alok atreya - Academia.edu (original) (raw)

Papers by alok atreya

JNMA: Journal of the Nepal Medical Association, 2021

Introduction: The killing of an illegitimate newborn immediately or within 24 hours of birth is n... more Introduction: The killing of an illegitimate newborn immediately or within 24 hours of birth is neonaticide which differs from other forms of homicide in terms of diagnosis and motives. Neonaticide is a cognizable offense where mothers are usually the perpetrators. This case reports the autopsy findings of a smothered neonate at a secluded location in rural Nepal. The present case study also highlights the medicolegal implications in such cases.

Wilderness & Environmental Medicine, 2022

Medico-legal Journal, Jun 13, 2023

In Nepal, police inquests have several limitations. When they receive information about a death, ... more In Nepal, police inquests have several limitations. When they receive information about a death, the police visit the crime scene and write an inquest report. Then, they arrange for the body to be autopsied. However, most autopsies are performed by medical officers in government hospitals who lack specialised training in conducting autopsies. Although all Nepalese medical schools teach forensic medicine to undergraduate students and require them to witness some autopsies, most private institutions are not authorised to perform them. Autopsies performed without expertise can be subpar and, even when trained personnel are available, these facilities are inadequately equipped. In addition, there is a lack of sufficient manpower to provide expert medico-legal services. The Honourable Judges and District Attorneys of all district courts believe that the medico-legal reports prepared by the doctors are inappropriate, incomplete and inadequate for use as evidence in court. Moreover, the police are more concerned with establishing criminality than other aspects of medico-legal death investigation, such as autopsies. Therefore, the quality of medico-legal investigations, including death investigations, will not improve until government stakeholders recognise the importance of forensic medicine in the judiciary and for the resolution of crimes.

Medico-legal Journal, Jun 13, 2023

“Honour-killings” are the intentional execution of women who are perceived to have disrespected t... more “Honour-killings” are the intentional execution of women who are perceived to have disrespected their families; in Nepal this is frequently considered socially acceptable while the United Nations condemns them as arbitrary executions that violate the right to life. In Nepal, “honour-killing” is typically a caste-based hate crime which is not limited to women as there have been reports of male victims as well. The perpetrators are sentenced to life imprisonment for murder, with the perpetrator serving 25 years. Pride-killing is common in the animal kingdom, but there is no logic in killing a family member to maintain family pride in a civilised human society.

Medico-legal Journal, Jan 18, 2023

Mental disorders are stigmatised in Nepal. There are many instances where mentally ill people are... more Mental disorders are stigmatised in Nepal. There are many instances where mentally ill people are tormented by their family members and society and where patients with mental illness are shackled and kept under house arrest. Physical illness attracts early medical care, but not mental illness. There are no asylums for patients suffering from mental illness. The Nepalese government must prioritise it as a serious health issue and allocate more money and take steps to tackle the stigma and deficiencies associated with it.

Journal of Nepal Medical Association, Nov 2, 2022

Introduction: Road traffic injuries are preventable yet one of the most neglected public health i... more Introduction: Road traffic injuries are preventable yet one of the most neglected public health issues. Road traffic injuries not only impact the health of the victim but also cause financial burden to the entire family. This study aimed to find out the prevalence of road traffic injuries in patients visiting the Emergency Department in a tertiary care centre. Methods: A descriptive study was conducted among patients visiting the Emergency Department in a tertiary care centre from 1 January 2021 to 30 June 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: IRC-LMC 07-J/020). Demographic information of the patients, accident profile and type of intervention at the hospital, and outcome were studied. Point estimate and 95% Confidence Interval were calculated. Results: Among 8,765 patients visiting the emergency department, road traffic injuries were seen in 112 (1.28%) (1.04-1.52, 95% Confidence Interval). Conclusions: The prevalence of road traffic injuries was found to be similar to other studies conducted in similar settings.

Medico-legal Journal, Feb 2, 2022

The nose is a prominent facial structure which is too often overlooked by forensic medicine pract... more The nose is a prominent facial structure which is too often overlooked by forensic medicine practitioners. Studies that consider the role of the nose in forensic practice are scattered throughout scientific literature. We provide a brief review of these.

