drajpatowary.net

2011-09-15T22:20:00.001+05:30

The most memorable day of my life when I am felicitated by my students (PGT) for geting the FELLOW of National Foundation of Clinical Forensic Medicine, awarded to me for my incision technique “Fourth Incision: The Cosmetic Autopsy Technique”.

Thank you students, thank you all.

Toxidromes

2011-09-12T21:22:00.001+05:30

What is a toxidrome

It is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others.

The cholinergic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Cholinergic SLUDGE	• Salivation • Lacrimation • Urination • Diarrhoea • GI cramps • Emesis • Wheezing • Diaporesis • Bronchorrhoea • Bradycardia • Miosis	• Carbamate • Organophosphates • Physostigmine • Pilocarpine	• Atropine • Pralidoxime for organophosphates

The anticholinergic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Anticholinergic Hot as a hare Dry as a bone Red as a beet Mad as a hatter Blind as a bat	• Mydriasis • Blurred vision • Fever • Dry skin • Flushing • Ileus • Urinary retention • Tachycardia • Hypertension • Psychosis • Coma • Seizures • Myoclonus	• Antihistamines • Atropine • Baclofen • Benztropine • Tricyclic antidepressants • Phenothiazines • Propantheline • Scopolamine	• Atropine • Pralidoxime for organophosphates

Hallucinogenic Sympathomimetic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Hallucinogenic	• Disorientation • Hallucinations • Hyperactive Bowel • Panic • Seizure • Tachycardia • Hypertension • Tachypnoea	• Amphetamine • Cocaine • Pseudoephedrine • Phencyclidine • Ephedrine	• Benzodiazepines

Sedative/hypnotic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Sedative / hypnotic	• Stupor & coma • Confusion • Slurred speech • Apnoea	• Anticonvulsants • Antipsychotics • Barbiturates • Benzodiazepines • Ethanol • Meprobamate • Opiates	• Naloxone • Flumazenil • Urinary alkanisation for Phenobarbital

Opiate toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Narcotic	• Altered mental status • Slow shallow breaths • Meiosis • Bradycardia • Hypotension • Hypothermia • Decreased bowel sounds	• Dextromethorphan • Opiates • Pentazocine • Propoxyphene	• Nalaoxone

Serotonergic syndrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Serotonergic	• Irritability • Hyperreflexia • Flushing • Diarrhoea • Diaphoresis • Fever • Trismus • Tremor • Myoclonus	• Fluoxetine • Meperidine • Paroxetine • Trazodone • Clomipramine	• Benzodiazepine

Protocol for Autopsy Examination

2010-01-29T12:25:00.003+05:30

Objectives:

To find out the cause of death

Mode of death

Manner of death

Nature of death

Time since death

To note the injuries present on the body

Weapons used

Recording the data for identification

In new born- live birth / still born / dead born

Rules of M.L. Autopsy

Proper authorisation papers

Command certificate
Forwarding letter
Inquest
Dead body challan

Should be done in an approved center

By authorised registered medical practitioner

Should be done in natural light

For night autopsy- written order from DC is a must

Arrangement for proper lighting must be done

Mention the time of autopsy with the order of the DC in the autopsy report

Note the following before performing autopsy:

Time of receiving the body

Time of performing autopsy

Person identifying the body with signature where of the escorting police is a must.

For identification- allow the person whose name is mentioned in the dead body challan.

External examination

Length & weight and complexion etc of the body

Wearing garment

Any stain / tear on cloth - whether these correspond with injuries on the body

Body surface - stains / discharge / foreign materials

All the natural orifices

Eyes

Finger nails - Colour Change / Foreign materials – keep nail scraping for foreign material

Injuries – type, size, shape & position

Rigor mortis

Postmortem staining - Colour, distribution

Decomposition changes

Temperature

Any other peculiarities

Internal examination

All autopsies must be complete

All the body cavities must be opened and examined

All the organs must be dissected and examined

Incisions used

I shaped

Y shaped

Modified Y shaped

4^th Incision: the cosmetic autopsy incision - for details, please go to the link bellow http://drajpatowary.blogspot.com/2007/08/fourth-incision-cosmatic-autopsy.html

For scalp- mastoid to mastoid incision in coronal plane (through the vertex).

Preservation of viscera in suspected poisoning cases

Viscera & body fluid to be preserved

• Stomach with content

• Portion of small intestine with content

• Portion of liver with gallbladder

• Half of each kidney

Viscera should be preserved in saturated solution of sodium chloride. Rectified spirit should be used in cases of poisoning by mineral acids, sodium chloride & vegetable poisons. Never use formalin as preservative.

