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Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed surgeries worldwide. The number of joint replacement surgeries being performed has increased considerably over the past two decades, but it has also seen an increase in litigation associated with it. The purpose of our study was to review and consolidate literature regarding medico-legal issues pertaining to THA and TKA cases. We looked at the causes of litigation, medico legal aspects of pre-operative requirements, optimisation of medical condition, indications and contraindications for arthroplasty, informed consent, implants, mixing of components from different manufacturers and post-operative rehabilitation. We also wanted to analyse available literature and legal proceedings regarding these cases in India specifically.

Background: Several reports show that suicide is the second and third leading cause of untimely death in young people below the age of 30. Little, however, is known about the profile and trend of suicide in this country due to lack of systematic studies and a lack of national statistics on suicide. This study seeks to examine the profile and pattern of suicide cases recorded within northern Ghana for the past decade. Aim: This study aimed to report the prevalence of suicide as an independent cause of death; the choice of suicide method and the alleged reasons for suicide within the northern part of Ghana. Setting: Retrospective review of coroners’ reports within the northern part of Ghana. Method: In this descriptive study, 309 completed suicides as archived by the office of the coroner were examined. The coroners’ reports of 309 individuals, whose deaths received a suicide verdict or an open verdict in which the cause of death was likely to be suicide from 2008 to 2017, were examined. Student’s t-test was used to ascertain significant age differences between the genders involved. Results: Amongst the 309 decedents examined, approximately, 61% were male, with ages ranging from 5 to 81 years. Hanging and poisoning were the most commonly used methods to complete suicide accounting for 124 (40.1%) and 102 (33.0%) deaths, respectively. Regarding the reasons for completed suicide, 78 (25.2%) were because of unknown reasons and 66 (21.4%) were because of social stigma. There was a notable decline in the prevalence of suicide from 2014 to 2017 compared with the years from 2010 to 2013. Conclusion: Suicide was highest in the 30–39 year age group with hanging and poisoning being the most common method employed. Stigmatisation and psychosocial problems arising from chronic illness and economic hardship were significant triggers of suicide amongst the suicide decedents in the northern part of Ghana.

This article shows how Mexico’s forensic institutions erase the identities of the corpses they recover and dispose of the bodies that the families of the disappeared seek during the Drug War. Based on ethnographic fieldwork among human identification specialists at the Mexico City morgue, I analyze the role of ordinary practices, bureaucratic routines, and moral attitudes in the administrative disappearance of corpses at the heart of the government of the dead in the country’s capital. The article opens with an ethnographic vignette that shows how experts at the Identification Department of the Mexico City morgue do not allow the daughter of a warehouseman in a working-class market to retrieve her father’s body which the police had found on the street-side and had designated an “unknown corpse” (cadáver desconocido). Even though the daughter identified her father, the experts argued that unless she could prove their relationship in the eyes of the State by producing an identity card, she could not claim his body. His corpse would thus finish in the potter’s field of the main public cemetery of Mexico City. Indeed, the entire article explores the hypothesis that the discretionary power that “street-level bureaucrats” of the government of the dead (experts called “peritos”) exercise over the fate of corpses makes their “second disappearance” possible, demonstrating thus that Mexico’s morgues function as “spaces of bureaucratic disappearance”. After an introductory note describing the recent modernization process of the material infrastructure and human resources of Mexico City morgue, the first section highlights the fact that a large number of “unknown corpses” that arrive for identification are already known by their first and last name. By reconstructing the post-mortem trajectories of the dead down to the morgue and the bureaucratic interaction that families experience in order to find them, I show that the condition of anonymity in which these bodies end up is, among other things, the result of the normalized practices of institutional violence that result from the idea that unclaimed corpses belong to the Mexican State by definition. In the second section, the article pays particular attention to the writing practices and documentary circulation that punctuate the work of experts at the Identification Department of Mexico City morgue as well as their relationship with other institutions in charge of looking for missing persons. This section highlights the practices whereby these workers assign the families of the disappeared a moral obligation to constantly visit the morgue if they truly wish to be informed of the fate of their loved ones, for relying on the “government of paper” exercised by Mexico’s forensic institutions, the priority of human identification experts is to fulfill administrative requirements rather than to identify unknown corpses. In conclusion, the article poses the anthropological question of where a person’s identity lies after death, proposing the hypothesis that it is the social relations accompanying the corpse to its final resting place that ultimately determine whether the deceased will be named. Through the empirical observation of the informal practices of classification of corpses inside Mexico City morgue, where bodies accompanied by their relatives are treated differently from those sent in by the city police, this conclusion follows the trail opened by ethnologist Robert Hertz, for whom mortuary rites appear as a transitional process by which the dead are transformed according to the care provided by the bereaved and society at large., Cet article montre comment les institutions médico-légales du Mexique effacent l’identité des cadavres qu’elles ont retrouvés et perdent les corps que les familles des personnes disparues recherchent à l’heure de la guerre contre la drogue. À partir d’une enquête ethnographique aux côtés des spécialistes en identification humaine de la morgue de Mexico, j’analyse le rôle des pratiques ordinaires, des routines bureaucratiques et des attitudes morales de ces agents de l’État dans la disparition administrative des cadavres au cœur du gouvernement des morts de la capitale du pays. L’article s’ouvre sur une vignette ethnographique qui montre comment les expertes du service d’identification de la morgue de Mexico ne permettent pas à la fille d’un manutentionnaire d’un marché populaire de récupérer le cadavre de son père retrouvé par la police dans la rue en tant que « cadavre inconnu » (cadáver desconocido). Bien que sa fille l’ait identifié, les expertes arguent que, sans carte d’identité qui atteste de leur relation de parenté, elle ne peut pas réclamer son corps. Ce dernier sera donc conduit à la fosse commune du cimetière de Mexico. En effet, l’ensemble de l’article explore l’hypothèse selon laquelle le pouvoir discrétionnaire dont disposent les « street-level bureaucrats » du gouvernement des morts (notamment les experts que l’on appelle « peritos ») sur le sort des cadavres rend possible leur « deuxième disparition », en démontrant par ailleurs que les morgues du Mexique fonctionnent comme des « espaces de disparition bureaucratique ». Après une description des infrastructures matérielles et des ressources humaines de la morgue de Mexico, qui rend compte de son processus de modernisation récente, la première partie de l’article souligne qu’une grande partie des « cadavres inconnus » qui y arrivent pour être identifiés ont pourtant déjà un prénom et un nom de famille. En restituant les trajectoires post-mortem des morts jusqu’à la morgue et les interactions bureaucratiques dont leurs familles font l’expérience afin de les retrouver, je montre que la condition d’anonymat dans laquelle se retrouvent ces corps est notamment la conséquence des pratiques normalisées de violence institutionnelle résultant de l’idée que les « cadavres non réclamés » appartiennent par définition à l’État mexicain. Dans une deuxième partie, l’article porte une attention particulière aux pratiques d’écriture et de circulation de documents qui rythment le travail des fonctionnaires du service d’identification de la morgue de Mexico ainsi que leurs relations avec d’autres institutions en charge de retrouver les personnes disparues. Cette partie met en lumière le fait que ces travailleurs assignent aux familles des personnes disparues l’obligation morale de se rendre constamment à la morgue si elles veulent véritablement connaître le sort de leurs proches puisque, dans le « gouvernement par la paperasse » qu’exercent les institutions médico-légales du Mexique, la priorité des experts en identification humaine est de satisfaire à des exigences administratives plutôt que d’identifier les cadavres inconnus. La conclusion de cet article pose la question anthropologique de savoir où se trouve l’identité d’une personne après sa mort, en faisant l’hypothèse que ce sont les relations sociales qui accompagnent le cadavre jusqu’à sa sépulture définitive qui déterminent si le défunt sera nommé. À travers l’observation empirique des pratiques informelles de classification des cadavres au sein de la morgue de Mexico, où l’on traite ceux qui sont accompagnés par leurs proches différemment de ceux qui sont envoyés par la police de la ville, cette conclusion s’inscrit dans le prolongement des pistes ouvertes par l’ethnologue Robert Hertz, pour qui les rites funéraires apparaissent comme un processus de transition où les morts se transforment selon la manière dont les prennent en charge les personnes en deuil et la société.

