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Key Words: Autopsy treatment jalapeno skin burn buy rivastigimine 3mg fast delivery, Missile treatment nausea cheapest generic rivastigimine uk, Fatal medications xl order genuine rivastigimine line, Stab Wound treatment uti order rivastigimine 4.5mg overnight delivery, Foreign Body, Firecracker, Iron Pipe, Forensic Pathology Introduction: Bursting of firecrackers is very common in India during festivals, while rejoicing victories or in religious processions. Minor accidental burns while bursting fireworks are often reported, however they are seldom fatal. It creates a huge sound while bursting and is the noisiest firecracker, exceeding the permissible sound barrier of 145 decibels (dB). We report a fatal case, where a 17 year old boy died while bursting a jute twine bomb contained in an iron pipe. The case highlights the fatal nature of such bomb when used in a container like pipe. The wounds from such injuries are of particular concern to the forensic pathologist as they closely mimic stab wounds and at times may resemble atypical gunshot wounds. Showing Jute Twine bomb Figure 2: Iron pipe used for bursting bomb Corresponding Author: 1 Assistant Professor, Associate professor, Professor & Head, 2 3 Dept. On perusal of inquest papers and enquiring with the investigating officer it was revealed that the deceased was a participant of a religious procession and was bursting jute twine bombs housed in an improvised iron pipe. The investigating officer, upon noticing a stab wound on the chest, registered a case of homicide against an unknown assailant. At autopsy, the deceased was thin built with generalised & well marked rigor mortis. A penetrating wound was noted on the right side of middle 1/3rd chest extending up to midline, situated 4 cm medial to right nipple of size 4. It was concluded that the injury is accidental and cause of death was ascertained as "Shock and Discussion: Chemical explosives are grouped as High-order or Low-order explosives. Loworder explosives such as gunpowder or petroleum-based devices produce a subsonic blast and, although they may produce 115 J Indian Acad Forensic Med. Flash powder is used as an explosive component of firecrackers, which is a chemical mixture consisting of potassium perchlorate and finely powdered aluminium. Secondary blast injury is due to the effect of projectiles activated and set in motion by the blast being dispersed at speed with high kinetic energy. In order to produce damage, this kinetic energy of the projectiles has to be absorbed by the target tissues, where it is dissipated as heat, noise and mechanical disruption. The iron pipe used in this case was a 2 feet long hollow pipe with the rear end closed by a circular disc. Upon busting, the jute twine bomb in this pipe, the sound created is of higher intensity with a long flash of light as compared to busting it in open. The busting of the jute twine bomb (low order explosive) contained in this improvised assembly resulted in an increased pressure within the iron pipe and by the virtue of which its rear end got detached. The detached rear end acted as a high speed projectile entering the thoracic cavity. Though the circular metal object weighed only 9 grams, the velocity attained due to blast pressure was enough the penetrate the body tissues. The rear end of the main pipe in the present case was missing and corresponded with the circular metallic body found in the thoracic cavity. Fatal wounds from high velocity projectile are not uncommon and reported by several authors. In one such case, a mechanic sustained penetrating mandibular injury, from the handle of a sledgehammer when the inner tube of a military truck tyre burst during repositioning. Interpretation of wound and comparing the foreign body with the alleged weapon/object in such a case is pivotal for determining the manner of death as the injury mimics homicidal stab wound. An unusual case of pneumaticallyinduced facial and cervical injuries: a case report. Penetrating missile injury by sudden oxygen release from compressed oxygen cylinder: a case report J Indian Acad Forensic Med 2013;35(4):392-97. A report on five cases involving five minor boys, who were forced into anal sex (sodomy) by three boys in their late teens in a remote area of a North-Eastern State of India is reported. Considering the nature of such a crime and to emphasize the fact that no age is safe and young boys can also be victims of such type of unnatural sexual offences, this paper has been presented. Key Words: Unnatural Sex, Sodomy, Minor Boys Introduction: Sodomy is anal intercourse between two males, or between a male and female. This sexual practice prevails all over the world without any age limitations, involving adults, children and old subjects.

