Author: Medico-Legal Journal

Medico-Legal Journal, Ahead of Print.
We analysed the recorded cases of suicides committed other than by hanging in prison in Milan. A retrospective analysis was conducted on 25,512 autopsies performed from 1993 to 2019, selecting all the suicides in prison but our attention was focused solely on cases where an alternative mode to hanging was used. From a total of 97 suicide events in prison, 15 were consistent with the established search criteria: 6 victims died from plastic bag suffocation, 4 by direct inhalation of butane gas, 2 associated plastic bag suffocation to inhalation of butane gas, one committed suicide with an edged weapon, one by self-burning and, finally, one by voluntary ingestion of a food to which he was allergic, with the intent of inducing an anaphylactic shock. Our analysis has shown that the landscape of prison suicides is diverse, not limited solely to hanging. Therefore, it is necessary for the forensic scientific community to raise awareness of potentially unusual suicide methods in prisons and, in the same way, for the Penitentiary Administration to put adequate preventive measures and strategies in place.

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Medico-Legal Journal, Ahead of Print.
Online gaming has become a concern for health professionals due to its dysfunctional effects. This study aimed to conceptualise and summarise the impact that gaming platforms like PUBG can have on an individual’s mental health. A systematic review was conducted using the PRISMA model. A total of five papers were shortlisted and reviewed for the purpose of this study. The results indicated the use of gaming platforms like PUBG by players to address and cope with anxiety and depression, and it also highly influences the presence of other concerns like ADHD and suicidality, self-harm and aggressive behaviours. While the literature points to the detrimental effects of PUBG, this study highlights the importance of undertaking more research to establish the causal patterns in PUBG use and how to address the issues posed from both psychological and legal perspectives.

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Medico-Legal Journal, Ahead of Print.
The Covid-19 pandemic in the UK has been greatly worsened by the mutation of the virus, which began in the South East and was rapidly spreading and in danger of overwhelming the NHS as hospital admissions and deaths continued to rise. In consequence, the Chief Medical Officers of all four nations supported the UK government’s sudden decision to delay the second dose of the Pfizer/BioNtech and Oxford/Astrazeneka vaccines for 12 weeks (instead of 3) so that more people in the most vulnerable population groups would receive a first dose and some immunity sooner. The expectation is that this strategy would reduce hospital admissions and deaths. This article considers key medical and legal issues arising from this decision and discusses inter alia rationing of scarce resources, fairness, whether it is for the greater good, consent, individual human rights, negligence and claims for potential or actual injury.

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Medico-Legal Journal, Ahead of Print.
In 1999, the Irish Government commissioned a report into the abuse of children who were in the care of facilities managed and run under the auspices of the Roman Catholic Church in the Irish Republic in the 1940s and 1950s. It reported in 2009. A Redress Board was set up to investigate and compensate claimants who were abused physically and mentally as children when living in these facilities. The Board sat for 16 years. In total, 16,650 applications were processed with awards worth €970 million. Of these, 1069 applications were withdrawn, refused or had a nil award. This report on work of the Commission and the Board derives from the histories given and the expert assessment of 19 claimants for compensation. Their ages ranged between 47 and 72 years at the time of the expert’s assessment.

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Medico-Legal Journal, Ahead of Print.
Increasing numbers of female victims of violent sexual assaults are being murdered with the aim of concealing the identity of the perpetrator. Proper handling and analysis of evidence is very important in gaining a conviction in many criminal cases. After evidence is collected, due precautions must be taken to ensure that the integrity of the sample is maintained, and chances of contamination are minimised. This paper presents a case study where improper handling of biological evidence led to loss of evidentiary value, and the semen could not be located on the vaginal swabs and victim’s garments due to improper preservation of samples. However, the DNA from the nail of a decomposed finger helped identify the victim, and the suspect was apprehended based on the clues given by her family.

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Medico-Legal Journal, Ahead of Print.
The activity of the SARS-CoV-2 virus has not yet been studied in a post-mortem setting. The absence of these data has led to the prohibition of exposure of infected corpses during burial procedures. Our aim was to assess the virus’s persistence and the possibility of transmission in the post-mortem phase including autopsy staff. The sample group included 29 patients who were admitted to our Covid-19 Centre who died during hospitalisation and the autopsy staff. All the swabs were subjected to a one-step real-time reverse transcription polymerase chain reaction with cycle threshold (Ct) values. Swab collection was performed at 2 h, 4 h, 6 h, 12 h, over 24 since death. The following were the analysis of patients’ swabs: 10 cases were positive 2 h after death; 10 cases positive 4 h after death; 9 cases were found positive 6 h after death; 7 cases positive 12 h after death; 9 cases remained positive 24 h after death. The swabs performed on all the forensic pathologist staff on duty who performed the autopsies were negative. The choice to avoid rituals and the display of corpses before and at the burial procedures given appears cautiously valid due to the persistence of the SARS-CoV-2 virus in the post-mortem period. Although the caution in choosing whether or not to perform an autopsy on infected corpses is acceptable, not to perform autopsies is not biologically supported.

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Medico-Legal Journal, Ahead of Print.
Cardiac tamponade is a life-threatening emergency having both acute and a delayed presentation. In the latter there is a potential for medical practitioners to miss the diagnosis as happened in our case resulting in allegations of medical negligence. Before starting the autopsy in such cases, the forensic pathologist should try to obtain the complete treatment record and be ready to request ancillary investigations as required. We report a case of death due to cardiac tamponade caused by a penetrating injury to the heart. A feature of this case was the failure of our medical system to diagnose the condition and the legal system due to failure of the police to register the first information report under appropriate legal sections.

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Medico-Legal Journal, Ahead of Print.
No amount of symposia and clinical meetings and formal management will make a clinical difference unless obstetric units regularly and ruthlessly self-assess to curb medical negligence. Court case, which represent a small portion of substandard outcomes, not infrequently reveal a serious lack of obstetric judgment as well as paucity of knowledge which are compatible with unsupervised responsibility of labour ward duties. One UK court case ACF 32(2): 09/2019 presents a factual picture of obstetric practice which is difficult to reconcile with modern UK practice. This article limits itself to a number of facts as presented to court by the claimant, and the comments are directed purely at the resulting implications. These facts as stated are seriously worrying in themselves as they reflect practice well below the minimum care to be expected in a modern country and are far from what is recommended by the Royal College of Obstetricians and Gynaecologists and indeed every day standards. The article recommends the shifting of focus from individual to collective or unit responsibility to achieve better care. In any case where gross mismanagement is found, there should be a wider check on practices within the whole obstetric unit.

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