Background Every year, millions of children face sexual exploitation worldwide. In India, 109 children (National Crime Records Bureau2018) were sexually abused everyday (22% jump from the previous year). Even with advanced DNA techniques, the conviction rate remains low. The methods used for forensic DNA evidence analysis vary around the world, but the primary step of biological evidence collection plays the most vital role. Proper and timely evidence collection from the victim by a trained medical professional is important. Main body Dynamics of child sexual assault being massively different from an adult rape demands altogether different approach of evidence collection. A standard sexual kit employed for evidence collection needs urgent modifications considering genital development of pre- and post-pubertal victims. In the present study, parameters including systemic collection and evaluation of forensic evidences, medico-legal examination, and developmental consequences of sexual assault on pre-pubertal victims were assessed. Further suggestions for separate evidence collection kit during medico-legal examination were given for pre-pubertal victims and alleged accused in sexual assault cases in order to streamline and for better evaluation of DNA analysis in forensic laboratories. Conclusion The importance of expert medical practitioners plays a significant role in collection of appropriate information and evidences from the victim of sexual assault. General guidelines for evidence collection in sexual assault cases are not well suited for pre-pubertal victims. Appropriate reforms pertaining to the age and genital development of victims are required. Securing clothing as forensic evidence is essential in most cases as it turned out to be the exclusive evidence bearing material. The purpose of this article is to bring awareness about the thorough medical examination and modified sexual assault kit for pre-pubertal victims and alleged accused for a better approach in evidence collection and conviction rate.

The COVID-19 pandemic has hampered the optimum management of retinal diseases. This study examined the impact of the pandemic on the intravitreal-injection practice in two academic centers in Italy along with the related medico-legal implications. A retrospective analysis of electronic medical records from 16 March 2020 to 14 March 2021 at the ophthalmological departments of University of Cagliari (SGD) and University Magna Græcia of Catanzaro (UMG) was conducted. The data collected between 16 March 2020 and 14 June 2020 (lockdown), 15 June 2020 and 13 September 2020 (unlock), and 14 September 2020 and 14 March 2021 (second wave) were compared with those of the same period of the previous year. Weekly data on the administered drug and the number and type of treated disease were collected and analyzed. During the lockdown, a drop of 59% at SGD (p < 0.00001) and 77% at UMG (p < 0.00001) in intravitreal injections was found. In the first year of the pandemic, the reduction in injections was approximately of 27% (p < 0.0008) and 38% (p < 0.0001) at SGD and UMG, respectively. The COVID-19-related containment measures and the health resources redistribution have led to a delay in the treatment of chronic diseases of the retina, prioritizing the undeferrable ones. The lack of management guidelines has conceived relevant ethical and medico-legal issues that need to be considered in future measures planning.

Introduction: Intraoperative record form is one of the cardinal parts of anesthesia practices. Ideally, it should contain complete information about patients under anesthesia and intraoperative events. It serves as valuable information for subsequent patient management, research, or during medicolegal conditions. The objective of this study was to assess the practice and completeness of manual intraoperative anesthesia record keeping. Methods: A descriptive cross-sectional study was conducted from May 1 to July 31, 2021, in the postoperative ward of Kathmandu Medical College, which is a multispecialty tertiary care center. Approval from the ethical committee of Kathmandu Medical College Teaching Hospital was obtained (Reference: 2603202105) before conducting the study. Convenience sampling was used. The data were entered in Microsoft Excel and statistical analysis was done using Statistical Package for the Social Sciences version 20. Point estimate was done at 95% Confidence Interval and data present in numbers and percentages. We devised forty-two variables, which included demographics, personal identifiers, intraoperative events, anesthesia and airway management, intraoperative parameters, monitoring and medication. Results: The overall completion rate was 202 (52.59%) (47.6-57.57 at 95% Confidence Interval). Out of 42 variables, the completion rate of 14 variables was less than 50%. Among those were important parameters such as known allergies 94 (24.4%), Body mass index 50 (13%), intraoperative saturation of oxygen 104 (27%), intraoperative electrocardiogram recording 107 (27.8%), total fluid volume administered 45 (11.7%), patient status on transfer 84 (21.8%) had poor completion rate. Conclusions: Our intraoperative record form shows poor completion rate, which was similar to other studies. many important variables were missing and had incomplete data.

Hypoxic ischemic encephalopathy is one of the major causes of neonatal death and neurological disability in the child, and represents the most common birth injury claim. Intrapartum asphyxia often leads to several long-term sequalae, such as cerebral palsy and/or developmental delay, epilepsy. Through the neuroimaging it's possible to identify and define the different lesioned pictures and provide useful elements to establish the moment in which the damage occurred; indeed, timing of injury is a key element in the legal arena. Magnetic resonance imaging (MRI) is emerging as one of the most important tools in identifying the etiologic of neonatal encephalopathy as well as in predicting long-term outcomes. The aim of this study is to evaluate all MRI tests performed in a group of infants and young patients with possible neonatal encephalopathy, in order to determine the role of MRI in perinatal hypoxic-ischemic damage and the specific patterns that can point towards a diagnosis of the time of the damage's onset. Another goal is to assess the role of MRI in cases subject to legal-medical ligation. Since the advent of hypothermic neuroprotection, new malpractice allegations have arisen, including the failure to initiate cooling in a timely manner. In all cases, documentation of the status of the baby at birth, including a thorough neurologic exam, can be extremely helpful to the later defence of a malpractice claim, which might occur years later.

