Application of artificial intelligence and machine learning technology for the prediction of postmortem interval: A systematic review of preclinical and clinical studies.

BACKGROUND /PURPOSE: Establishing an accurate postmortem interval (PMI) is exceptionally crucial in forensic investigation. Artificial intelligence (AI) and Machine learning (ML) models are widely employed in forensic practice. ML is a part of AI, both terms are highly associated and sometimes used interchangeably. This systematic review aims to evaluate the application and performance of AI technology for the prediction of PMI. METHODS: Systematic literature search across different electronic databases using PubMed/Google Scholar/EMBASE/Scopus/CINAHL/Web of Science/Cochrane library was conducted from inception to 3 December 2021 for preclinical and clinical studies reported ML models for PMI estimation. RESULTS: We identified 18 studies (12 preclinical and 06 clinical) that met the inclusion criteria in the qualitative analysis. Most of the studies employed supervised learning (N = 15), and others employed unsupervised learning (N = 3). Due to the heterogeneity of the samples, quantitative analysis was not performed. CONCLUSION: In this systematic review, we discussed the performance of AI-based automated systems in PMI estimation. ML models have demonstrated accuracy and precision and the ability to overcome human errors and bias. However, the research is limited, conducted in primarily small, selected human populations. In addition, we suggest further research in larger population-based studies is needed to fully understand the extent of integrated ML models.

N-acetyl cysteine in the treatment of cannabis use disorder: A systematic review of clinical trials.

BACKGROUND AND AIM: Cannabis is the most consumed illicit drug globally, with a high risk of developing cannabis use disorder (CUD). No approved pharmacological treatment exists for CUD, but N-Acetyl Cysteine (NAC) has shown promising results in different clinical studies. This study aims to conduct a systematic review of NAC clinical trials for the treatment of CUD. METHODS: Systematic review of randomized controlled trials (RCTs) was conducted to determine the effect of NAC for the treatment of cannabis dependence/cannabis use disorder (CUD). Articles were electronically searched across different databases using PubMed, Google Scholar, EMBASE, Cochrane Library, Medline and PsycINFO from inception to June 2021. Several study characteristics, including study duration, sample size, study population and age group, intervention, adverse effects, and outcome measure were extracted. A PICO table was used for data extraction. RESULTS: We included 08 RCTs in the qualitative analysis. The risk of bias (RoB) was assessed according to Cochrane RoB criteria, and a 5 point grading system according to the Oxford Centre for Evidence-Based Medicine was used to rate the methodological quality (level of evidence) of the included articles. Mild and well-tolerated adverse events were reported in the placebo and NAC group. CONCLUSIONS: The studies collectively offer mixed results, although the strength of the evidence available on which to make a recommendation is strong. NAC has shown to be effective in promoting abstinence, medication adherence and reducing cannabis use and craving among cannabis dependent users. This review also suggests recommendations for future research.

Cerebrospinal fluid monoamine metabolite concentrations in suicide attempt: A meta-analysis.

AIM: The purpose of this meta-analysis was to critically examine the data from individual studies on CSF neurotransmitter metabolites to see whether there were consistencies in the results of the comparison of suicide attempters and psychiatric controls and of the comparison of attempted suicides using violent versus nonviolent methods. METHOD: Systematic literature search across different electronic databases using PubMed/Google Scholar/EMBASE/Cochrane library was conducted for studies that reported concentration of CSF-neurotransmitter metabolites: 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxy phenylglycol (MHPG) in suicide attempters, from January'1981 to November'2020. Standardized mean differences (SMDs) and corresponding 95 % confidence interval (CIs) were deduced for outcome measures. I2 statistics were used to assess heterogeneity within studies. Data were analyzed using STATA software. RESULTS: A total of 36 studies (N = 1987 attempted suicide and N = 1235 psychiatry control) were included for the meta-analysis. We found CSF levels of all the 3 metabolites i.e. 5-HIAA (SMD= -0.43; 95 %CI: -0.61, -0.24), HVA (SMD= -0.16; 95 %CI: -0.33, -0.00) and MHPG (SMD= -0.33; 95 %CI: -0.71, -0.05) were lower in suicide attempters. While the findings were consistent for 5-HIAA, they were inconsistent for the HVA and MHPG. CSF levels of 5-HIAA (SMD= -0.66; 95 %; CI: -1.01, -0.31), HVA (SMD= -0.14; 95 %CI: -0.45, 0.16) and MHPG (SMD= -0.12; 95 %CI: -0.56, 0.31) were significantly lower in violent suicide attempters than non-violent attempters. No significant publication bias found in any study. CONCLUSION: We found a significant association between lower levels of CSF 5-HIAA in suicide attempters, particularly the violent ones, compared to psychiatric controls, whereas findings from CSF HVA and MHPG were inconsistent.

