Vol 9, No 2 (2023)

BACKGROUND: Sexual assault has been a major concern to our society. It is one of the most underreported offences to the law enforcement agencies. Such offences are multi-faceted and certain details of the offence may be hard to be unearthed even after a thorough investigation.

AIMS: To study factors associated with reporting of sexual assault cases and to correlate findings with the alleged history.

MATERIALS AND METHODS: The study was conducted in the Department of Forensic Medicine, M.S. Ramaiah Medical College Bangalore from January 2018 and December 2020. All victims of alleged sexual assault brought for medical examination to the Department of Forensic Medicine were interviewed through a detailed questionnaire after taking consent. Relevant information was sought from the victim and the consent from victims. Descriptive statistics for qualitative type of data were summarized using frequency and percentage.

RESULTS: 82 victims those who had come to or brought by the parents or guardian or police with alleged history of sexual assault were subjected for medical examination. All of them were females except two juveniles. Majority of the victims (n=71, 86.5%) were less than 18 years of age and were considered as juvenile / minors under Indian law. Either the victims or their parents reported to the police in most of the cases (n=76, 92.7%). In 53.65% of the cases the alleged assaults were reported to the police after three days of alleged recent sexual assault. The purpose of reporting to the police was because of honour or pride of the parents / guardian in 59.75% of the cases. It was observed that only in four cases there were positive findings of recent penetrative sexual assault in the form of fresh hymeneal tears or presence of spermatozoa in the swabs taken during genital examination.

CONCLUSION: Majority of the victims of alleged sexual assault were minors. Only 12% of them reported to the law enforcement directly without anybody persuading. More than 50% of victims presented to the hospital after 3 days of the alleged sexual assault. In most of minor victims the sexual intercourse was consented, but it was invalid since the girl below 18 years cannot consent for sexual intercourse. Majority of adult victims had consented for sexual intercourse on promise of marriage. In view of these, no physical injuries were seen on victims and positive evidence of sexual assault was detected only in 5% of cases.

BACKGROUND: Due to a lack of unified recommendations, difficulties often arise when making diagnoses, as well as selecting and coding according to ICD-10 of the initial cause of death in cases of fatal outcomes of patients after organ transplantation.

AIM: To offer practical recommendations on the formulation of diagnoses, selection, and coding according to ICD-10 of the initial cause of death in cases of fatal outcomes based on the experience of the pathology department at the N.V. Sklifosovsky Research Institute of Emergency Medicine.

MATERIALS AND METHODS: Sixty autopsy reports of fatal outcomes in patients after organ transplantation at the N.V. Sklifosovsky Research Institute of Emergency Medicine for 7 years (2016–2022) were analyzed.

RESULTS: Based on the results of the analysis, taking into account the literature data, recommendations for making diagnoses, selecting, and coding according to ICD-10 of the initial cause of death of patients after organ transplantation were formulated.

CONCLUSION: The developed recommendations on the formulation of diagnoses in patients’ death cases after organ transplantation can be used in the daily practice of forensic medical experts.

From the 19th century to the present, forensic physicians have been interested in the subject of damage formation prescription. After reviewing the literature on the problem of traumatic hemorrhage prescription, it is clear that there is no single position, approach to the study of this issue, or an unambiguous time frame that accurately determines the period from injury to the victim’s death. Forensic doctors in the 19th and 21st centuries initially focused on the macroscopic picture of the injury, followed by microscopic examination. When studying micropreparations, they are guided by the cellular composition of the hemorrhage, based on previously known data, their own experience and knowledge in this field, the brief circumstances of the incident (if any are indicated in the direction of forensic histological examination), and the victim’s age. Researchers have determined approximations and developed approximate time frames for the formation of damage throughout the years, now taking into account the above characteristics and the victim’s condition during and after the injury, with the acquired experience and accumulated knowledge. However, scientists have not come to a consensus. Medicine, achievements, progress, and perseverance of scientists strive forward, involving related sciences in the study of antiquity. As a result, methods, such as molecular genetics, biophysical, biochemical, and immunohistochemical, have found use, allowing researchers to analyze cellular composition and enzymatic and hormonal changes in damaged tissues. Ultrasound is one of the instrumental methods being developed. This problem remains completely unresolved when both laboratory and instrumental methods and their combination are used.