Journal of Lumbini Medical College, Dec 29, 2019

Introduction: In Nepal, morbidity and mortality from Hymenoptera stings is mainly from three comm... more Introduction: In Nepal, morbidity and mortality from Hymenoptera stings is mainly from three commonly encountered insects: hornets (local: aringal), wasps (local: barulo) and honey bees (local: mahuri). The present study documents the incidence of hymenoptera sting in Western Region of Nepal and explores the cause behind such unprovoked attack upon human subjects. Methods: This hospital-based study included all the patients with history of insect sting attending the Emergency Department of Manipal Teaching Hospital, Pokhara from May 2015 till November 2015. Results: Of total 16 cases during the study period three were brought dead cases. The alleged insect happened to be bee in two cases, hornet in two cases, and wasp in eight cases with a case of unidentified insect sting. Severe burning pain with swelling, redness and itching were the common presenting symptom in all the admitted patients (n=13). Conclusion: Agricultural activity during the day was the cause of most unprovoked stings followed by deliberate destruction of the insect hive. Immediate medical attention in the nearby health care facility to the victims might decrease mortality. The health care facility also needs to have surplus lifesaving medication to counteract the life-threatening anaphylaxis reactions from such stings.

Perspectives in Public Health, Sep 1, 2016

Medico-legal Journal, Mar 10, 2021

There is inadequate research and study into the use of garlic and other herbal medicine in clinic... more There is inadequate research and study into the use of garlic and other herbal medicine in clinical practice; accordingly, the general population should be cautious when using such complementary and herbal treatments. We report a case which highlights the potential complications following the application of garlic-related naturopathic remedies mostly on skin burns.

International journal of gynaecology and obstetrics, Nov 10, 2017

PubMed, Mar 7, 2023

Background: This systematic review collated the literature on the prevalence rate of different ty... more Background: This systematic review collated the literature on the prevalence rate of different types of intimate partner violence (IPV) during pregnancy in South Asia. Methods: Systematic literature searches were conducted in four major databases (Embase, Scopus, PubMed, PubMed Central) to identify relevant articles published from the inception of each database to May 2021, which reported data on the prevalence of intimate partner violence during pregnancy in South Asia. The Joanna Briggs Institute critical appraisal tool for prevalence studies was used to assess the risk of bias in individual studies. A random-effects model was used to calculate the pooled prevalence and corresponding 95% confidence interval due to significant between-study heterogeneity. Results: Thirty-seven studies were reviewed which showed an overall prevalence of IPV from South Asian countries was 23.4% (physical violence: 13.6%; sexual violence: 8.5%; emotional violence: 20.2%). Conclusions: There was a higher prevalence of intimate partner violence during pregnancy reported, with an overall prevalence ranging from 1.7% to 66.4% across studies. Emotional violence was more prevalent form when compared to sexual or physical violence.

Medico-legal Journal, Feb 8, 2023

Air guns used for plinking are weapons with a short range and low velocity. Because of their low ... more Air guns used for plinking are weapons with a short range and low velocity. Because of their low velocity, the ammunition usually enters the body without causing any immediate life-threatening complications. Lead toxicity is a potential side effect of a pellet lodged in the body. However, there are cases where blood lead level was below the reference value even after decades of an air gun pellet remaining in the body. We report a case of 40-year-old man whose X-ray of the skull revealed a metallic foreign body that appeared to be an air gun pellet in the maxillary sinus. The patient recalled receiving a gunshot wound to his left cheek ten years ago. The wound healed, the pain subsided, and the patient was symptom-free, so he did not seek medical attention. The present case study illustrates the incidental finding of impacted foreign body and its medico-legal aspects in the Nepalese context.