Community/Public participation in medico-legal form bench-mark of health determinants and quality integrated services towards criminal justice support in health. Globally, over 44 million cases of unclaimed bodies or missing dead persons (UCBOMDPs) occur annually, 88% of these cases are in Sub Saharan Africa. In western Kenya and Kenya the rate of UCBOMDPs from road traffic accidents accounts 30% and 10% respectively, 80% of these UCBOMDPs are associated with limited community participation / next of kins in identification of UCBOMDPs, thus prevailing chronic prevalence of occupational health and safety hazards in public mortuaries. The study aimed to assess extent of community participation, uptake of community mortuary services and awareness on quality medico-legal concepts, training, embalming and assess how of knowledge, attitude and practices (KAP) of service providers influence the uptake of medico-legal concepts to mitigate occupational health and safety hazards and improve health. In Exploratory and cross sectional, 235 respondents were investigated through purposive and saturated sampling using structured questionnaires, focus group discussions (FGDs), observations and key informant interviews (KII) guides to collect data. Analyzed statistical inferences and contents analysis to saturation, results showed, 94% of mortuary service providers in tier 4 were primary and secondary education drop outs of males, on contract jobs with limited access to quality forensic in mortuary science, contrarily to trained females and males counterparts from tiers 5 and 6 mortuary facilities on permanent. Embalming by gravitation method significant OD (1.2, 0.44). Prevalence of male being admitted as UCBOMDPs in the community was significant with, OD (8.3, 0.12), RR (0.33), 95% CI (1.23, 1.02), significance were associated with male deliberately leaving IDs in houses for anonymity. Community participation in medico-legal concepts were sufficient than Detective police with OD (0.43, 6.0), 95% CI (2.12, 1.34). Advocacy to empower community comprehensively and holistically in medico-legal concepts remains vital.

Medico-legal form bench-mark of health determinants and provide integrated services towards criminal justice support in health. Investigations of medico-legal approaches are multifaceted and require expertise of multidisciplinary teams of skilled practitioners from various fields. Globally, over 44 million cases of unclaimed bodies or missing dead persons (UCBOMDPs) occur annually, 88% of these cases are in Sub Saharan Africa. In Kenya and western Kenya, rate of UCBOMDPs from road traffic accidents accounts 30% and 10% respectively, 80% of these UCBOMDPs are associated with limited access to affordable quality comparison tests for identifications, attributed to the increased prevalence of health and occupational hazards in population health. The current investigations aimed at identifying UCBOMDPs from public mortuaries, by quantifying demographic data and determining DNA finger print and chemical tests (electrophoresis) using comparison standards. In Exploratory and cross sectional, 235 respondents were investigated through purposive and saturated sampling using Finger print forms, structured questionnaires, focus group discussions (FGDs), observations and key informant interviews (KII) guides to collect data. Analyzed statistical inferences and contents analysis to saturation, results showed, 94% of mortuary service providers in tier 4 were primary and secondary education drop outs of males, on contract jobs with limited access to quality services in mortuary science, contrarily to females and males counterparts from tiers 5 and 6 mortuary facilities on permanent and trained. Rate of gross infection in public mortuaries and congestion had significant, OD, (2.2, 0.44). Prevalence of male being admitted as UCBOMDPs was significant due to being family bread winners, OD (8.3, 0.12), RR (0.33), 95% CI (1.23, 1.02), significance were associated with male deliberately leaving IDs in houses due to identity. Utilization of Dactylography was significant, than electrophoresis method, P value (0.67), OD (4.8, 1.3) due to high costs, procedures, DNA quantifying reagents and next of kin sampling for comparisons. Need for quality service advocacy in Department of Forensic Pathology to develop subsidized functional DNA chemical structures

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Studies of viscera in medico-legal autopsies are crucial for detection of undiagnosed disease conditions. A cross sectional study was carried out at the Muhimbili National Hospital to medico-legal autopsies. A total of 103 cases were studied, 88.3 % were males with mean age of 35.8 +/- 16.6 years. The mean weight was 627.3 + 138.5 g and 591.7 + 129.7 g for the right and left lung, respectively, in males; and 616.7 + 166.1 g and 583.3 + 155.8 g in females. More than half of lung samples had some pathological disease. Age was found to relate with the observed histological diagnosis of the lungs.

All through medical school, aspiring medical practitioners spend most of their time learning about the inner workings of the human body and study to pass their exams so that one day they may be in the position to accomplish that ever-daunting task, already pursued by their predecessors , to serve mankind, to restore normal health, to stamp out disease, to prevent its occurrence, explain sicknesses to patients and stay out of jail. Once in practice however, the physician may be called upon one day to assess medico-legal aspects of a case in his practice or that of a colleague, something he may never have been shown how to do while in medical school. Has the point of Maximal Medical Improvement been reached, is there an impairment? A functional limitation? A temporary or permanent disability? A handicap? Did the incident cause the injury and the sequelae? Is there an apportionment? An aggravation of a pre-existing condition? Is there evidence of malpractice? Is the individual employable? Part-time or full-time? Are there other investigations or treatments to come? Would you be willing to testify in court? Answers to these questions are equally important in the overall helping of mankind, particularly for the great multitude toiling in the manual working class who are most often subjects involved in the medico-legal process. Because such people seldom have the capabilities of changing careers in mid-stream, they require some form of support should they become unable through misadventure to continue in their chosen pre-injury line of work.

Radiography for forensic purposes is a complex area of practice and the International Association of Forensic Radiographers (IAFR) is pleased to provide this guidance and advice document for Radiographers and Radiological Technologists involved in providing forensic imaging services. These guidelines were originally published as a collaboration between the IAFR and the College of Radiographers in the United Kingdom (UK), in 1998 [1]. As membership of the IAFR continues to grow internationally, these guidelines have now been updated to be more applicable outside the UK justice system [2]. The aim is that the principles outlined in these international 'best-practice' guidelines will be adapted by national professional bodies and relevant health and justice departments to suit local medico-legal systems within each country, and that departmental managers and employers should also find this document invaluable [3]. It is recognised that the level of best practice that can be achieved is dependent on local facilities and resources, as well as the expertise of the radiographer(s).

