Medico-Legal Journal最新文献

Organophosphorus, an insecticide used in agricultural and industrial settings, is the most common cause of poisoning in India. Organophosphorus is a nerve poison that causes irreversible inhibition of acetylcholinesterase, which leads to the accumulation of acetylcholine, resulting in excessive cholinergic stimulation of several organ systems. Several complications have been reported, but pancreatitis is quite rare and mainly due to ductal hypertension and injury to parenchyma, consequent to cholinergic hyperactivity in the pancreas. We present a case series of four cases where organophosphorus poisoning was suspected. Autopsy revealed that, in all four cases, the stomach walls were congested, pancreas showed gross haemorrhage over the surface and on cut sections, with other visceral organs showing generalised congestion. Later, after visceral and histopathological examination, all cases were confirmed as organophosphorus (dichlorvos) poisoning with haemorrhagic pancreatitis. Acute pancreatitis in organophosphorus poisoning usually has a subclinical course and gets masked by the systemic effects. Haemorrhagic pancreatitis sequela of acute pancreatitis is a rare and fatal complication of organophosphorus poisoning.

The vast majority of GP appointments had to move from in-person to remote consultation during the pandemic. Rather than phasing this out now that the threat of the coronavirus has begun to ebb, the UK government has announced that digital-first primary care will continue for the foreseeable future. While remote consultation can be beneficial on several fronts, it can compromise professional identity, therapeutic alliance, patient safety and access to healthcare. A hasty push towards normalising digitally-enabled care may therefore increase the risk of misdiagnoses, medical negligence, unnecessary referrals and health inequity. To enhance the gains and iron out the challenges associated with IT-led triage and consultations, it is important to reflect on the lessons learned from the pandemic.

Incidences of multiple bee stings have been increasing globally; the substantial amount of bee venom injected in such incidents can result in anaphylactic shock, rhabdomyolysis and renal failure, proving fatal in some cases. While anaphylactic reactions are more common and have established treatment protocols, inflammatory response induced by the venom demands a tailored approach. Here we report a case of a 70-year-old male in India who succumbed from approximately 500 bee stings. Based on our literature review, this case stands out as one of the first reported fatalities caused by 500 bee stings in our country. The unidentified species of bees in this case makes management of such bee venom-related toxic reactions more difficult. This report emphasises the importance of prompt and appropriate interventions.

Pakistani law recognises that no young person under the age of 18 years can enter into a valid and binding contract. In hazardous industries, such as brick kilns, none of the children working in them have any formal contract, so limiting any rights they may have. Any contract that does exist is with the child's father and will be linked to everlasting debts and constitutes a form of bondage. This paper reviews the adverse medical effects on children of such employment.

Child sexual abuse is a public health and medico-legal problem in developed and developing countries. Prompted by rare presentations of cases from this issue that change the course and outcome of events, we present the completed criminal-medico-legislative procedure as a contribution to the dynamics of the investigative process from my own many years of forensic practice. Two preschool teachers of late reproductive age from a home for neglected children reported to the State Attorney's Office a former ward of the home, now an older minor, and an auxiliary employee of the same home, for having sexual relations with a two-year-old girl. But the state attorney also ordered an examination of the reported young man, so the reported case that the teachers "saw" penetrative intercourse was rejected by the expert and the state attorney as an action impossible without injuring the girl at that age. Further investigation proved the continuous sexual abuse by two teachers of the young man since he was 13 years old, i.e. for three years, which he did not report for fear that he would be kicked out of the home. He had sexual relations with each of them several times during those incriminated years. After his statement, other employees of the home were questioned as witnesses who confirmed the suspect boy's claims. He was then released from custody, and the teachers were dismissed from their jobs and accused of years of sexual abuse of minors and abuse of their position and authority as competent persons.

Most bee stings are not life-threatening. Bee venom often causes local, mild allergic reactions in people, but even a single bee sting may induce a fatal anaphylactic reaction. Usually, anaphylactic reaction is the cause of death, but, when a child suffers multiple stings (more than 30), direct toxicity of venom can also be fatal. A three-year-old male child was brought to the hospital with pain, swelling and redness at the sting sites. He had more than 35 stings at various sites over his face, on his tongue and over his body. He died 10 hours after the incidence of the honey bee stings and was maintaining oxygen saturation until the terminal stage of his life. At autopsy, the honey bee sting sites showed redness, swelling and a small effusion of blood surrounding the stinger tracks. On the tongue two stingers were found in situ. Facial puffiness and eyelid swelling, along with congested organs, were also found, but features suggestive of anaphylactic death like airway oedema, mucous plug or cyanosis were absent. Hospital treatment records show that blood pressure remained low with tachycardia despite treatment. Having regard for all the evidence it was concluded that death was due to multiple honey bee stings that caused direct venom toxicity.

Medical errors and adverse effects of treatment are inherent to medical practice. Like any other medical specialty, rheumatology is not exempt. Although the problem is imprecisely quantified, according to some authors it affects up to 10% of hospitalised patients. Describing and qualifying misdiagnoses in rheumatology will help us to understand and reduce these. Further, misdiagnosis generates unjustified costs and medico-legal consequences with errors in initial diagnosis the basis for medico-legal disputes involving assessment of work incapacity.