For many years, the topic of the participation of forensic experts in the elimination of the consequences of emergencies with a large number of human casualties has remained relevant. Every year, there are more reports about problematic issues of the organization and provision of forensic medical support in cases of mass death of people, particularly in armed conflicts.

The presented report attempts to rethink the tasks and formulate the principles of forensic medical specialists who work in emergencies, including mass death and unknown disappearances of people.

Based on international and domestic experiences, work is needed to standardize procedures and algorithms for registering primary information and identifying signs of the deceased.

Standardized work algorithms and standardized forms are important for deceased identification because they simplify and formalize the registration, description, and subsequent information sharing on unidentified dead bodies, avoiding mistakes and omissions.

Given the importance of childhood injuries in the structure of common problems associated with children’s health, it is important to determine the exact mechanism of fractures, particularly diaphyseal fractures of the shin bones, during the examination because the specification of the mechanism for the formation of bodily injuries leads to the actual origins of injuries and allows further development of a set of preventive measures to prevent the occurrence of these situations. Moreover, it sometimes allows the defendants to accurately distribute the burden of responsibility for what happened.

In the presented expert case, the circumstances of bodily injury described by the subject and her legal representative were inconsistent with the type and nature of fractures received while trampoline jumping and the video recording from the surveillance camera did not provide complete information about the specific conditions of injury. A detailed analysis of the results of shin bone radiography, including determining the morphological features of fractures and their nature, and a frame-by-frame study of the presented video recording.

The diaphyseal fractures of the shin bones of atypical localization for a “trampoline injury” detected in a child could serve as a source of expert errors in determining the mechanism of their occurrence; however, a thorough, comprehensive assessment of all objects for examination, such as medical documents, including X-ray data and case materials, taking into account the age-specific morphology of the bone tissue of the child, enables to determine the exact mechanism of the occurrence of fractures.

One of the most common cases in practice is the possession by mentally ill and healthy people of various objects and chemicals for suicide. These observations are interesting; a sick soldier aged 21 years, with suicide intention, swallowed 32 pieces of metal nails, each of which was about 15 cm long.

Taking into account our examinations and observations, for patients with mental illness who have taken foreign bodies for suicide, the type and shape of the objects taken do not play a special role. The intellectual level of individuals who took foreign bodies to commit suicide is not satisfactory. Their actions are the product of primitive thinking.

This observation demonstrates a casuistic clinical case that miraculously did not end in death.

In the article, the doctrine of denying a forensic medical assessment of the severity of local injuries of the musculoskeletal system, which are not life-threatening, is considered from a critical position, based on an interdisciplinary approach, without considering the influence of medical care. The article shows the inconsistency, still present among some forensic physicians, of the opinion that determining the severity of harm to health by causing nonlife-threatening injuries without the fact of a determined outcome is allegedly expressed in violation of the basic provisions of the Criminal Code of the Russian Federation. In the context of the topic, the author reasonably points to the two-component essence of the definition of clause 6.11, 194th order of the Ministry of Health and Social Development of Russia of 2008, dated April 24, 2008, N 194n “On approval of medical criteria for determining the severity of harm caused to human health.” The fundamental explanatory provisions of the conceptual construction of the wording of clause 6.11 are provided in criminal law and medical relations. The author showed that there were no inconsistencies between these components. The presence of a list of medical criteria for harm to health of a similar direction, as in the existing paragraph 6.11, demonstrates the objective need in the updated version of the draft order of the Ministry of Health of Russia “On approval of the procedure for determining the severity of harm caused to human health.”

The 10th Anniversary International Congress, “Topical Issues of Forensic Medicine and Expert Practice, 2023,” was held at the Moscow Regional Research Institute on April 19–20, 2023. This article is an overview of the most important events of the Congress.