Background It is now considered standard of care to use Spinal cord monitoring during scoliosis surgery. Use of Image intensifier during scoliosis surgery, on the other hand, is highly variable in United Kingdom (UK) spine centres. Our objective was to evaluate the use of image intensifier during scoliosis surgery in UK spine centres. Methods Ninety three British scoliosis spine surgeons were invited to complete a survey via email using Survey Monkey platform. Surgeons were asked about the routine use of image intensifier during scoliosis surgery, including the reasons for using it and if, in their opinion, routine use is medico-legally mandatory. Results Thirty four Spine surgeons replied (response rate of 36.5%). Among these 85% have been consultants for at least 5 years. 91% performed more than 10 paediatric scoliosis operations per annum and 53% performed more than 30 operations per annum. 68% always routinely use image intensifier during scoliosis surgery while 21% do not use it routinely. However 66% mentioned that in their opinion, it is not medico-legally mandatory to use the Image intensifier during scoliosis surgery and that routine use should be left to the discretion of the operating surgeon. Conclusions Although majority of the United Kingdom spine surgeons, who responded to this survey, routinely use image intensifier during scoliosis surgery, they agree that it is not medico-legally mandatory to routinely use the image intensifier.

El presente artículo está orientado a realizar una aproximación desde un contexto médico-legal, al estudio del consumo de la marihuana, destacando los aspectos que le son inherentes. Se abordan de manera generalizada los aspectos históricos que enmarcan la introducción de la marihuana (Cannabis sativa) a las diversas regiones del mundo, pasando por los nocivos efectos en quienes la consumen. Asimismo, se desarrollan algunos de los mitos e hitos que rodean el consumo de esta planta, además de su legalización. El estudio fi naliza con el caso venezolano. The present article is oriented to make an approximation from a medicallegal context, to the study of marijuana consumption, highlighting the aspects that are inherent to it. The historical aspects that frame the introduction of marijuana (Cannabis sativa) to the various regions of the world are addressed in a generalized manner, including the harmful effects on those who consume it. Also, some of the myths and milestones that surround the consumption of this plant are developed, in addition to its legalization. The study ends with the Venezuelan case. 93-116 galvizleonardo@hotmail.com

Background Maxillofacial fractures are of great medico-legal implications because they are of common occurrence with other injuries, predominantly head injuries that might involve serious esthetic and functional problems, and so clinically described as consequential injuries. The aims were to assess the medico-legal aspects of maxillofacial fractured cases concomitant with closed head injury over a 6-year period (2011–2016) in the Trauma Unit of Assiut University Hospitals, Egypt, and to evaluate the demographic feature and the trend of different patterns of such fractures. Patient and methods A descriptive hospital-based study included all cases of maxillofacial fractures combined with closed head injury attending the Trauma Unit of Assiut University Hospitals in the period of January 2011 to December 2016. Results The study included 1221 cases, the percent of maxillofacial fractures with a closed head injury was 4%, the age group 18–40 years was having the highest incidence, and mean age was 25.9 ± 15.3 years with male to female ratio of 7:1. Road traffic accidents were the main etiology of injury (69.7%), followed by falls (15.1%) and violent assaults (10.2%) while firearm injuries were the last (5%). Unintentional injuries were the commonest in 83.1% followed by homicidal (16.3%); only 7 cases were due to suicidal attacks. The mandibular fracture was the commonest (49.7%) followed by fracture maxilla (19.2%), fracture zygoma (16.8%), and lastly frontal bone and nasal fracture. The trend of maxillofacial fractures over the 6-year period tended to be increased with the highest number in 2011 (21.5%) and the lowest in 2014 (13.3%). Conclusion Maxillofacial fracture with a closed head injury in Upper Egypt is common in the middle age with male predominance. Road traffic accident is the main etiologic factor, and accidental trauma is the commonest manner. Mandibular fractures are the commonest pattern followed by fracture maxilla. Traumatic head injuries in cases of maxillofacial fractures were mild in about half of the cases. The trend of maxillofacial fractures over the 6-year period of the study (2011–2016) tended to be increased with the highest number in 2011 and the lowest in 2014.

Background: The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. Methods: 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: “telemedicine”, “privacy”, “ophthalmology”, “COVID-19” and “informed consent”. Results: Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. Conclusions: Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.

O artigo analisa as condições de formação do conceito psiquiátrico de “perversão” e mais especificamente a maneira como, a partir dos anos 1820, se constrói uma oposição fundamental e estruturante entre “perversão” e “perversidade” que se evidencia tanto no campo jurídico como no médico-legal. Compreender esse jogo de oposição e de poder entre ambos os conceitos permite entender alguns conflitos profissionais entre médicos e juristas, mas também algumas disputas políticas. The article analyzes the conditions of formation of the psychiatric concept of “perversion” and, more specifically, the way in which, from the 1820s, a fundamental structuring opposition between “perversion” and “perversity” in juridical and medical-legal fields was constructed. Understanding this game of opposition and power between both concepts allows assimilating some professional conflicts between doctors and jurists, as well as some political disputes.

Highlights • Facial lesions of dental origin are rare. • We present the largest series in the surgical literature. • The presentation is variable and dental treatment is curative. • The wrong diagnosis/treatment may lead to medico-legal claims., Introduction Facial cutaneous lesions of dental origin are rare and hence the correct diagnosis is usually missed on the initial presentation to the surgeon. We present the largest series in the surgical literature to increase the awareness to this entity and emphasize that the wrong diagnosis may lead to medico-legal claims. Patients and methods This is a retrospective study of 28 patients seen between 1994 and 2017. Results The series had one child and 27 adults. The presentation varied and included: a nodule, a subcutaneous soft mass, a sinus, an abscess, a cyst, a pigmented skin lesion and a scar. Thirteen cases had an initial wrong diagnosis and of these 4 had surgery to the lesion. Two out of the 4 surgically treated lesions ended with medico-legal claims. Conclusions The surgeon should be aware of this rare entity and have a high index of suspicion. Dental treatment is curative and there is no need to operate the facial lesion. The wrong diagnosis and unnecessary surgery may lead to medico-legal claims.

Background Domestic violence is a forced pattern of behavior that happened in domestic settings to gain or maintain power and control over an individual. The aim of this work is to study the magnitude of domestic violence in south region of Jordan. Methods The retrospective study was retrieved from the medico-legal reports of domestic violence cases referred to the Directorate of Forensic Medicine in south region of Jordan during six years period starting from 1st of January 2010 till the end of December 2015. Results The total number of cases was 128. The majority was females (77.3%), high prevalence (41.4%) was found in adult age group (18 years and above) in both genders. The prevalence was higher in rural areas (75%). Sexual abuse was the commonest method of domestic violence in both genders (41.4%). Nearly a quarter of cases (23.4%) leaving home as an outcome. Spring months represented the highest percentage of domestic violence occurrence (28.1%). Family and financial problems were reported in 71.1% of cases. Conclusion Domestic violence rate in South Jordan is much lower than in other areas but still considered a problem and should be given high priority with regard to prevention, investigation and treatment.

