Biomedical subjects

B R Sharma

Publications and source records attributed to B R Sharma.

At least 19 recordsLinked to original sources

PubMed2006

Suicides in Northern India: comparison of trends and review of literature.

Trends of suicide vary widely according to time, region, age group, sex, and race. Despite mixed trends of increases or decreases in suicide rates around the world, suicide remains an important public-health problem. In an effort to understand and prevent suicide, researchers have investigated medical, psychosocial, cultural, and socio-economic risk factors associated with the environment as a promising line of research. There is now considerable evidence that childhood and family adversities in general such as childhood sexual and physical abuse, witnessing domestic violence, parental separation or divorce and living with substance abusing, mentally ill or criminal family members may be both strongly interrelated and individually related to suicidal behavior in adolescents as well as adults. The approach towards prevention of suicide has to be multidisciplinary. To recognize that adverse childhood experiences that frequently take place as multiple events, identifying and treating those young people who have been exposed to such experiences, promoting increased awareness among parents, teachers, and health professionals of the important role that severe interpersonal difficulties and dysfunctional cognitions can play in the development of suicidal behavior in young people, and helping parents modify their maladaptive child-rearing behavior could help. Child and family support programs, employment support for mothers, and legal guarantees of gender equality, could moderate problems of socio-economic disparity and poverty, which predicts both parents' and children's suicidal behaviors in modern societies.

Adolescent↗

PubMed2006

Death during or following surgical procedure and the allegation of medical negligence: an overview.

A great variety of mishaps can occur during or following the administration of anesthesia and operative or investigational procedures that do not necessarily convey an error of judgment or negligence on the part of the surgeon or the anesthetist. However, all deaths occurring during the course of anesthesia and surgery or within a reasonable period thereafter (commonly referred to as peri-operative period) have to be reported to the police as these deaths cannot be regarded as natural. Despite the death occurring due to some preexisting disease or some co-existent condition, there may be a tendency on the part of the relatives of the deceased to impute negligence on the part of the anesthetist and/or the surgeon merely because of the fact that the death was closely associated with the anesthesia and surgical intervention. As such, any death suspected to be caused, or contributed to, by any of these procedures needs to be adequately investigated both from the point of view of the relatives of the deceased as well as instituting future safety measures. This paper examines the medical, ethical and legal aspects of such deaths with reference to the allegations of medical negligence in these cases.

Anesthetics↗

PubMed2006

Forensic considerations of missed diagnoses in trauma deaths.

Injuries missed at initial diagnoses or operations have the potential to cause disastrous complications in trauma patients. Understanding the etiology of unrecognized injuries is essential in minimizing its occurrence. For this purpose, we scrutinized the treatment and the autopsy records of the trauma deaths from 2000 to 2004 to determine the frequency, body regions, severity and causes of injuries that escaped recognition during the initial assessment, primary, secondary and tertiary surveys by the clinical team in patients who died of trauma. We also examined the accuracy of the cause of death as recorded on death certificates. The frequency of unrecognized injuries was found to be 11% in all trauma deaths. Abdomen (40%) and head (29%) were the more common regions of the body where injuries were frequently missed. System related errors (68%) and patient related factors (32%) were responsible for the injury remaining unrecognized. It was concluded that the injuries may be missed at any stage of the management of patients with major trauma and repeated assessments both clinical and radiological are mandatory not only to diminish the problem but to avoid litigation as well.

Adolescent↗

PubMed2006

Delayed death in burns and the allegations of medical negligence.

Burns and deaths due to burns to remain an important public health and social problem in India. Most of the victims, who survive the initial 24h after burns, succumb to infection of the burnt area and its complications. Burns cause devitalization of tissues, leaving extensive raw areas, which usually remain moist due to the outflow of serous exudate. This exposed, moist area along with the dead and devitalized tissue provides the optimum environment favoring colonization and proliferation of numerous microorganisms, which is further enhanced by the depression of the immune response. All these factors, i.e., disruption of the skin barrier, a large cutaneous bacterial load, the possibility of the normal bacterial flora turning into opportunistic pathogens and the severe depression of the immune system, contribute towards sepsis in a burns victim, which usually is life threatening. Despite various advances in infection control measures, early detection of microorganisms and newer, broader spectrum antibiotics, management of burn septicemia still remains a challenge. Pulmonary, cardiac and other complications also contribute to the delayed deaths following severe burn.

