Background: Many times, a ligature mark may be the only evidence available in cases of asphyxial deaths due either to hanging or strangulation. A thorough examination of the ligature mark and analysis of the information provided by it is, therefore, a must to confirm the death as due to hanging. Materials and Methods: A retrospective study was conducted at the Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, between 2011 and 2019 to assess the information provided by a ligature mark in such cases. Results: We found that deaths due to hanging constituted 7.1% of the total unnatural deaths subjected to medicolegal autopsy. Rope (34.93%) was the most common ligature material used. Majority of the victims preferred slip knots (53.61%), followed by fixed knots (46.38%). In most of the cases, the mark was obliquely placed (83.73%) and above the larynx (77.1%). Imprint over the groove when present corresponded with the ligature material used in all the cases. Conclusion: It was concluded that a thorough, scientific examination of the ligature mark, though not conclusive, is the most important part of the postmortem examination of deaths due to hanging.

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Background: COVID-19 is the third serious Coronavirus outbreak after severe acute respiratory syndrome (2002–2003) and Middle East respiratory syndrome (2012). There is an increasing need for a credible marker to triage patients and for telescoping the prognosis of COVID-19 more so in resource-constrained settings. COVID-19 patients were found to have a significant increase of C-reactive protein (CRP) levels (20–50 mg/L). Severe COVID-19 patients were noted to have up to 86% elevated CRP. 10-fold higher CRP was found in patients who died from COVID-19 than the recovered cases. Objectives: To demonstrate the association of CRP levels with COVID-19 infected patients and to assess the findings in accordance with different variables. Materials and Methods: Thirty-three nonconsecutive COVID-19 tested positive patients whose blood samples were sent for CRP testing were included for a retrospective study conducted between August 2020 and February 2021. Results: This study revealed elevation in CRP levels in patients belonging to severe cases (median = 46.71 mg/L) followed by moderate (median = 21.61 mg/L) and mild cases (median = 8.572 mg/L). Patients with comorbidities were noted to have higher median CRP (37.86 mg/L) compared to those without comorbidities (median = 20.3 mg/L). This study also detected increased CRP levels (median = 43.732 mg/L) in morbid cases compared to recovered cases (median = 20.3 mg/L). Conclusion: In a hospital with limited resources, this study successfully demonstrated the significant role of CRP in COVID-19 outcome elucidating the importance of CRP levels when used for triaging patients and monitoring disease progression.

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A medical student is expected to acquire multiple learning competencies during the course of his/her training period. The present review was carried out to explore the scope, merits, and challenges attributed to telesimulation in medical education, and devise a plan to successfully implement the same in medical college settings. An extensive search of all materials related to the topic was carried out on the PubMed search engine and a total of 33 articles were selected based on their suitability with the current review objectives. Keywords used in the search include telesimulation and medical education in the title alone only. Telesimulation has emerged as an innovative approach in the last couple of decades to strengthen and facilitate education, training, and assessment processes in the field of medicine. Similar to any method, even telesimulation has its own limitations that need to be addressed for enhancing the overall effectiveness and benefit to the medical students. Telesimulation plays an important role in facilitating the acquisition of knowledge, kinesthetic, and procedural skills through real-time training and via the inputs given during feedback or debriefing sessions. To conclude, telesimulation is a new domain in medical education, which has the potential to offer an ample number of opportunities in application and research. The need of the hour is to explore the effectiveness of telesimulation in training different topics and the learning objectives that can be covered and accordingly integrate the same for the benefit of medical students or other health professionals.

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Background: With the emergence of highly infectious epidemics/pandemics, such as Ebola virus diseases, severe acute respiratory syndrome, and coronavirus disease-2019 (COVID-19), doctors are at much greater risk of infection due to the exposure to the highly infectious bodily fluids and droplet nuclei. Hence, treating and caring for patients need the use of personal protective equipment (PPE) to reduce the transmission risk. Objectives: The present study was conducted to estimate the prevalence of skin injury and its type due to PPE usage, to find the association of related factors with the skin injuries among doctors. Materials and Methods: This descriptive cross-sectional study was conducted after obtaining the institutional ethical approval in dedicated COVID-19 hospital for a period of 4 months among 132 doctors wearing grades 2 and 3 PPE kit using a questionnaire collecting the details regarding baseline, duty, skin injury characterization. During analysis of data, an association between variables was significant for P < 0.05. Results: It was observed that 17.1% of doctors were wearing the PPE kit for 5 or more hours/and 13.0% of subjects reported absenteeism from duty hours due to PPE-induced skin injuries. 76.4% of subjects have suffered from skin injury after PPE usage. The most common symptoms/signs for the skin injury occurred was indentation and pain on back of ears (61.0%). Conclusion: The skin injuries of PPE among the doctors may result in reduced morale for overloaded work and made them anxious. Hence, an appropriate monitoring of these adverse effects should be done and effective preventive measures should be adopted.