• Blood in sodium fluoride

• Urine in thymol

Precautions to be taken in preservation of viscera

Stomach to be preserved in one container

Portion of liver and kidney in 2^nd container

Sample of preservative used in 3^rd container

All the containers are to be sealed and labeled

Sample of the seal to be sent on the forwarding letter

Blood to be sent in air tight container in death due to alcohol poisoning

Sample of tissue from injection site to be sent along with similar control tissue in separate container

Precautions to be taken during autopsy

Examine all the papers carefully- read the inquest and note the injuries mentioned.

Put signature on all the pages of the papers.

In case of disparity in the inquest and the findings on the body- call the I.O. / inquesting officer, show the disparity and take his signature. Insist on photography / video recording.

All the directions to the I.O. should be in writing, in case of inability on the part of the I.O. to comply with the directions, he has to inform that in writing.

Protocol for the Sexually Assaulted Female Examination

2010-01-29T12:09:00.006+05:30

Record name address and other relevant data

Take consent – informed consent of the alleged victim in writing

Note at least two identification marks

Signature of the identifying police and the female attendant present during examination

Date, time and place of examination

History of the case

Examination proper-

always examine in presence of a female attendant

note all the dimensions and parameters

injuries to be noted with dimension and position

collect swab from all the stains present on the body

collect and preserve any foreign material detected

vaginal swab from introitus & deep vaginal swabs

Precautions to be taken while preserving samples

Materials to be preserved:

Vaginal swab –

· Collect from vaginal introitus, from around the cervix and posterior fornix separately.

· Make smears on slides separately and fix the slides

· Stain by using Gram stain

· Look for spermatozoa

Swabs from seminal or salivary stain found on the body - Collect on cotton swab, air dry. Pack in sealed paper envelop and send to lab.

Stained cloth - Keep the stained part, dry it if wet, pack and seal and hand over to police. Keep receipt from police.

Foreign hairs or any foreign materials found - Pack and seal in paper envelop and send to laboratory.

Investigations required

Examination of Vaginal swab

Pregnancy test & ultrasonography if pregnancy is suspected

X ray examination for appearance and fusion of epiphyses

Laboratory examination of the suspected stain

DNA test for determination of the offender

After introduction of Sec 164(A) in the CrPC - in relation to Medical examination of the victim of rape, all the steps mentioned must be followed.

Reporting of sex crime cases

should be reported in a prescribed form

whether evidence of recent sexual intercourse is detected or not

evidence of injury detected or not

what is the age of the girl

any other relevant finding detected

Protocol for the Examination of injured and Injury Reporting

2010-01-29T12:07:00.000+05:30

Note name and address of the person

Take consent of the person

Note the points of identification

Signature of the identifying person

Examine the injured person and give the opinion in the proper format

Type of injury
( abrasion / bruise / laceration / incised / stab / firearm etc. )

Size of the injury

Position of the injury

Nature of injury
(simple / grievous / dangerous)

Object / weapon causing the injury

( blunt / sharp / pointed etc. )

Nature of the weapon

(weather dangerous or not )

Remark

( treatment given, investigations advised etc. )

Simple injury : which is not extensive, nor serious and heals without leaving any residual damage or defect.

Grievous injury: (Sec 320IPC)

Emasculation
Permanent privation of sight of either eye
Permanent privation of hearing of either ear
Permanent privation of any member of joint
Destruction or permanent impairment of power of any member or joint
Permanent disfiguration of head and face
Fracture and dislocation of bone and teeth.
Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain, or unable to follow his ordinary pursuits

Dangerous injury: Injuries which are extensive and serious and likely to cause death in ordinary course of time.

Dangerous weapon: Weapons which can be used for cutting, stabbing or shooting or any weapon or object which when used as weapon of offence, is likely to cause death of a person.

Protocol for the Examination of Drunken Person

2010-01-29T11:58:00.002+05:30

Consent of the accused for examination is necessary and it should be written informed consent

Never use rectified spirit on the skin for collection of the blood sample

The samples collected should be sealed and labeled properly and handover to the police for chemical analysis

If the accused is not in a state of giving consent or if the accused refuses to give consent

If consent is denied reasonable force can be applied for physical examination under section 53 of the Cr. P.C. If the person is incapable of giving consent by reason of unconsciousness or gross intoxication, the doctor may make an examination, take samples and give treatment as is necessary to save the life. However, he should not divulge the results of his examination until he can obtain the consent of the patient or the patient dies except when directed to do so by a court.

Opinion: (may be any one of the three)

The person has not consumed alcohol

The person has consumed alcohol but not under influence.