Background Defensive medicine is becoming increasingly prevalent in the United States and is estimated to cost billions of dollars in excess healthcare spending. There is evidence that the practice of defensive medicine starts early in the medical career. Defensive medicine has been investigated among residents in high medico-legal risk specialties, but there is a paucity of information on its prevalence among internal medicine residents. Objective To examine the prevalence and patterns of defensive medical practices among internal medicine residents. Methods We conducted an online survey among the residents of three internal medicine residency programs in the 2018-2019 academic cycle. We invited all internal medicine residents within the selected programs to participate through email and asked them to complete an electronic survey assessing defensive medical practices. Results A total of 49 out of 143 residents participated in the study (response rate: 34.3%); 55% (n = 27) of the residents who participated considered the risk of being sued during residency to be low, compared to 40.8% (n = 20) who considered it to be moderate and 4.1% (n = 2) who considered it to be high. Defensive medical practices were found to be widely prevalent (40.0-91.3%) among internal medicine residents across all three clinical training stages. Assurance defensive practices were more common than avoidance practices. Conclusion Defensive medical practices, especially of the assurance type, were widely prevalent among our sample of internal medicine residents.

Radiography for forensic purposes is a complex area of practice and the International Association of ForensicRadiographers (IAFR) is pleased to provide this guidance and advice document for Radiographers andRadiological Technologists involved in providing forensic imaging services. These guidelines were originallypublished as a collaboration between the IAFR and the College of Radiographers in the United Kingdom (UK), in1998 [1]. As membership of the IAFR continues to grow internationally, these guidelines have now been updatedto be more applicable outside the UK justice system [2]. The aim is that the principles outlined in these international 'best-practice' guidelines will be adapted by national professional bodies and relevant health and justicedepartments to suit local medico-legal systems within each country, and that departmental managers and employers should also find this document invaluable [3]. It is recognised that the level of best practice that can beachieved is dependent on local facilities and resources, as well as the expertise of the radiographer(s).

ObjectivesTo describe the characteristics of deaths reported to the Coroners Court of Victoria (CCOV) during Victoria’s last heatwave (14–17 January 2014) and subsequent 4 days (18–21 January) using medicolegal data obtained from both the police investigation report and the pathologist’s report.Design, setting and participantsA single-jurisdiction population-based retrospective analysis of consecutive heat-related deaths (HRDs) reported to the CCOV between 14 and 21 January 2014 with a historical comparison group.Main outcome measuresDescriptive statistics were used to summarise case demographics, causes of death and the types of investigations performed. The cases from 2014 were subgrouped into HRD and non-HRD.ResultsOf the 222 cases during the study period in 2014, 94 (42.3%) were HRDs and 128 (57.7%) were non-HRDs. HRDs were significantly older than non-HRDs (70.5 years: SD=13.8 vs 61.0 years: SD=22.4, t(220)=3.60, p2=20.1, p2=10.9, p2=16.0, pConclusionsA heatwave places a significant burden on death investigation services. The inclusion of additional laboratory tests and more detailed circumstantial information are essential if the factors that contribute to HRDs are to be identified.

Background Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms “operative deaths” and “anesthetic deaths” are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient’s unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient’s circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications.

International audience; Ce chapitre se propose de mettre en relief les articulations et leurs différentes modalités entre morale, médecine et droit concernant la sexualité. Est d'abord interrogée la pertinence du concept de « perversion sexuelle » et de ses dérivés qui font l'objet d'usages aussi bien moraux, médicaux que juridiques depuis le XIX e siècle. La psychanalyse et la première sexologie se sont développées en tension avec les condamnations morales et juridiques des perversions, tout en posant les jalons d'une remise en question de leur pathologisation. La sexologie en particulier a promu la liberté sexuelle, ce qui a abouti à la fin du XX e siècle et au début du XXI e à l'institutionnalisation du concept de « santé sexuelle » et à son articulation aux droits sexuels. Dans le même temps, les classifications psychiatriques des perversions sexuelles ont évolué vers l'usage des termes de « troubles paraphiliques », où le concept juridique de consentement devient central. Sont alors mis en exergue les problèmes que cela pose pour le diagnostic même de trouble paraphilique dans le champ psychiatrique.

Resumo O artigo analisa as condições de formação do conceito psiquiátrico de “perversão” e mais especificamente a maneira como, a partir dos anos 1820, se constrói uma oposição fundamental e estruturante entre “perversão” e “perversidade” que se evidencia tanto no campo jurídico como no médico-legal. Compreender esse jogo de oposição e de poder entre ambos os conceitos permite entender alguns conflitos profissionais entre médicos e juristas, mas também algumas disputas políticas. Abstract The article analyzes the conditions of formation of the psychiatric concept of “perversion” and, more specifically, the way in which, from the 1820s, a fundamental structuring opposition between “perversion” and “perversity” in juridical and medical-legal fields was constructed. Understanding this game of opposition and power between both concepts allows assimilating some professional conflicts between doctors and jurists, as well as some political disputes.

Providing an apology which contains a factual explanation following a medical adverse incident may facilitate an amicable settlement and improve patient experience. Numerous apology laws exist with the aim of encouraging an apology but the lack of explicit and specific protection for factual admissions included in “full” apologies can give rise to legal disputes and deter their use. The new Hong Kong Apology Ordinance expressly prohibits the admission of a statement of fact in an apology as evidence of fault in a wide range of applicable proceedings and thus provides the clearest and most comprehensive apology protection to date. This should significantly encourage open medical disclosure and the provision of an apology when things go wrong. This paper examines the significance and implication of the Apology Ordinance in the medico-legal context.

With training in pharmacology, a pharmacologist has an expert knowledge as well as working experience in the subjects of therapeutics, pharmacokinetics, and toxicology along with exposure to subjects such as forensic medicine during the medical education. All these knowledge domains can be applied and act as an interface to the forensic situations. The skills and expertise of a forensic pharmacologist can be useful in a large and diverse number of legal cases. With an ever increasing incidence of criminal and civil cases in India, the development and inclusion of forensic pharmacologist in the judicial system of India are the need of the hour. The research in pharmacology has witnessed great technological advancement that allows it to expand its scope beyond the domain of therapeutics, thus enabling Indian pharmacologists to explore the niche area of Forensic Pharmacology. Differing pharmacokinetics and pharmacodynamics of drugs in living and dead, drug interactions, abuse of drugs, personal injury or death due to drug exposure leading to medico-legal issues, environmental exposure to chemicals, and doping and forensic pharmacovigilance are the diverse aspects of Forensic Pharmacology.