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Background: For the overall development of medical professionals, the affective domain compromising attitude, communication, and ethics needs to be taught. Hence, the aim was to analyze the perception of the students regarding the ethics and communication module “How to deal with Death?” Materials and Methods: A study was conducted on 81 undergraduate students of the 9^th semester who attended the module. They were told to fill the questionnaire based on Likert scale regarding the module after the module was over. Later, the results were analyzed. Results: More than half of the respondents felt that role-play was the best method of teaching this module. This module had a positive impact on more than 90% of the students. More than 90% felt that empathy and compassion are required while dealing with death. Half of the students felt that empathy and compassion while dealing with death can be taught to medical students. More than 80% felt that this module helps them in developing patient-centered care. More than 75% felt that such modules help them to become good doctors. More than 95% of the students felt that medical students should know about euthanasia and end-of-life issues. Conclusion: Students feel that such a module on ethics and communication should be taught in their regular MBBS curriculum.

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Background: Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy. This can be due to direct causes or indirect unrelated causes. It is an important indicator of health-care services. Autopsy, which is an important tool of investigation, provides valuable input regarding the sequence of events leading to maternal death. Objectives: The objective of this study is to determine factors causing maternal deaths and to discuss the utility of medicolegal knowledge in ascertaining the causes of maternal deaths. Materials and Methods: This was a retrospective study where individual records of all maternal deaths brought for autopsy in the hospital mortuary during the past 10 years from January 2011 to December 2020 were studied. The cause of death and the factors which led to death in each individual case were analyzed. Results: A total of 15 maternal deaths were brought during the study period. Most maternal deaths (40%) occurred in the age group of 31-40 years. Maximum of the cases 11 of 15 were able to reach a health-care center before delivery. Direct causes accounted for 86.67% of maternal deaths. Hemorrhage and shock (38.46%) were the major direct cause of maternal deaths. The majority of the deaths occurred during the postnatal period (53.33%). Regarding the pregnancy outcome, 8 (53.33%) mothers were able to deliver live-born babies, of which 5 (62.5%) were delivered by lower segment cesarean sections and 3 (37.5%) by normal vaginal deliveries. Conclusion: There is scope for improvement as a large proportion of the observed deaths are preventable. Improving the rural health centers, upgrading the referral centers with round-the-clock functioning blood banks is the need of the hour.

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Patients with chronic myeloid leukemia (CML) usually present in the elderly age and rarely in the adolescents and young adults (AYA) groups. In this case report, we describe a case of a 28-year-old male who presented to the hospital with priapism and pain abdomen along with a positive history of coronavirus disease 2019 (COVID-19) disease. The patient was diagnosed as CML based on his peripheral blood smear and bone marrow aspiration findings. These findings were confirmed by fluorescence in situ hybridization (FISH) which showed the presence of breakpoint cluster region/ABL1 fusion gene. The patient was treated with tyrosine kinase inhibitor along with surgical shunt for priapism which showed clinical improvement. There is a very limited understanding of disease management and survival outcomes in this group of patients; therefore, the aim of this case report is to understand the association of COVID-19 infection in patients of AYA group suffering from CML.

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During the phase of medical training, patients are considered as the best teachers and it is strongly believed that exposure to patients helps medical students in both learning and practicing medicine. Nevertheless, the changing health dynamics has significantly affected the availability of patients in hospitals. This has led to the introduction of simulated patients in the delivery of medical education, initially for facilitating the acquisition of clinical skills and subsequently for the sake of assessment, including giving feedback to the learners. Any medical college, which is planning to initiate such curricular reforms within their setup, has to be aware of the standard practices to be adopted for recruitment, screening, and retention. In conclusion, the use of simulated patients in teaching and assessment in medical training has immense potential to improve the skills of medical students. It is the need of the hour for every medical college to explore their dynamics and then plan for the introduction of simulated patients within their setup and thereby improve multiple skills of future doctors.

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