Role of clinical forensic medicine unit in quality and standardization of medico-legal reports.

INTRODUCTION: Incomplete and inaccurate medico-legal report (MLR) often slow down the court trials and lead to incorrect judgments. Identification of such mistakes and shortcomings in the report can help in preventing litigations against doctors, unbiased court judgments, and injustice. Clinical Forensic Medicine Unit (CFMU) deals with all medico-legal cases (MLC) brought to the institution. It prepares MLR's, collect evidence, and supervises medicolegal issues of the institute. MATERIAL & METHOD: Pre-CFMU included 50 poisoning and 50 non-poisoning reports, selected randomly among 504 cases. Post-CFMU also included 50 poisoning and 50 non-poisoning reports, which were chosen randomly among total 588 cases. RESULT: Comparing the pre and post CFMU non-poisoning reports, the following parameters were statistically significant; date and time of examination, address of the patient, details of accompanied police, details of attendant, identification marks, history of incidence, consent, description, dimension, location and age of injuries, pictorial presentation, general condition of the patient on arrival, and final opinion. Comparing the pre and post CFMU poisoning reports, statistically significant results were obtained for the following parameters; address of the patient, identification marks, history of incidence, consent, general condition of the patient on arrival, details of evidence collected, preservative used, seal status, and final opinion. CONCLUSION: The present study concludes that the errors were significantly reduced in medico-legal reports prepared by forensic experts. It is, therefore, necessary to employ forensic experts at every healthcare facility not only to prevent lawsuits but also to strengthen the judiciary. Additionally, we recommend regular training of non-forensic professionals to acquaint them with medico-legal work.

Autopsy diagnosis of a death due to scorpion stinging--a case report.

Post-mortem diagnosis of envenomation by a scorpion with or without a reliable history is a herculean task for any forensic pathologist. The challenge is compounded when stinging occurs at night, with the history remaining unreliable. The autopsy diagnosis is further complicated when the inflicted wound is small, and the mark is obliterated by healing within few days. As the venom of a scorpion is a mixture of enzymes, most of the forensic science laboratories in India fail to diagnose the poisoning. We present a case in which there was no external evidence of stinging, but the internal post-mortem findings along with histology of the organ systems pointed towards the diagnosis and were corroborated by the history. We reemphasise the importance of pathological sampling of organ systems, whenever there is death due to a suspicious, unknown insect bite.

Cataract as the root cause of fatal road traffic accidents in pedestrians.

Senile cataract is an important cause of preventable blindness, affecting 12-15 million people worldwide. In India, approximately 3.8 million people become blind from cataract each year. Moreover, in India, senile cataract develops at a relatively younger age than that seen in developed countries. However, during routine postmortem examination, search for cataract is often ignored, although it could be a major factor responsible for many road traffic accidents. This paper reports two cases of road traffic accident, where the judgement of the court exonerated the accused drivers based on the findings of eye examination during autopsy. Routine examination of the eye for cataract is recommended in every person involved in a road traffic accident irrespective of whether he is a victim or an accused.

Consent to treatment: practice vis-à-vis principle.

It is a principle recognised not only by our own but by other legal systems that ignorance of the law is no excuse for violating it. This is also expressed in the form of a legal presumption that everyone knows the law. So it is the duty of every person to be acquainted with that part of it which concerns him or her. In recent years there have been a number of malpractice suits based on lack of consent or inadequate consent from the patient for procedures used in treatment. The common meaning of consent is permission, whereas the law perceives it as a contract, that is, an agreement enforceable by law. Keeping this view, the present article aims at highlighting certain misconceptions prevailing regarding consent.