Objective : Cauda equina syndrome is a relatively rare condition with a disproportionately high medico legal profile. Definitive management involves prompt surgical decompression with outcome dependent on timing of surgery. Documentation of a comprehensive clinical and neurological assessment including examination of anal tone and perianal sensation is essential in reducing litigation and identifying patients requiring urgent surgical decompression. The aim of this study was to evaluate the documentation of focal neurology in patients with suspected cauda equina syndrome and devise an assessment proforma to use in the accident and emergency departments. Methods : A retrospective case note review was performed in all patients presenting to A&E with suspected cauda equina syndrome from January 2013 to March 2014. A full neurological examination was defined as having all modalities documented such as: MRC grade power, reflexes, sensory exam, vibration proprioception, anal tone & perianal sensation. Results : Sixty-nine patients with suspected cauda equina syndrome were identified with a median age of 44 (35-55) and a male to female ratio of 1:1.6. 4 patients (6%) had confirmed cauda equina syndrome and were transferred to a tertiary neurosurgical centre for further management. Only 2 patients (3%) had a complete neurological examination documented. 11 (16%) patients did not have any documentation of perianal sensation and 8 patients (12%) did not have documentation of anal tone Conclusion : Documentation of neurological was poor across our department. The introduction of an assessment proforma is proposed to increase documentation and optimise emergency department evaluation in these patients.

Acute stroke care has undergone momentous changes in recent years with the introduction of intravenous thrombolysis, mechanical thrombectomy and integrated stroke services. While these are welcome developments, they also carry unique medico-legal challenges. In 2015, a patient from Greater Manchester was awarded over £1 million in compensation after ambulance paramedics failed to admit her to a specialist unit. This paper explores the medico-legal implications of this first but over looked thrombolysis-related claim in the United Kingdom. It is submitted that the highly time-dependent and multidisciplinary nature of acute stroke care may expose a host of healthcare personnel, both medical and non-medical, to risks of legal pursuit for failing to provide appropriate care, and that available scientific evidence will likely support such claims. The situation calls for an urgent and concerted effort at implementing improvement measures at national levels. A reminder of the legal consequences of substandard acute stroke care is timely and necessary.

El objetivo de este trabajo es conocer el abordaje forense de la Violencia de género, definir el concepto, ver la evolución en Valladolid, Castilla y León y España en los últimos años. Se trata de una Revisión Bibliográfica en la que se realizan búsquedas generales, búsquedas de publicaciones científicas en Pubmed, estadísticas de Organismos oficiales y datos propios del Instituto de Medicina Legal de Valladolid. Analizamos la actividad de las unidades de Valoración forense integral de Valladolid, a través del protocolo de valoración Médico-Forense Urgente del Riesgo de Violencia de Género, con el objetivo de que se responda de manera inmediata a los casos de Violencia machista sobre todo para la protección de las víctimas. En España en 2017 se presentaron 166.260 denuncias, un 16,4% más que en 2016 y este año más que en 2015. Aumenta el número de denuncias aunque las condenas no se corresponden, tan solo un 10% de las denuncias llegan a condenas. Al igual que las órdenes de protección que de las 44.106 solicitadas en España 12.447 fueron denegadas. Con este trabajo pretendo concienciar de este gravísimo problema, a todos los profesionales sanitarios que podemos tener contacto con estas víctimas y en general a toda la población con datos objetivos, en los últimos 10 años han muerto 654 mujeres víctimas de Violencia de Género en España, para que pongamos nuestro granito de arena y tratemos de evitar más muertes., Grado en Medicina

Background The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. Main body This article discusses some of the ethical challenges that were encountered in these research projects. Among these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. Conclusion It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa.

Introduction: Unnatural deaths in women of reproductive age (range 12-49 years) have a serious psychological and social impact on the family and community. Women of reproductive age comprise a vulnerable section of the society as they are confronted with menstrual and pregnancy related stress factors in addition to the stressors prevalent in the general population. Aim: To analyse the socio-epidemiological and medicolegal factors involved in unnatural deaths among women of reproductive age. Materials and Methods: This cross-sectional study was conducted on 1379 unnatural deaths of women of reproductive age subjected to medico-legal autopsy during a period of five years. Information was based on documents submitted by police at the time of autopsy and postmortem reports. Various demographic and medico-legal parameters were studied in detail. Results: Unnatural deaths among women of reproductive age were 1415 (25.2%) cases of total autopsy. Road traffic accidents with 684 (49.6%) cases followed by poisoning in 157 (11.3%), hanging in 133 (9.6%), burn in 114 (8.2%) and railway injuries in 108 (7.8%) cases were the leading causes of death. Nature of death was accidental in 877 (63.6%) cases followed by suicide in 434 (31.5%) cases and homicide in 68 (4.9%) cases. Dowry related deaths accounted for 247 (22.7%) deaths. Poisoning in 152 (35%) cases followed by hanging in 133 (30.6%) and burn in 71 (16.4%) cases respectively were the most common methods of suicide. Strangulation or smothering with 33 (48.5%) cases was preferred method of homicide. Road traffic and railway injuries in 727 (82.8%) cases constituted the bulk of accidental deaths. Married women with 1087 (78.9%) cases and housewives in 917 (66.5%) cases from combined families in 829 (60.1%) cases from rural background in 875 (63.5%) cases with low socioeconomic in 912 (66.1%) cases and poor education in 739 (53.6%) cases were the most vulnerable victims. Conclusion: There is a strong association of various socioepidemiological and medico-legal factors with respect to unnatural deaths among women of reproductive age group. To bring down the incidences of such deaths, multipronged preventive measures have been suggested.

Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion, emergency CS, advanced labor, cesarean hysterectomy etc., are the predisposing factors for bladder injury during CS. While operating on such conditions, one should be meticulous to explore the possibility of bladder injury. Family physician practicing community obstetrics should be aware of this and know how to tackle this. Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6–10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10–14 days. While postoperative adhesion, CS during full dilatation of cervix, abnormal anatomy etc., may not proceed for negligence, bladder injury in normal patients and unrecognized intraoperative bladder injury may attract penalty from the consumer court.