Burns↗

PubMed2006

Septicemia as a cause of death in burns: an autopsy study.

In burn victims, invasion by the bacteria is not unexpected, despite advances in antibiotics, and it has been reported that in the absence of topical therapy, the superficial areas of burn wound contain up to 100 million organisms per gram of tissue within 48h following the injury. We examined the autopsy reports of 334 cases who died because of complicated burns and who underwent medico-legal autopsy during a period of 5 years to study the rate of infection/sepsis. It was observed that in 65% of fatal burn cases, septicemia was the cause of death. Pseudomonas aeuroginosa and Klebsiella sp. were the most common organism, isolated either singly or in combination in 29% and 28% cases, respectively. High mortality from burns in young married women has been recognized as an alarming and contentious problem in India, particularly among the low socio-economic groups. We found that the females aged 21-25 were the most common victims accounting for 37% of burn fatalities due to septicemia. It was concluded that to carry out periodic review of patterns of isolation and susceptibility profiles of microorganisms infecting burn wounds should be a routine in all burn units. In view of the limited resources of developing countries, we recommend the use of available scoring systems to estimate burn outcome so that the best care can be directed to those who have a better chance of improvement.

Adult↗

PubMed2006

Historical and medico-legal aspects of infanticide: an overview.

In practice, all cases of abandoned newborn deaths are reported to the police/coroner, who asks for a post-mortem examination because only this can establish the viability of the infant, proof of separate existence, and the cause and manner of death in such cases. The pathologist who conducts the autopsy will have to use his skills and experience to assess a wide variety of marks and injuries so as to give his opinion fairly and frankly, not allowing any personal feelings to influence his findings. In some cases, he may be unable to give a firm opinion and should not shirk from stating this clearly. This paper examines some historical, legal and pathological aspects of infanticide.

Autopsy↗

PubMed2005

Forensic considerations of surrogacy -- an overview.

In the past two decades, there has been a spectacular change in the field of reproductive technologies. Reproductive sciences have come in with techniques such as donor insemination; in vitro fertilization and embryo transfer methods, which have completely revolutionized the reproductive environment. These techniques have given hope to many infertile couples, who wish to have a child of their own. With the oncoming of surrogacy agreements, concepts of fatherhood and motherhood have been subject to much controversy. Motherhood was never under much scrutiny as it was rightly thought that childbirth was the natural and conclusive fact establishing it, though paternity was at times a controversial concept burdening legislators to provide for suitable tests. Medical sciences have now compartmentalized motherhood into the genetic, gestational and the social mother leading to a clash of interests. This paper reviews some medicolegal, ethical and social aspects of surrogacy.

Altruism↗

PubMed2005

Clinical forensic medicine in the present day trauma-care system--an overview.

Criminal violence and its associated trauma comprise a critical health problem throughout the world. Clinical forensic medicine represents a new discipline of medical practice that is evolving in direct response to the sequelae of criminal and interpersonal violence. The application of the principles and standards of the forensic specialist has been increasingly recognized as playing a crucial role in trauma care; the results of the extremes of human behaviour-abused children, individuals suffering from blatant neglect and maltreatment, or self-inflicted injury, and victims of road-traffic accidents, firearm injuries and other assaults. These cases must be reported to a legal agency for investigation and follow-up. As trends in crime and violence change, new antiviolence legislation is likely to be implemented; consequently, new personnel resources are required to ensure that these legislative mandates effectively meet the needs of society.

Emergency Medical Services↗

PubMed2005

Triage in trauma-care system: a forensic view.

Trauma is a significant cause of death and suffering in society and there is strong evidence that mortality and morbidity may be reduced by provision of effective medical care through a trauma care system. It is reasonable to believe that severely injured patients should be transported as quickly as possible to a center where definitive medical care is possible. Conversely, it is also an argument that the resources of a trauma center must not be overwhelmed by assessment and treatment of minor trauma for patients who could be reasonably expected to do well with care in a clinic or a primary care hospital. Triage was developed to sort out those most likely to survive and to need medical care. Many triage tools have been developed and evaluated. However, the goal in setting triage criteria to provide a protocol for properly categorising injured patients, transporting them to appropriate hospitals, and ensuring an appropriate response to all trauma patients is yet to be achieved. Whatever the reasons and rate of failure due to different reasons, it is not unusual to read the reports wherein the quality of care becomes suspect in an increasingly litigious society. This paper examines the evolution of triage systems in trauma care from a forensic viewpoint.