The person has consumed alcohol and is under influence.

Duties of medical practitioner while Treating Poisoning Cases

2010-01-29T11:43:00.004+05:30

First and most important duty is to resuscitate the patient.

In suicidal or accidental poisoning, doctor (in private set up) is not bound to inform police.

In case of death, do not issue death certificate. Police have to be informed.

Doctors in Govt. Hospitals are to report every cases of poisoning to police

All cases of definite/suspected homicidal poisoning must be informed to police. sec. 39 (CrPC)

Collect and preserve all materials like vomitus, faeces, stomach washing contaminated food etc and send to State Forensic Science Laboratory for analysis. (Deliberate omission will lead to sanction under 201 IPC)

In conscious patient, who is dying, arrange for dying declaration.

Notify all cases of poisoning from public eatery to public health authority

Maintain written records in all cases of poisoning.

Book review

2009-12-09T09:58:00.007+05:30

Text Book of Forensic Medicine and Toxicology by V.V. Pillay is a very concise book of Forensic Medicine for the undergraduate students. The 15th Edition is much more elaborate one than the previous issues, many advancement in the field of Forensic Medicine and Forensic Science has been included like the fMRI, Brain Fingerprinting and many more. In the field of Toxicology, as we all know he is one of the pioneers in India and as such, the toxicology section of the text book is very impressive; all the topics are described in concise without any unnecessary elaborations but, has narrated a few case references at the appropriate place which will be beneficial for the undergraduate students. The photographs included in the book are also of good quality and are very appropriate in relation to the text. In my opinion it is a complete book for the undergraduate students.

Case report:

2009-10-14T19:40:00.010+05:30

A case of burn was brought to the Deptt. of Forensic Medicine, Assam Medical College, Dibrugarh, Assam, for ML autopsy. The victim suffered approximately 98% burn. No injury detected except the burn injury on external examination. I used the “Fourth Autopsy Incision” which I developed in the year 2006, and found few contusions in the back of the chest which would have remained unnoticed in ‘I’ shaped, ‘Y’ shaped or modified ‘Y’ shaped incisions. Advantages of the “Fourth Autopsy Incision”:

whole of the circumference of the neck, thorax and abdomen is visualised, so, better detection of the wounds.
no or minimal seepage from the cavities.
stitches can be kept hidden in the front of the neck, so, better acceptance for the relatives of the deceased.
no separate incision is required for opening the spinal canal from the back.

Indications: in cases of death related to

torture,
custodial death
burn
road traffic accidents and any other cases, where there is history of injury just before death of the person.

Case of death with 98% burn

Same case with contusion in the deepper tissues

N.B. The incision is described in “Text Book of Forensic Medicine and Toxicology” by Dr. V.V. Pillay pp. 152-155.
Article on the incision technique is being published in the American journal of Forensic Medicine and Pathology in Volume 30, Number 4, December 2009.

2008-07-24T10:04:00.014+05:30

CASE REPORT:

A bundle of bone was sent by the police for autopsy. Police suspected that the bones belong to a boy aged around 17 years who was kidnapped for ransom around two years back.

On examination of the bones found as follows:
List of the bones found

Skull bones
Right maxilary bone
Mandible
Both femures
Both hip bones
Both the scapulae
Sacrum
Two clevicles
11 Vertibrae
17 Ribs.

Photographs of the findings:

On the basis of the findings, the following opinion was formed:

The skeletal remains were of human origine and from one and same individual.
Sex was male
Age of the person was above 16 years and bellow 18 years at the time of death.
Height of the person was approximately 160.4 ± 3.9 CM.
Time since death was approximately 18 to 24 months.
Death of the person was due to the incised wound over the skull caused by sharp cutting heavy weapon and was homicidal innature.

VIRTOPSY: One step forward in the field of Forensic Medicine

2007-09-28T18:51:00.004+05:30

Virtual autopsy or more popularly known virtopsy is a scalpel free procedure of autopsy carried out using modern imaging techniques. Here, there is no need of any dissection of the body for opening the body cavities or dissection of the different organs of the body. Using the different imaging techniques, which provide a complete three dimensional view of the inside as well as outside of the body, all the vital information like position and dimensions of the wounds, or other pathological conditions in the body can be known and documented without use of any scalpel. The technique could offer an alternative to the standard invasive procedure that upsets many families and is prohibited by some religions, the developers say.