Sexual assault is a heinous crime. Man com-mits the act to fulfill his sexual urge, to showhis masculinity, to get control of the victim, totake revenge and various other reasons, out ofabnormal mind, out of ignorance of the law ofthe land or out of opportunity. The mental traumasuffered by the victim may linger till end of herlife [1].Women who wish to pursue a justice againsttheir assailant are usually examined by a doc-tor or in most cases a state-employed districtsurgeon, and obtain a report of their injuries.Expert medical evidence is widely used in sexualassault cases, but its contribution to theprogress of legal cases is unclear.The objectives of the paper are -1. To study the legislative provisions re-lating to medical examination in SexualAssault cases.2. To assess the impact of medico legal evi-dence in sexual assault cases.3. To make suggestions.

With extended and continued expansion of medical imaging utilization in modern medical practice over last decade, radiologists as well as other faculty staff dealing with radiographic and magnetic resonances contrast media (CM) have to be well oriented with their potential hypersensitivity reactions and recognize high-risk groups liable to develop it and enable early recognition. Radiologists and other medical staff involved in administration and dealing with CM have to be ready to implement prompt, practical and effective management plan to deal with these scenarios should they emerge. Strategies to prevent potential contrast-induced acute and delayed renal injuries have to be routinely exercised. Paying attention to the pregnant and nursing women, pediatrics, diabetics, as well as other fragile populations is of utmost importance for patient safety during contrast administrations. Radiologists should play a pivotal role in orienting patients about necessity to use CM for their imaging studies, in case it is needed, and assure them about its safety. Moreover, they have to be oriented with the medico-legal issues related to use of CM. These will pay as improved patient safety as well as safe daily working environmentat different levels of radiology practices.

Angioinvasive aspergillosis is a rare but potentially devastating disease especially in immunocompromised hosts. However diabetes mellitus is one of the chronic conditions that leads to immunosufficiency in patients, it is rarely reported in such cases. Here we aimed to present an autopsy case of disseminated angioinvasive aspergillosis with diabetes mellitus and discuss the other possible underlying reasons for this situation. A 52 year old man with diabetes mellitus operated for the fracture of his L1 vertebra and tibia due to falling down from the third floor of a building. After his death on postoperative 34th day, histopathologic examination of the tissue samples presented multiple hyphae having dichotomous branching at 45-degree angles in infiltration areas. In conclusion, in long-term hospitalized patients with diabetes mellitus, fungal infections should be taken into account and an empirical antifungal therapy is recommended. Besides, sterilization procedures should be obeyed in order to prevent infectious diseases.

AIM: With the background knowledge that auditing of Medical Records (MR) for adequacy and completeness is necessary if it is to be useful and reliable in continuing patient care; protection of the legal interest of the patient, physicians, and the Hospital; and meeting requirements for researches, we scrutinized theatre records of our hospital to identify routine omissions or deficiencies, and correctable errors in our MR system. METHOD: Obstetrics and Gynaecological post operation theatre records between January 2006 and December 2008 were quantitatively and qualitatively analyzed for details that included: hospital number; Patients age; diagnosis; surgery performed; types and modes of anesthesia; date of surgery; patients’ ward; Anesthetists names; surgeons and attending nurses names, and abbreviations used with SPSS 15.0 for Windows. RESULTS: Hardly were any of the 1270 surgeries during the study period documented without an omission or an abbreviation. Hospital numbers and patients’ age were not documented in 21.8% (n=277) and 59.1% (n=750) respectively. Diagnoses and surgeries were recorded with varying abbreviations in about 96% of instances. Surgical team names were mostly abbreviated or initials only given. CONCLUSION: To improve the quality of Paper-based Medical Record, regular auditing, training and good orientation of medical personnel for good record practices, and discouraging large volume record book to reduce paper damages and sheet loss from handling are necessary else what we record toady may neither be useful nor available tomorrow. [TAF Prev Med Bull 2010; 9(5.000): 427-432]

Post-operative adhesions are an almost invariable consequence of abdominal or pelvic surgery, no matter whether this is performed by the open or laparoscopic technique. Their most important morbidity is small bowel obstruction, but other sequelae include female infertility and dyspareunia, and increased risk of visceral injury at any subsequent laparotomy or laparoscopy. Whether chronic abdominal pain is truly a consequence of adhesions is still a matter of some discussion, but it is likely to be accepted as an entity both by patients and by their legal advisors. While there is currently a scarcity of published literature on the subject, a recent assessment of adhesion-related medico-legal claims dealt with by the British medical defence associations has been undertaken. Successful medico-legal claims include cases of bowel perforation after laparoscopic division of adhesions, delays in the diagnosis of adhesion obstruction of the small bowel, infertility as a result of adhesions and ‘pain'. This problem is unlikely to be unique to the UK alone and general practitioners, surgeons and gynaecologists worldwide need to be aware of the increasing burden of medico-legal claims arising from the complications of intra-abdominal adhesions. Most importantly they need to consider whether it is now timely to take steps to avoid them.

La amenaza de la violencia ejercida contra las mujeres en el Perú se ha convertido en un problema para la Salud Pública, la violencia contra la mujer es considerada como una realidad que afecta la integridad física, biológica, mental y social de las mujeres. La elección de este tema surge de la experiencia de más de 10 años de trabajo como médico legista en la División Médico Legal en San Juan de Miraflores, perteneciente al Distrito Fiscal de Lima Sur, por lo cual se decidió hacer este estudio, tomando como muestra el año 2013. La presente investigación es de tipo descriptivo, no experimental, y retrospectiva, tiene como objetivo general identificar las características sociodemográficas y los resultados médico legales en mujeres víctimas de violencia de género, en una División médico legal de Lima Sur, durante todo el año 2013 recopilados de los certificados médico legales, para lo cual se hizo una lista de chequeo. Para el análisis estadístico se usó una matriz de datos en Excel y el programa estadístico SPSS versión 19. La población fue de 110 mujeres víctimas de violencia de género de un total de 2084 personas atendidas. Los resultados arrojaron que la mayoría de las víctimas están comprendidas en una edad de 26 a 40 años (51,8%), son casadas o convivientes (55,5%), su nivel de instrucción es secundaria completa (34,5%), son católicas (56,4%), los agresores son las parejas (55,5%) o ex-parejas (23,6%), en su mayoría nacieron en Lima (65,5%), fueron agredidas por agentes contundentes (76,8%), los reconocimientos son solicitados por la Policía Nacional (73,6%) y el Ministerio Público (22,7%), obtuvieron de 1 a 10 días de incapacidad Médico Legal (74,5%), la mayoría presentó lesiones (77,3%), acudieron por primera vez (60,0%), en menos de 24 horas (42,7%), denunciaron Violencia Física (49,1%), Psicológica (19,1%) y Sexual (9,1%). Tesis