Forensic Medicine↗

PubMed2005

Artistic assault: an unusual penetrating head injury reported as a trivial facial trauma.

The authors report a case of penetrating head injury that presented with a deceptively mild complaint. To our knowledge, it is the first report of a paint brush penetrating the brain. The patient reported being punched in the left eye and presented with a minor headache, swelling around the left orbit, a small cut on the cheek and slightly reduced left eye abduction. After radiological evaluation, a penetrating head injury was diagnosed. Under general anesthesia, through a lateral eyelid incision a 10.5 cm long paint brush, which had penetrated from the left orbit to the right thalamus, was removed. No post-operative infection was seen at six months follow-up. This brief report serves to highlight that penetrating brain injury can occur without neurological deficit and that a minimally invasive surgical approach was successful in avoiding any complications.

Brain Injuries↗

PubMed2005

Development of pre-hospital trauma-care system--an overview.

Trauma is recognized as a serious health care problem world-wide and there is a general agreement that trauma is best addressed in a systematic manner. Accordingly, trauma systems must be designed to use efficiently the limited health care resources available. The majority of injuries are of only minor, or moderate, severity, and can be managed well at local community hospitals. On the other hand, a significant minority of injured patients will require extensive and expensive care in order to survive, or to minimize the morbidity of injury. For a trauma system to be optimally effective, given limited available resources and the need for urgent care of the seriously injured, it is critical to utilize a method of differentiating those injury victims, who need the specialized expertise and resources available in trauma centres, from those who can be cared for adequately locally. Rapid field assessment of injured patients is, therefore, an essential element of any effectively functioning trauma system. This review examines the evolution of pre-hospital trauma-care systems, during the triage of a trauma victim.

Emergency Medical Services↗

PubMed2005

Missed diagnoses in trauma patients vis-à-vis significance of autopsy.

Post-mortem examination is considered to be the gold standard for the critique of medical practice, providing a quality control tool for the retrospective evaluation of diagnoses and treatment. Performing autopsies also facilitates new insight about the pathogenesis of disease and effects of therapy, gives feedback to clinical research protocols, provides epidemiological information and occasionally helps to console and reassure grieving families that death was inevitable. Its significance becomes paramount in cases of missed diagnosis in trauma-related deaths. The true incidence of missed diagnoses in trauma-related deaths is unknown, because autopsy is conducted in only about 50% of injury-related deaths. Few studies have documented the frequency of missed diagnoses leading to deaths specifically in the trauma ICU population. The present study is an attempt to evaluate the incidence and nature of missed injuries and complications in trauma-related deaths given an autopsy rate of close to 100%. This study also sought to identify the primary factors contributing to each missed injury. However, the study is in no way intended to assigning blame to human or system errors. Rather, it is focussed specifically on the issue of whether autopsy can be useful to provide feedback in identifying clinical problems of trauma patients.

Adolescent↗

PubMed2005

The injury scale--a valuable tool for forensic documentation of trauma.

An accurate method for quantitatively summarizing injury severity has many potential applications. The ability to predict outcome from trauma (i.e., mortality) is perhaps the most fundamental use of injury severity scoring, a use that arises from the patient's and the family's desires to know the prognosis. Field trauma scoring also is used to facilitate rational pre-hospital triage decisions, thereby minimizing the time from injury occurrence to definitive management. Another use of trauma scoring is for quality assurance by allowing evaluation of trauma care both within and between trauma centers, a contentious and controversial area that is likely to only increase in importance. However, the most important role for injury severity scoring is in trauma care research. Scientific study of the epidemiology of trauma and trauma outcomes would not be possible otherwise. Injury severity scoring is indispensable in stratifying patients into comparable groups for prospective clinical trials. Similarly, this technique can be used retrospectively to identify and control for differences in baseline injury severity between patient populations. More recently, physicians suggested that injury severity scoring could provide objective information for end-of-life decision-making and resource allocation. Unfortunately, trauma mortality prediction in the individual patient is limited and fraught with uncertainty. In fact, decisions for individual patients should never be based solely on a statistically derived injury severity score.

