legal arena in the United Kingdom, building upon previous research. Many important findings emerged from this analysis including a complicated relationship between the diagnosis of mental disorder and the gender of the claimant. In addition, this article provides detailed normative data using the Symptom Checklist 90 Revised, the Impact of Events Scale, and the Beck Depression Inventory.

Help or Hindrance? The Support Person in the Psychiatric Medico-legal Examination

The option of having a support person available in industrial disputes and disciplinary hearings has become a well-accepted practice. However, the implications of having a third party present and the potential for inhibition of disclosure in the forensic psychiatric/psychological assessment has not been examined in more than a limited fashion. Expectations of claimants and lawyers that the presence of a support person is a right and assumptions that altering the usual one-to-one dynamic has no influence are challenged in this experience-based commentary. Instances in which the support person may be a “help” or a “hindrance” are outlined, as are recommendations for managing some of the common pitfalls in conducting the evaluation in the presence of another party. An argument is also made for heightened awareness on the part of solicitors about choosing an appropriate support person.

PHYSICAL INJURIES;

Introduction: Injury is one of the leading causes of mortality and morbidityworldwide. Objectives: The aim of the study was to determine the pattern of physical injuriesin medicolegal cases presented to Services hospital, Lahore. Study Design: Descriptive study.Setting: Accident and emergency department of Services hospital, Lahore. Period: 1stJanuary2014 and 31stDecember 2014. Method: All cases presenting for medico legal examination withphysical injuries were included. Data was collected regarding age, gender, types of injuries,body area involved, causative weapon and whether certification of injuries was done accordingto Qisas and Diyat Ordinance. Results: A total of 86.4% cases were of physical injuries. Out ofthese cases, 73% of blunt weapon, 11% of firearm weapon, 10% of sharp weapon, 4%of roadtraffic accidents and1.5 % of bomb blast presented in the medico-legal clinic. Males (87.4%)outnumbered females (12.5%) Almost two-third of victims (64.2%) were between 21 and 40years of age. The head and neck were the areas most commonly injured in cases of blunttrauma 48.3% while limbs were more likely to be involved in other physical injuries. All caseswere certified according to Qisas and Diyat Ordinance. Conclusion: It is the hour of need thatboth public and private sectors work together in devising and implementing effective injuryprevention programs.

Case Report: Cyanide in a Fatal Herbal Drink: An Exhumation Case Study

Background: Traditional herbal drink, Jamu, is popular among Javanese. This paper reports two cases of death after taking a slimming Jamu. Interestingly, an illegal love affair was involved in this the case too. Case Report: The first victim (victim 1), a female, rapidly convulsed and died after taking a slimming Jamu drink. However, her brother (victim 2), after tasting just a small amount of that Jamu, rapidly became convulsive and unconscious. Although, he was immediately brought to hospital, he died before receiving any treatment. Because the death was unnatural, he was sent to the Department of Forensic Medicine for investigation. His sister was buried without any medico-legal examination, but later on the exhumation was performed. In autopsy, the victim 1 was found pregnant. Both victims had no injury on their bodies. Evidence of cyanide was positive in tissue samples, but negative in the control sample (soil). Conclusion: Both victims had the same cause of death, which was cyanide poisoning. The manner of death was suspected as homicide.

New, previously unreported correlations between latent Toxoplasma gondii infection and excessive ethanol consumption

A number of world literature reports indicate that a latent Toxoplasma gondii infection leads to development of central nervous system disorders, which in turn may lead to altered behavior in the affected individuals. T. gondii infection has been observed to play the greatest role in drivers, suicides, and psychiatric patients. Studies conducted for this manuscript involve a different, never before really reported correlation between latent T. gondii infection and ethanol abuse. A total of 538 decedents with a known cause of death were included in the study. These individuals were divided into three groups: the risky behavior group, inconclusively risky behavior group, and control group. The criterion for this division was the likely effect of the individual’s behavior on the mechanism and cause of his/her death. The material used for analyses were blood samples collected during routine medico-legal examinations in these cases. The blood samples were used to measure anti-T. gondii IgG antibodies with an enzyme-linked immunosorbent assay (ELISA). Moreover, the following data were recorded for each decedent: sex, age, circumstances of death, cause of death, time from death to autopsy, and (if provided) substance abuse status (alcohol, illicit drugs). In those cases where blood alcohol level or toxicology tests were requested by the Prosecutor’s Office, their results were also included in our analysis. Test results demonstrated a strong correlation between latent T. gondii infection and engaging in risky behaviors leading to death. Moreover, analyses demonstrated a positive correlation between the presence of anti-T. gondii IgG antibodies and psychoactive substance (especially ethanol) abuse, however, the causal relationship remains unclear. Due to the fact that alcohol abuse constitutes a significant social problem, searching for eliminable risk factors for addiction is extremely important. Our analyses provided new important information on the possible effects of latent T. gondii infection in humans.

Practice of community-service doctors in the assessment and medico-legal documentation of common physical assault cases

Background: In South Africa, allegations of physical assault are managed primarily at the primary healthcare level, where they are attended to by medical officers or community service doctors (CSDs). However, reports that the knowledge and skills provided at undergraduate level are not sufficient to equip these CSDs to deal with evidence in medico-legal examinations in various settings, including in cases of patients who allege being the victims of common physical assault or assault with intent to inflict grievous bodily harm, have been documented in the literature. This study investigates the practice of CSDs in relation to the assessment and medico-legal documentation of allegations of common assault, with a view to identifying gaps in their knowledge of clinical forensic medicine.Method: The study was a cross-sectional descriptive study. A questionnaire with quantitative sections that used an adapted Likert scale was used to gather data. An electronic survey tool was employed to target 150 CSDs country...

Medico-legal documentation of rape or sexual assault: are community-service doctors equipped for the task?

AbstractBackground: Following upon two-year internship, community-service doctors make mistakes when they deal with evidence of medico-legal examinations in various settings. These mistakes result in alleged perpetrators being released by courts. This study investigated undergraduate clinical forensic medicine training, based on experiences and opinions of community-service doctors. This article focuses on incidents of alleged rape cases only.Methods: The study was a quantitative retrospective cohort study that made use of a questionnaire with an adapted Likert scale. An electronic survey tool was employed to target 150 community-service doctors throughout South Africa. Percentages are used to display results.Results: A response rate of 59.3% was achieved. Although 80% of the participants reported that they had undergraduate training on how to manage alleged rape or sexual assault cases, only 11.4% of the participants had hands-on exposure to an alleged rape case during their undergraduate training. In ad...