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They concluded that the parasympathetic nervous system must be intact to observe the light reflex; the sympathetic nervous system influences the shape of the reflex medicine bg order generic rivastigimine pills. For example medicine you can give dogs cheap rivastigimine 4.5 mg on-line, in the absence of sympathetic innervation the constriction velocity is increased and the dilation velocity is decreased symptoms to pregnancy generic 4.5 mg rivastigimine. The effects of abused drugs on these and other components of the light reflex were studied in the experiment described below in treatment 1 discount 3mg rivastigimine otc. During their participation in the study, they resided on a clinical research ward. The subjects had extensive histories of illicit drug use that included recent ingestion (within the past 2 years) of opiates, marijuana, stimulants, alcohol, and sedative-hypnotics although they were not dependent on any drug (except nicotine). Neither the subjects nor the technician knew the identity of the treatment at the time of the experiment. On study days, subjects swallowed three opaque capsules, drank a large cold tonic drink (480 ml, in 15 min) with 2 ml 95% ethanol floated on top, and smoked a cigarette (either marijuana or placebo) according to a paced puffing procedure: 8 puffs per cigarette, 20-s puff retention, 40-s interpuff interval. A battery of subjective, performance, and physiologic tests were completed before drug administration, and at selected times up to 300 min after drug. Study Measures - (1) Pupillary Measures: Measures of pupillary diameter and parameters of the light reflex were made using a Pupilscan (Fairville Medical Optics) handheld pupillometer. Initial (prestimulus) pupil diameter, and the following parameters of the light reflex, were derived from the data collected on a personal computer: constriction and dilation velocities, and the amplitude of constriction. The measures were made before the drug and at 30, 105, 180, and 300 min after the drug. The 100-mm scale was anchored with the terms "not at all" (0 mm) and extremely (100 mm). The subjects rated subjective effects before the drug and at 30, 105, 180, and 300 min after the drug. The subject used the numeric keypad of the computer to reproduce a geometric pattern (3 keystrokes) that was uniquely associated with the displayed digit. The dependent measure used was the number of correct responses during the 2-min task. Using a priori tests, data points after drug administration were compared to baseline values and placebo values. Although the changes were statistically significant, their magnitude was not large. The magnitude of the effect was small and the maximal changes occurred at the time of the maximal change in pupillary size. The high dose of marijuana, hydromorphone, and pentobarbital reduced the constriction velocity by 1. Similarly, scores on the drug liking visual analog scale differed significantly among the drug conditions. These data indicate the subjects perceived the high doses of the experimental drugs as being strong and being liked. The positive endorsement of questions of drug liking and strength by experienced drug users indicate that such drugs have a high abuse potential. The effects varied as a function of the drug administered and the time after administration. The effects varied as a function of the administered drug and the time after administration. Performance was significantly impaired after high doses of marijuana, ethanol, pentobarbital, and hydromorphone. Circular lights task - High doses of ethanol and pentobarbital significantly decreased the number of hits on the circular lights task. The other experimental drugs caused no significant change in this measure of performance. Correlational Analyses - A visual comparison of the pupillary, subjective, and performance effects of the experimental drugs (Figures 4. For example, smoked marijuana produced maximal subjective and performance effects 30 min after drug administration, whereas after the capsules (pentobarbital, hydromorphone and amphetamine) significant maximal changes occurred 120 min or longer after drug administration. Correlational analyses were performed to determine if performance and subjective changes varied as a function of pupillary change. Correlations between the change in pupil diameter and the changes in the subjective and performance measures (total of 176 correlations) were statistically significant in only 15 cases (7 at the high dose condition).