APACHE↗

PubMed2005

Cloning controversies: an overview of the science, ethics and politics.

Man's quest for knowledge is boundless. It is because of this quest and his untiring efforts to acquire it, that we have made such tremendous breakthroughs in the fields of science and medicine. Vaccines for hitherto incurable diseases, genetic engineering, and the correction of congenital and hereditary diseases are a few of these. With the successful cloning of 'Dolly', 'Molly' and 'Polly' we are now standing at the threshold of another major breakthrough--human cloning. However, are we ethically, morally and politically mature enough to 'go all the way' in a purely scientific manner, for the benefit of the human kind? A review of the scientific, ethical and political events in this field may be pertinent in trying to answer this important question.

Animals↗

PubMed2005

Dowry--a deep-rooted cause of violence against women in India.

The world has entered the new millenium but it is a harsh reality that the woman in India has long been ill-treated in our male-dominated society. She is deprived of her independent identity and is looked upon as a commodity. She is not only robbed of her dignity and pride by way of seduction by the men outside, but also may become a victim of cruelty by her saviours, within the four walls of her own house. However, her trauma does not end here, it may even go to the extent of forcing her to commit suicide or she may be burnt to death for various reasons, including that of dowry. This type of violence transgresses the boundaries of caste, class, region or religion and is prevalent in almost all societies in India. The system of dowry is a social practice which on its own has claimed the lives of scores of women--both young and old, and has made life a virtual hell for many more. Unfortunately, education among women has not produced a reformative effect on their social outlook, nor encouraged any change in them conducive to social upliftment. Those parents who prefer not to take dowry for their well-qualified and settled male children, are in fact considered 'strange' by the society and doubts about 'the respectability of the groom's family' are usually raised. The present study makes an in-depth review of the dowry system in India and analyses the reasons which have demonized dowry into its present commercialized and institutionalized form.

Adolescent↗

PubMed2005

Neck structure injuries in Hanging--comparing retrospective and prospective studies.

Deaths due to hanging are common among suicides. Various studies in the forensic literature have reported considerable differences in the frequency of hyoid bone or thyroid cartilage fractures and injuries to the musculature and the vasculature of the neck. Some important reasons to which these variations could be attributed include: lack of a common method for examination of neck structures, varying degrees of thoroughness in examining the neck structures and lack of seriousness in the documentation of the findings (as cases of hanging are almost always suicidal) thus affecting the results of retrospective studies. The present study was conducted retrospectively (1994 to 1999) and prospectively (2000 to 2003) on 108 cases of hanging. Seventy-one per cent of the cases were male and 29% female, aged between 15 to 60 years. Hanging was typical in 20% of cases and atypical in 80%; it was complete hanging in 46% of cases and incomplete in 54% of cases. Neck structure fractures were found to be more common in atypical complete hangings; the incidence was found to be 10% in the retrospective group and 27% in the prospective group. Contusions and lacerations of musculature were found in 20% of cases in the retrospective group and 34% in the prospective group, thus stressing the need for thorough postmortem examinations and meticulous documentation of the findings.

Adolescent↗

PubMed2004

The end of life decisions -- should physicians aid their patients in dying?

Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia.

Attitude to Death↗

PubMed2004

Child abuse in Chandigarh, India, and its implications.

Few abuses of human rights are so universally condemned but at the same time so universally practiced as child abuse. Over the centuries, children have been subjected to physical, sexual and emotional abuse as well as neglect. By any objective measures, this issue should rank high on the global agenda but in practice it is surrounded by a wall of silence and perpetuated by ignorance. Child sexual abuse is a dark reality that routinely inflicts our daily lives but in a majority of cases it goes unnoticed and unreported on account of the innocence of the victim, stigma attached to the act, callousness and insensitivity of the investigating and the law enforcement agencies, etc. A child who has been sexually abused is traumatized for life but it is only much later in life when the emotional and psychological trauma aggravates that such people seek medical help. There is an urgent need to take up the problem as a larger social issue where the society has a responsibility to help the victims overcome their trauma and move on with life as normally as possible. We report a retrospective review of children (age<16 years) referred for medicolegal examination, an autopsy in Chandigarh, India, between 2000 and 2003.

Adolescent↗