Post-traumatic stress disorder, depression and generalised anxiety disorder in adolescents after a natural disaster: a study of comorbidity.

BACKGROUND: Information on mental health sequel in adolescents following natural disasters from developing countries is scant. METHOD: Around one year after a super-cyclone, proportion of adolescents exhibiting post-traumatic psychiatric symptoms, prevalence of post-traumatic stress disorder (PTSD), major depression and generalized anxiety disorder, comorbidity and impairment of performance in school were studied in Orissa, India. Mini International Neuropsychiatric Interview for children and adolescents was used for evaluation and diagnosis. The criteria for diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders-IV. RESULTS: Post-disaster psychiatric presentation in adolescents was a conglomeration of PTSD, depression and anxiety symptoms. The prevalences of PTSD, major depressive disorder and generalised anxiety disorder were 26.9%, 17.6% and 12.0% respectively. Proportion of adolescents with any diagnosis was 37.9%. Comorbidity was found in 39.0% of adolescents with a psychiatric diagnosis. Adolescents from middle socioeconomic status were more affected. There were gender differences in the presentation of the symptoms rather than on the prevalence of diagnoses. Prolonged periods of helplessness and lack of adequate post-disaster psychological support were perceived as probable influencing factors, as well as the severity of the disaster. CONCLUSION: The findings of the study highlight the continuing need for identification and intervention for post-disaster psychiatric morbidities in adolescent victims in developing countries.

Socio-cultural aspect of sexual practices and sexual offences - an Indian scenario.

Ignorance of the law of the land is no defence. Furthermore, it is a legal dictum that one should not be held criminally liable unless possessing a guilty mind. But during trials of some sexual offences in India it is often observed that the accused did not know that he had committed an offence because the crime in question was a part of his socio-cultural milieu. India is a vast country with great socio-cultural diversity and many different ethnic groups, each with its own distinct cultures. However, the entire Indian culture is religion based and finds its root from the ancient Holy Scriptures. The sexual culture of Indian society stems from the Kama Sutra of Vatsyayana, an epic on sex. This text is considered holy and is accepted culturally, even though many practices contained therein are offences under modern law. Child marriages and arranged marriages are an integral part of Indian society and in some tribes, even prostitution is socially sanctioned. However, all of these are also against the law. Many of the conflicts observed between the sexual practices that are accepted in Indian culture but not by the law can be explained on the basis that the Indian legal system is borrowed from that of the British.

Litigation suits in otorhinolaryngology - Areas of concern.

The factors that separate an otolaryngology related law suit from others are manifold. The definition of standard of care, the patient's expectation of a surgical outcome and the psychological consequence that results from the surgical complications are unique to this specially. As this specially deals with one of the most sensitive part of a human body, patient's expectations of any treatment is bound to differ from that of the doctor. Unlike other fields, the definition of standard of care is constantly evolving due to continuous introduction and modification of the techniques and instruments. Statistics shows that the most common allegation in law suits relating to this branch is inadequate consent for the proposed treatment followed by wrong techniques used for operation. Negligence in postoperative care, failure to diagnose early and faulty maintenance of medical words are the other major areas that concern a doctor in a court room. The present article aims at reviewing some major problem areas and addressing the legal aspects concerning those areas.

Death by attack from a wild boar.

Attacks on humans by wild animals causing fatal injuries are not uncommon in rural and forest areas of India. But death occurring due to attack by a wild boar is rare. As the victims of boar attack are usually recovered from dense forest areas, the investigating officers could be misled as to the nature of infliction of these multiple, fatal penetrating injuries to a possible homicide. Unlike the injuries inflicted by wild cats, canines and bulls, the hallmark of boar attack is the infliction of multiple penetrating injuries to the lower part of the body. This case is reported for its rarity, for the awareness of the possible injuries in such unnatural deaths, and for the factors predisposing to a boar attack.