Nonetheless medications ending in zine buy 4.5mg rivastigimine free shipping, this does not preclude use of saliva in forensic testing for evidence of recent use medicine you can take while pregnant purchase 3mg rivastigimine mastercard. However medications zoloft 3mg rivastigimine free shipping, the immunoassay utilized in the analysis was targeted toward benzoylecgonine medicine 2410 effective 6mg rivastigimine, with poor cross-reactivity to the parent drug. According to the authors, the concentration of drugs in the ultrafiltrate was approximately 20% lower than in whole saliva. Kidwell22 analyzed the concentration of cocaine and opiate analogs in urine by immunoassay and in saliva by liquid chromatography/mass spectrometry and reported significantly lower concentrations in saliva samples. Use of saliva rather than urine for drug testing led to the detection of fewer drug users. The prolonged occurrence of cocaine in human saliva after multiple dosing and high drug exposure was reported by Cone and Weddington. The authors concluded that drug accumulated in the deep body compartments and was slowly released back into the circulation. Cocaine was found to be stable in unstimulated human saliva for as long as 4 days when refrigerated. Tetrahydrocannabinol is highly protein bound and does not readily pass from blood to saliva and in addition, inhibits salivary excretion. Tetrahydrocannabinol detection times in saliva are variable and range from 2 to 10 h. No detection limits were reported for the assay and the amount of metabolite present was not reported. Saliva concentrations of tetrahydrocannabinol generally vary over a wide range from 50 to 1000 ng/mL shortly after marijuana exposure. Thompson and Cone28 reported that tetrahydrocannabinol was detectable immediately after smoking in very high concentrations, followed by a rapid decline over the first hour. Thereafter, concentrations declined gradually and appeared to mimic plasma concentrations. The S/P ratio declined rapidly over the first 20 min followed by a gradual increase over the following 4 h. Correlations of saliva tetrahydrocannabinol concentrations with behavior and physiologic measures also have been reported. However, when individual saliva data were correlated with concurrent measures, the correlations were not significant, leading the authors to conclude that predictions of performance effects from a single tetrahydrocannabinol saliva test would be unreliable because of high inter-individual variability. They suggested that saliva tetrahydrocannabinol concentration is a more sensitive index of recent cannabis smoking than either urine or blood cannabinoid concentration. Saliva concentrations of morphine were poorly correlated with urine concentrations. Gorodetzky and Kullberg40 evaluated three different immunoassays for detection of morphine in plasma and saliva after heroin administration. They found that 5 and 10 mg doses of heroin could be detected with high probability for 2 to 4 h in plasma and 1 to 2 h in saliva. Following chronic dosing and utilizing a lower sensitivity immunoassay, Gorodetzky and Kullberg40 reported a high probability of detecting morphine in plasma for at least 6 h and in saliva for 3 to 4 h after the last morphine dose. Saliva drug concentrations were much higher than plasma concentrations for the first hour and continued to be elevated throughout the detection period as a result of contamination of the oral cavity from intranasal administration of drug. However, both saliva and plasma had substantially shorter detection periods (4 to 8 h) than urine (24 to 72 h). Contamination of the oral cavity during smoking was responsible for the high saliva/blood (S/B) ratios in the early period following drug administration. Since plasma and saliva drug detection times correspond more closely than urine to the time course of heroin-induced effects, saliva could add unique information in forensic investigations of cases concerned with drug-induced impairment. Cone and Jenkins44 noted a delay in the appearance of morphine in saliva following intramuscular morphine injections. Equilibrium between plasma and salivary morphine concentrations were not reached for approximately 45 minutes after dosing. Salivary morphine concentrations are reduced relative to plasma by approximately one-third, equivalent to the amount of plasma protein binding for morphine. After equilibration, saliva morphine concentrations declined in a parallel manner to plasma concentrations. Codeine has been detected in saliva following oral45 and intramuscular43 administration.