To overcome kidney donation, the pool of potentially eligible donors has been widened by using suboptimal organs harvested from living donors or cadavers. These organs may engender health complications as age, risk factors, and pathologies of donors fail to meet the standard donor criteria. After examining a wide array of literature on suboptimal kidney transplants, we evidenced two major issues: the lack of standardized terminology and the lack of longterm data on the health outcomes of both suboptimal living donors and recipients. Consequently, surgeons are still unable to provide patients with thorough information to obtain a well-informed consent. Suboptimal kidney transplantation still remains in its experimental stage, thereby raising many ethical and medico-legal concerns. We suggest that one possible solution to overcome some of the ethical shortcomings of suboptimal kidney donations is to provide living donors and recipients honest, accurate, and thorough information about its health risks. To this aim, we advocate adopting a widely standardized terminology that would embrace the whole concept of suboptimal kidney transplantation, increasing the number of future publications on the health outcomes of living donors and recipients, spurring ethical reflection to improve the experience of suboptimal kidney transplantation and reduce the waiting-list for kidney transplantation.

Introduction Microscopic study of the organization of the Subdural Haemorrhage (SDH) verified against the time period can help us in the determination of its age which has serious medico-legal implications. Very few studies concerning the dating of SDH are present in the literature. Aim This study was conducted for dating the early subdural haemorrhage by routine histopathological stains. Materials and methods A prospective analytical study was conducted during July 2009 to December 2010. A total of 100 cases (50 males and 50 females) fulfilling the inclusion and exclusion criteria were included in this study. Routine histopathological staining of the subdural haematoma was done. Results Correlation between the frequency of a given histomorphological phenomenon and the length of the Post-Traumatic Interval (PTI) was evidential. All the histomorphological features, when correlated with PTI groups, were found to be statistically significant, except for Polymorphonuclear Leukocytes (PMN). Conclusion We concluded that routine histopathology was reliable in the dating of early subdural haemorrhages.

New Zealand patients have rights in relation to their healthcare including the right to consent to medical treatment. Medical imaging is the third largest category of hospital procedure in New Zealand and it constitutes a circumstance where examination without consent could be assault. New Zealand assault law is unique, and medical radiation technologists (MRTs) must be educated about their responsibilities. A literature review was conducted focusing on the medicolegal aspects of consent as it relates to medical imaging. This was compared to the practical realities of practicing radiography as experienced by the author. Finally, the guidance given by the professional bodies for MRTs in New Zealand was examined to determine whether it adequately informs MRTs of the responsibilities and provides them with a framework to guide their practice. Medical imaging is a diverse area presenting a range of challenging circumstances for consent. Currently, the consent framework and guidance provided by professional bodies is insufficient and in need of updating.

The effects of mentally disabling conditions on legal capacity are escalating, particularly given the ageing Australian demographic. Wills, enduring powers of attorney, and advance health directives are coming to the fore as a means of ensuring that the wishes of people with regard to their property, finances and health care needs are respected should they become legally incapable of making their own decisions. Assessing when a person has lost legal capacity in this context is an ever-increasing concern facing society as a whole but, in particular, the legal and medical professionals conducting the assessments. Empirical and doctrinal research has been undertaken which canvassed legal and medical opinions about the relationship between members of these professions when assessing legal capacity. This research supports the hypothesis that tensions exist when assessing capacity, especially testamentary capacity. One source of tension is the effect of conflicting evidence about the loss of legal capacity given by legal and medical professionals in court, which raises questions such as: which evidence is, and should be, preferred; and who should be responsible? The exploration of these issues will be conducted with reference to the empirical data collected, and a review of the relevant Australian case law.

Background Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. Methods In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care. Results The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions. Conclusions The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services.

Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video were very positive. Most respondents indicated that they had improved memory as well as decreased anxiety about their neurosurgical problem. There have been no legal challenges to date from giving patients access to the video recording. Our results indicate that the benefits to patients for expanding the use of video in medicine may outweigh perceived risks to providers.

Traité d'Anthropologie médico-légale

The management of a rape case in the emergency department is shrouded in an unacceptable level of lack of confidence. Since South Africa has a high incidence of rape, the contribution of health practitioners in addressing the crime successfully is essential. The medical management of such cases carries a high level of uncertainty with an accompanying element of not feeling in control. The intimidation associated with the responsibility of being an expert witness complicates the matter further. This article attempts to address the reluctance to get involved in medico-legal cases and emphasises the holistic management of survivors of rape. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1280900

Controversy has arisen over interpretation of performance validity tests (PVTs) when multiple PVTs are given. Some papers state that more stringent criteria are needed to judge overall performance as invalid, while others argue that concerns about the number of PVTs are overstated and that widely used criteria are appropriate. We examine theoretical models and assumptions, and analyze published data to determine the magnitude of effects implied by theory and observed in practice. Assertions advanced in the primary papers are examined for consistency with the empirical data. Existing theoretical models do not account well for the diverse empirical data, substantial empirical effects remain poorly understood, and the primary papers include assertions that are not empirically supported. The results indicate that: (a) neuropsychology lacks solid theoretical bases for estimating PVT failure rates given various combinations of PVTs, and thus needs to rely on empirical data; (b) existing empirical data fail to support the application of any uniform criteria across the broad range of scenarios involving multiple PVTs; and (c) practice should rely on empirical studies involving combinations of PVTs that have been studied together, in samples clearly appropriate to the individual case, using experimental designs germane to the questions under consideration.

The authors aimed to assess the Portuguese circumstances concerning situations of medico-legal dispute in Obstetrics, evaluate the conclusions of technical–scientific opinions and analyze their consequences. The analysis of all cases of Obstetrics medical responsibility examined in Medico-legal Council since the creation of the National Institute of Legal Medicine was performed. Technical–scientific opinions of those files were examined according to the existence of a causal link and of infringement of the ‘leges artis’. The most common reasons for dispute in Obstetrics were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). In the technical–scientific opinions of files examined, the existence of a causal link was established in 17.4%, and the infringement of the ‘leges artis’ was suggested in 15.5% of cases, numbers which have grown significantly over the years and which are particularly relevant in the proceedings of perinatal asphyxia and traumatic lesions of the newborn. In 11% of cases the opinion was inconclusive due to the poor quality of the clinical process sent for analysis. These results highlight the impact that litigation can have on the professional activity and personal lives of obstetricians. It should alert them for the need to better fulfill medical clinical files in order to reduce or avoid medico-legal conflicts, as well as to the fact of the increasing practice of defensive medicine and its consequences in daily clinical routine for doctors and patients.