Arshad Anjum

Epidemiological Profile of Snake Bite at Tertiary Care Hospital, North India

This hospital based prospective study was conducted from September 2009 to September 2011.All the patients irrespective of age and sex, who reported with history of snake bite were included in the study. A total 169 snake bite patients, consisting of 116 (68.7%) male and 53 (31.3%) female [mean (SD) age 32±12 years] were admitted to the hospital during the study period, the ratio being 2.2:1. The majority of victims belonged to rural areas (67.5%) and most vulnerable occupation group was the people involved in agricultural activities (48.5%). The study population was predominately bitten outdoors (62.7%). Most of the time people could not identify the snake (52.1%) and among identified poisonous snakes Elapidae and Viperidae type were 15.4% and 13.0% respectively. The maximum cases of snakebite were recorded in the 3rd quarter of the year (67.4%) and peak incidence of snake bite was recorded in the time between 6:00 PM to 12:00 midnight (30.2%). In 69.2% of cases, the site of snake bite was lower limbs. The commonest manifestation was fright (85.2%) followed by pain at local site (57.9%). Majority of the victims were treated with ASV (81.1%) and most of them survived (92%).

Tubercular cold abscess at an unusual site mimicking a pyogenic abscess

Tuberculosis affects much of the world’s population, and 1 - 5% of all cases are musculoskeletal. Tuberculosis of the soft tissues secondary to underlying bone involvement is not uncommon, but selective tissue involvement without bony abnormality is rare. We present a case in which two tubercular abscesses presented at an unusual site with no underlying bony involvement, simulating a pyogenic abscess.

Tuberous Sclerosis Presenting as Delay in Development of Speech

A 3-year-old male child presented as delay in development of speech, a rare single presenting feature with tuberous sclerosis. Clinical history and examination were consistent with tuberous sclerosis including major features like Ash-leaf spots and Adenoma sebaceum. The clinical manifestations and evaluation of tuberous sclerosis are discussed.

In defense of defensive forensic medicine.

Defensive medicine comes into play when health professional conducts tests or procedures with a concern over liability, rather than its need. It’s highly emphasized by Dr Alan Woodward, Vice Chairman of committee on Professional liability of Massachusetts Medical Society (MMS). He further estimates that more than 80% of doctors across the country are engaged in defensive medicine 1 introducing “the fear factor in care cost”. 2 To be fair the defensive forensic medicine cannot be equated completely with the practice of defensive medicine in clinical setting. In the latter case the entire exercise of subjecting the patient to tests and procedures is only to protect the flanks of the doctor from perceived litigation and ill-conceived liability. The patient stands the least to gain from that maneuver. The authors contend that defensive forensic medicine may not be considered as regressive, costly and immoral. On the contrary it should be embraced as a progressive attempt to embody the defense of diagnosis reached by the autopsy surgeon or clinical forensic expert after rigorous application of mind, bodily material and convergence of lawful need. Some times additional measures to rule out “zebras”, i.e., unusual conditions unrelated to the problem at hand may be instated best illustrated by a case of battered to death of an eighty years old woman after robbery. The autopsy surgeon’s love of “defense” revealed that the woman was raped. Under normal circumstances, considering the advanced age of the woman and the crime scene offering all indications of violence and restraint of an elderly woman would be enough to wrap-up the case as that of robbery and ensuing violence. It is the exploratory virtue of defensive forensic medicine that rendered the revelation of additional information of sexual assault which would have otherwise gone unnoticed. The vaginal material established the identity of the suspect and led to the successful conviction of the accused. Defensive forensic medicine is anchored on the trinity of hope, suspicion and resistance – hope of the doctor to reach a final and viable diagnosis to stand in the court of law, suspicion of the prosecution, and resistance by the defense. Hence by practicing defensive forensic medicine it would be the endeavor to protect the autopsy surgeon’s/clinical forensic expert’s liability, to strengthen the deceased’s silent voice for justice, and may be of the suspect as well, and to raise the level of information provided to the court of law to form a reasonably consolidated corpus of opinion. Come to think of it the practitioners of forensic medicine are exposed to allegations, counter claims and litigations more than other practitioners of medicine simply because they form a broad interface with the law. No matter how well construct the good intentions may be the sunk-cost fallacy shadows their professional life throughout their career. Crusading defensive forensic medicine is like balancing the trilogical tryst with three destinies – that of the doctor, the deceased and the accused in the dock (the 3 Ds).

Laterality: Coffee vs Tea - Is it forensically relevant?

The question of laterality is discussed in this paper pertaining to use of the right or the left hand. Interestingly, some amazing cue is derived which though do not confirm to the projection, yet demonstrate conformity to deviant reasoning leading to promising forensic lead.

Motor aphasia in the first week of enteric fever

Typhoid (enteric) fever is an endemic disease in many tropical countries, with diverse modes of presentation. The classic clinical manifestations are rarely seen nowadays owing to early diagnosis and institution of antibiotic therapy. Moreover, the epidemiology of the disease is constantly shifting, with some cases presenting with complications in the early part of the illness. Of all the complications reported in enteric fever, the neurological manifestations constitute an important but often under-diagnosed group. We report a 10-year-old girl with typhoid fever who presented with motor aphasia during the first week of illness, a complication that has not been reported previously.

Recurrent Immune Thrombocytopenic Purpura: Interesting Case of a Child with 5 Recurrences

Immune thrombocytopenic purpura [ITP], also known as idiopathic or autoimmune thrombocytopenic purpura, is a benign hematological disorder characterized by a low circulating platelet count, caused by destruction of antibodysensitized platelets in the reticuloendothelial system. It is a common cause of acquired thrombocytopenia particularly in children, which often remits in weeks to years. ITP can be classified based on duration of thrombocytopenia as acute and chronic form. Recurrent ITP is defined as recurrence of symptoms, after at least three months of remission without treatment. It is rare entity and seen in just 5% of all ITP cases. Further, its treatment is often cumbersome and warrants use of non-conventional drugs and splenectomy. We report a case of ITP in a 9 year old boy, who presented with five recurrences and all episodes were successfully treated with just oral prednisolone.