Imaging techniques used:

Multi-slice computed tomography (MSCT) and
Magnetic resonance imaging (MRI) – which visualise the interior of the body for collection of all the data in details in regards of condition of different organs. One can examine the part of the body in slice by slice in different planes according to the requirement of the situation.
3-D surface scan used in the automobile designing is used to map the exterior of the body. It gives and documents the three dimensional image of the body surface area in details.
Magnetic resonance imaging spectroscopy for estimation of time since death by measuring metabolites in the brain emerging during post-mortem decomposition.

Advantages:

Most effective in study of the wounds including the matching of the probable weapon. The wound can be studied without disturbing the body architecture.
No scalpel method, so no hazard of infections from the blood or other tissue fluids.
No mutilation of the body, so, can be examined again without any autopsy artifacts.
The data is stored in digital format, so can be transmitted to any part of the world easily.
Less time consuming and body can be released immediately after the scanning.
Better acceptance for the relatives of the diseased and also by the religious customs as incisions are used.

Disadvantages:

Insufficient data base of comparative study of virtopsy and conventional autopsy.
It is not possible to distinguish all the pathological conditions with this technique.
Collection of sample for histopathological and the toxicological samples from internal organs is not possible.
Can not speak about the infection status.
Difficult to differentiate antemortem or the postmortem wounds.
Difficult to appreciate the postmortem artifacts.
Difficult to appreciate the colour changes.
Small tissue injury may be missed.
In our scenario, it is not possible to provide these types of investigations to all the living persons, so how far it will be practical to start with the same for the dead is questionable as in our setup, deads come last in the priority list.

FOR VIDEO OF VIRTOPSY PLEASE CLICK THE LINK BELLOW http://www.virtopsy.com/index.php?id=45

Modern Mortuary Plans

2007-09-08T18:40:00.000+05:30

PLAN FOR A MEDICAL COLLEGE MORTUARY

PLAN FOR A DISTRICT HOSPITAL MORTUARY

THE FOURTH INCISION - A COSMETIC AUTOPSY INCISION TECHNIQUE

2007-08-01T07:45:00.000+05:30

Abstract

Autopsy procedure includes thorough external examination as well as internal examination including opening of all the body cavities for proper visualization of all the visceral organs. As such there remains incision marks with stitches which harts the sentiment of the already traumatized relatives of the deceased. Moreover, it looks odd especially in cases of otherwise healthy dead bodies.
So, autopsy incisions should be such that, we can get maximum possible visualization of the body particularly the thorax and abdomen and at the same time the incision as well as the stitch marks are also hidden.
This new incision technique is designed with few modifications in the autopsy incisions for opening the thorax and abdomen and also proper visualization of the neck structures during autopsy where the incisions and the stitches are kept hidden. In all the other incisions, the back of the neck, thorax and abdomen is not at all visualised. So, this incision is designed in such a way that, the whole circumference of the body can be visualised.

Advantages of this incision technique are-

whole of the circumference of the neck, thorax and abdomen is visualised, so, better detection of the wounds particularly in cases of death related to torture, road traffic accidents and any other cases, where there is history of injury just before death of the person.
no or minimal seepage from the cavities.
stitches can be kept hidden in the front of the neck, so, better acceptance for the relatives of the deceased.
no separate incision is required for opening the spinal canal from the back.
the only disadvantage that I encountered is that, it is more time consuming in comparison to the “I shaped incision”. It takes 25min more time in comparison to the I shaped incision.

Few photographs of the incision: ( for medical professionls only )

( please do not copy )

For details of this incision technique, please contact at drajpatowary@gmail.com .

My CV

2007-07-03T12:56:00.027+05:30

Dr Amarjyoti Patowary, MD

Parmanent address:

HOUSE NO. 21,

PRAFULLA BORO PATH

RUPNAGAR, GUWAHATI

ASSAM, INDIA. PIN-781032

Present address: Same as above

Phone: +919435018221

Email:

Personal Information:Guwahati, Assam, India.

Marital status: Married

Nationality: Indian

Date of Birth: 01.03.1969.

Place of Birth:

Objective: To join Deptt. of Forensic Medicine as faculty member and increase its popularity.

Education:

1999, MD (Forensic Medicine) from Gauhati Medical College, under Gauhati University।
1993, MBBS from Gauhati Medical College, Under Gauhati University.

Interests and activities: Teaching, higher education, music, Photography, Mountaineering.

Languages: English, Hindi, Assamese - read, speak, write.

