Medico-Legal Journal最新文献

In Nepal, police inquests have several limitations. When they receive information about a death, the police visit the crime scene and write an inquest report. Then, they arrange for the body to be autopsied. However, most autopsies are performed by medical officers in government hospitals who lack specialised training in conducting autopsies. Although all Nepalese medical schools teach forensic medicine to undergraduate students and require them to witness some autopsies, most private institutions are not authorised to perform them. Autopsies performed without expertise can be subpar and, even when trained personnel are available, these facilities are inadequately equipped. In addition, there is a lack of sufficient manpower to provide expert medico-legal services. The Honourable Judges and District Attorneys of all district courts believe that the medico-legal reports prepared by the doctors are inappropriate, incomplete and inadequate for use as evidence in court. Moreover, the police are more concerned with establishing criminality than other aspects of medico-legal death investigation, such as autopsies. Therefore, the quality of medico-legal investigations, including death investigations, will not improve until government stakeholders recognise the importance of forensic medicine in the judiciary and for the resolution of crimes.

The Covid-19 pandemic has created exceptional challenges for patients and medical care systems. Among many factors influencing postponed cancer diagnosis, mask-wearing created difficulties in initial diagnosis of head and neck tumours. This report features a patient who had been covering a submandibular tumour under a surgical mask for more than 6 months. He visited his general practitioner due to a significant weight loss, but he neither took his mask off, nor was he asked to do so. When he reported to our emergency room, we noticed a massive ulcerous mass in the right submandibular region. Histological examination confirmed primary squamocellular carcinoma of submandibular salivary gland. During the Covid-19 pandemic, significant clinical observations may be missed if a surgical mask or respirator are not removed during examination with the potential for increased incidence of medical malpractice claims.

The disorder of internet gaming is increasingly being blamed on major psychological problems affecting youth. Action video games are enjoyable for masochists. Video game chores that practise bondage and other acts that cause pain and anoxia may be masochistic in nature in order to promote player satisfaction. Asphyxia will result in pleasure in asphyxiophilia, a dangerous and occasionally lethal form of sexual masochism. Constriction of the neck with ligature materials is a frequent method of causing hypoxia. The subject of this case study was a compulsive player of online video games. During the masochistic act, along with a recording of it, he unintentionally died. Given that he was naked, had a ligature around his neck, had his wrists and legs bound, and had two fabric-holding clamps on his scrotum, asphyxiophilia was determined to be the cause of his death. At the scene of death, neither pornographic materials nor proof of frequent use of this kind of behaviour were discovered. Along with recording, the subject's cell phone's flash was on to help with the dim lighting and he may have been videotaping these masochistic acts as part of a videogame task. The results of the autopsy, circumstantial evidence, police inquiry and witness accounts all support accidental death.

Background: The common methods of suicide are hanging and poisoning. Suicidal electrocution using a homemade device is very rare. Victims usually possess knowledge of electrical circuits. Here, we report two cases of suicide by electrocution using a homemade device.

Case presentation: Case 1: A retired electrical technician was found unresponsive in his bedroom, with two bare copper wires; one encircling the index finger of the left hand, and the other placed in the mouth. The other ends of the wires were connected to a wall plug supplying 220 V current. Forensic autopsy and microscopic findings attributed death to suicidal electrocution.Case 2: A 51-year-old-man was found dead in the bathroom with bare copper wires encircling both wrists and connected to a wall plug carrying 220 V current. Death scene investigation, necropsy, histological tests and toxicological screening indicated suicide by electrocution.

The right to refuse treatment and the advance decision were two major issues that came up in Re J (Blood Transfusion: Older Child: Jehovah's Witnesses) [2024] EWHC 1034. This paper discusses that case in relation to (a) the meaning of the right to refuse treatment, (b) why the term, "right", should be replaced with "immunity" in the expression, "right to refuse treatment", (c) the limitations of that right and (d) what the advance decision is and why it was not effective in Re J. The paper concludes that, although the right to refuse treatment and the advance decision are important facilities under the law, they do have limitations.

Sickle cell disease (SCD) is an autosomal recessive genetic condition characterized by the presence of a mutated form of haemoglobin (HbS). HbS polymerises into long needle-like fibres under low oxygen conditions, leading to the erythrocytes forming sickle shaped red blood cells. With repeated sickling, the red blood cells become irreversibly sickled and trapped within the circulation, and this leads to vaso-occlusive crisis. The patient, a 25-year-old female, previously undiagnosed with SCD, presented with high grade fever, splenomegaly and succumbed due to heat exertion precipitating sickling crisis, multiorgan failure and shock.

Air guns used for plinking are weapons with a short range and low velocity. Because of their low velocity, the ammunition usually enters the body without causing any immediate life-threatening complications. Lead toxicity is a potential side effect of a pellet lodged in the body. However, there are cases where blood lead level was below the reference value even after decades of an air gun pellet remaining in the body. We report a case of 40-year-old man whose X-ray of the skull revealed a metallic foreign body that appeared to be an air gun pellet in the maxillary sinus. The patient recalled receiving a gunshot wound to his left cheek ten years ago. The wound healed, the pain subsided, and the patient was symptom-free, so he did not seek medical attention. The present case study illustrates the incidental finding of impacted foreign body and its medico-legal aspects in the Nepalese context.

Modern techniques have enabled routine diagnosis of congenital cardiac defects, notwithstanding, there will be some that remain undiagnosed and asymptomatic until adulthood. But this is rarely the case with the patent foramen ovale, with the anomalous aortic origin of the left main coronary artery and bicuspid aortic valve. This case describes the sudden death of a female in her post-partum period due to cardiac tamponade following a ruptured aneurysm of the coronary artery at its origin at the sinus of Valsalva. Autopsy shows patent foramen ovale findings and anomalous aortic origin of coronary artery (AAOCA) and bicuspid aortic valve. The association of AAOCA with bicuspid aortic valve and patent foramen ovale is rare.

This paper highlights the background to the legislation passed in India to curb the menace of ragging and offers an insight into the serious issues associated with this heinous practice and the liabilities for administrators when it happens. We aim to achieve the goal of "zero tolerance for ragging".