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Where a psychiatric disorder is seen to be of primary importance and driving the substance use medications during breastfeeding cheap rivastigimine amex, the psychiatric disorder should be the focus of treatment treatment plan for anxiety purchase rivastigimine 4.5 mg on line. However top medicine buy generic rivastigimine on-line, psychiatric disorder which initiated substance misuse or precipitated a relapse may be superseded by dependence driving the maintenance of substance use medicine to stop diarrhea discount rivastigimine 1.5mg otc. When undertaking a mental state examination, the doctor tries to balance benefits of pharmacotherapy against risk; risk is a function not only of the medication but also the treatment setting. In assessing risk, it is the ephemeral nature of psychological distress coexisting with substance misuse that is perhaps the most compelling reason to wait until a patient is drug free or stable before prescribing, and also a reason to consider hospital admission solely for the purpose of establishing a psychiatric diagnosis. With a focus on alcohol, Allan170 has recommended that patients presenting with anxiety and alcohol dependence should first be detoxified and reassessed after 6 weeks when only an expected 10% will be found to have persistent symptoms amounting to an anxiety state. The persistent anxiety can then be treated using conventional pharmacological or behavioral methods. She points out that patients may resist such an approach, preferring to deal with their psychological distress before tackling their substance use. People who are dependent on alcohol or other drugs usually succumb to a number of financial, family, health, and relationship problems and it is not surprising that many will complain of depression; again it is not surprising that 80% or more will recover within a few weeks of abstinence without recourse to anti-depressant treatment. Pharmacological anti-depressants should be avoided unless there is unequivocal evidence of a biological depression of mood. The key point is that diagnoses of mental illness and substance use comorbidity made in haste will often evaporate. Nonetheless, it may be that the severity of symptoms is so severe when a patient presents as to indicate immediate symptomatic prescribing without the benefit of a diagnosis. Equally it may be that a provisional diagnosis, for example alcoholic delirium or Wernicke encephalopathy, demands urgent treatment. The general principle to observe of "wait and see" can be a difficult one to follow and in addition to cases of obvious florid psychosis, there are times when urgent action (usually not pharmacotherapy) is required. For example, suicidal ideation is a common emergency for doctors specializing in addiction. Alcohol and other drugs are commonly found on toxicological screening of subjects who have committed suicide. Depressant drugs in particular are likely to impair judgement and, therefore, increase both the risk of any suicide attempt, but especially suicides involving violence or impulse, such as driving into a bridge or jumping in front of a train. Murphy172 has identified seven risk factors for suicide in "alcoholics": · · · · · · · depression suicidal thoughts poor social support physical illness unemployment living alone recent interpersonal loss the risks accumulate over a number of years, suggesting that there is scope for preventive social and health care. In short, people that misuse alcohol or other drugs are at increased risk of committing suicide: pharmacological treatment risks providing a means of suicide and active, social therapy is more likely to be effective. Other psychiatric conditions may be less urgent than a suicide threat, but none the less complex in terms of reaching prescribing decisions. Again the best course of action may be the delay in prescribing even though an established psychiatric condition has been recognized. Insomnia, which may result from psychological distress and may be a symptom of recreational drug use or may be part of a withdrawal syndrome, is ubiquitous and merits special mention. Short-acting hypnotics and alcohol are, in normal amounts, metabolized through the night causing rebound arousal and wakenings. Stradling174 has drawn attention to the insomniac effect of mild stimulants such as nicotine and caffeine: a cup of ground coffee contains approximately 85 mg of caffeine and 500 mg is approximately equivalent in arousal effect to 5 mg of amphetamine. On occasions a drug that will not have been misused, and to which the patient will not therefore be tolerant, such as chlorpromazine, can be helpful. In summary, for many people who suffer from psychiatric or psychological disorders, substance use and misuse has utility. It is particularly important for doctors to be clear about the purpose of their prescribing and to monitor its effectiveness. Where substance misuse and psychiatric disorder co-exist the case for not prescribing, even for psychiatric illness, should always be vigorously explored. Although doubts persist about the value of drugs-of-abuse screening as opposed to selfreporting by patients in drug rehabilitation programs,29, 176-177 it is well recognized that screening procedures provide much needed evidence about the prevalence of drug use. The most significant factor favoring urine is the concentration of the drugs, most of which are usually excreted in urine either as the parent drug, or a water soluble metabolite or conjugate. In common with most xenobiotics, drugs undergo metabolic conversions (usually in the liver) to form first a less active (occasionally, more active) metabolite which, in turn, is conjugated to a more water soluble product, thus making the drug itself more water soluble, and suitable for excretion in the urine.

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