Work experience:

MD in Forensic Medicine (1999)
Demonstrator of Forensic Medicine, Gauhati Medical College from 4th of April 2000 to 15th of May 2005.
Assistant Professor of Forensic Medicine, Gauhati Medical College from 16th of May 2005
Assistant Professor of Forensic Medicine, Assam Medical College, Dibrugarh, Assam, India from 1st of August 2006, till 15th of February 2011.
Associate Professor of Forensic Medicine, Gauhati Medical College, Guwahati, Assam, India, from 16th of February 2011, till date.
Internal Examiner for the undergraduate courses under Gauhati University.
Internal Examiner for the undergraduate courses under Dibrugarh University, Assam.
External Examiner for the undergraduate courses under West Bengal University of Health Sciences and Tripura University.
External Examiner for the undergraduate courses under Sikkim Manipal University.

Papers and presentations:

Presented six Papers in the conferences of Indian Academy of Forensic Medicine and one paper in East Zone Forensic Medicine Conference

Injury caused by atypical secondary missile- a postmortem case report
- 1998at Imphal IAFM conference.
Study of firearm injury cases in medicolegal postmortem examination in Gauhati Medical College during last five years
- 1999 at Delhi, IAFM conference at AIMS, Newdelhi.
Study of pattern of homicidal forearm injury in ML autopsy
- 2005 at Dehradoon IAFM conference.
Bones unveiled gruesome killing a case report
- 2005 at Dehradoon IAFM conference.
Study of pattern of injuries in homicidal firearm injury cases
- 2006 at Siliguri IAFM conference.
Cosmetic autopsy incision - Proposed modification in autopsy incision
- 2007 at Amritsar IAFM conference.
Hurdles in medicolegal practice in Assam
- 2007 at Eastern Zonal Conference of Forensic Medicine and Toxicology at Guwahati.

Publications:
National

1. Injury caused by atypical secondary missile a postmortem case report
- 4th Medicolegal Bulletin, Special issue on FORENSICON 1998.
2. Bones unveiled gruesome murder, a case report
- Journal of Indian Academy of Forensic Medicine, Vol. 27, No. 1, 2005.
3. Study of pattern of injuries in homicidal firearm injury cases
- Journal of Indian Academy of Forensic Medicine, Vol. 27, No. 2, 2005.
4. Virtopsy: One step forward in the field of Forensic Medicine – A Review
-Journal of Indian Academy of Forensic Medicine, Vol. 30, No. 1, 2008. pp 32-36.
5. The Fourth Incision-A Few Modifications in Autopsy Incisions
- Journal of Indian Academy of Forensic Medicine, Vol.32, No. 3, 2010. pp 234-238.
International
1. Study of pattern of homicidal firearm injury in ML autopsy
- International Journal of Medical Toxicology & Legal Medicine, July-Dec. 2007. pp 52-55.
2. Planning an Ideal Mortuary in India-Plan for a Medical College and A District Hospital
-International Journal of Medical toxicology & Legal medicine, 2008; 11(2):41-47.
3. The Fourth Incision- A Cosmetic Autopsy Incision Technique
- The American Journal of Forensic Medicine and Pathology. Vol. 31, No. 1, March 2010. pp 37-41.
4. Lie detection: different methods with special discussion on brain fingerprinting
- Medico-Legal Update. Vol. 10, No. 2, July - December 2010. pp 58-60.

Other achievements:

Awarded as the FELLOW of National Foundation of Clinical Forensic Medicine in 2011.
Developed a new autopsy incision technique- "The Fourth Incision- A Cosmetic autopsy Incision Technique" in August 2006.
Best paper award in Eastern Zonal Conference of Forensic Medicine and Toxicology.
Joint Secretary, East Zone, of Indian Academy of Forensic Medicine (2006-2008).

Guest lectures:

Guest lectures at the Assam Police Training course.
Guest lecture at the State Forensic Science Laboratory Assam.
Examination of the medico-legal cases -Formalities and reporting protocol
- Guest lecture at the CME in BTC Doctors meet, Kokrajhar, Assam.
Medico-legal formalities in day to day practice - Guest lecture at the CME in AMA Tezpur meet, Tezpur, Assam.
Antidotal Management of Poisoning – benefit and pitfalls: CME oration in the CME Programme on “Approach to management of Poisoning in day to day practice” held on 2^nd Sept. 2011 at North Bengal Medical College, Silguri.

Summary of qualifications:

FELLOW of National Foundation of Clinical Forensic Medicine.
Currently working as Associate Professor of Forensic Medicine at Gauhati Medical College, Guwahati, Assam, India.
Internal Examiner of Gauhati University and Dibrugarh University.
External Examiner of West Bengal University of Health Sciences and Tripura University.
Teaching experience in undergraduate teaching in the deptt. of Forensic Medicine, Gauhati Medical College after completion of post graduation for more than 8 years.
More than 14 years experience in the field of Medicolegal work.
MD, Forensic Medicine.
MBBS