PubMed, Jul 1, 2018

Although maggots are unanonymously linked to carcass or dead tissues, there are reports of its in... more Although maggots are unanonymously linked to carcass or dead tissues, there are reports of its infestation into living tissues as well. Myiasis denotes maggot infestation in living tissue. There are two forms of myiasis namely obligate and facultative. Obligate myiasis denotes maggots feeding on living tissue whereas facultative myiasis represents the opportunistic behaviour of the fly taking advantage of wound or necrotic tissue, laying by eggs which hatch into maggots. Decreased physical activity and poor hygiene leads to maggot infestation. Maggot invasion of living tissues is undesirable occurrence which can best be avoided by improving hygiene. People with low living standards in the developing nations are the occasional victims for maggot infestations. We present cases of obligate myiasis for their uniqueness and rarity.

Medico-legal Journal, Apr 24, 2023

Children who experience violence are more prone to develop high-risk behaviour, mental illness an... more Children who experience violence are more prone to develop high-risk behaviour, mental illness and anxiety disorder. Nepalese law is against any form of physical violence but corporal punishment by parents on children continues in patriarchal Nepalese society. We describe a case of a young boy who attempted suicide twice due to maltreatment and discuss the legal and social issues involved.

Medico-legal Journal, Oct 4, 2021

Palliative care, namely the relief of pain, is a priority for cases of incurable diseases in Nepa... more Palliative care, namely the relief of pain, is a priority for cases of incurable diseases in Nepal. However, since oral morphine is not available, pain control is often inadequate. Euthanasia is not permissible by law but could be a better solution in some cases and should be made understandable to patients and physicians as in developed countries. Should euthanasia be legal? If cheap and effective palliative care were easily accessible, most terminally ill Nepalese would avoid pressure to practise euthanasia because it is a cheaper option.

Wilderness & Environmental Medicine

JNMA: Journal of the Nepal Medical Association, 2021

Introduction: The killing of an illegitimate newborn immediately or within 24 hours of birth is n... more Introduction: The killing of an illegitimate newborn immediately or within 24 hours of birth is neonaticide which differs from other forms of homicide in terms of diagnosis and motives. Neonaticide is a cognizable offense where mothers are usually the perpetrators. This case reports the autopsy findings of a smothered neonate at a secluded location in rural Nepal. The present case study also highlights the medicolegal implications in such cases.

Wilderness & Environmental Medicine, 2022

Medico-legal Journal, Jun 13, 2023

In Nepal, police inquests have several limitations. When they receive information about a death, ... more In Nepal, police inquests have several limitations. When they receive information about a death, the police visit the crime scene and write an inquest report. Then, they arrange for the body to be autopsied. However, most autopsies are performed by medical officers in government hospitals who lack specialised training in conducting autopsies. Although all Nepalese medical schools teach forensic medicine to undergraduate students and require them to witness some autopsies, most private institutions are not authorised to perform them. Autopsies performed without expertise can be subpar and, even when trained personnel are available, these facilities are inadequately equipped. In addition, there is a lack of sufficient manpower to provide expert medico-legal services. The Honourable Judges and District Attorneys of all district courts believe that the medico-legal reports prepared by the doctors are inappropriate, incomplete and inadequate for use as evidence in court. Moreover, the police are more concerned with establishing criminality than other aspects of medico-legal death investigation, such as autopsies. Therefore, the quality of medico-legal investigations, including death investigations, will not improve until government stakeholders recognise the importance of forensic medicine in the judiciary and for the resolution of crimes.

Medico-legal Journal, Jun 13, 2023

“Honour-killings” are the intentional execution of women who are perceived to have disrespected t... more “Honour-killings” are the intentional execution of women who are perceived to have disrespected their families; in Nepal this is frequently considered socially acceptable while the United Nations condemns them as arbitrary executions that violate the right to life. In Nepal, “honour-killing” is typically a caste-based hate crime which is not limited to women as there have been reports of male victims as well. The perpetrators are sentenced to life imprisonment for murder, with the perpetrator serving 25 years. Pride-killing is common in the animal kingdom, but there is no logic in killing a family member to maintain family pride in a civilised human society.

Medico-legal Journal, Jan 18, 2023

Mental disorders are stigmatised in Nepal. There are many instances where mentally ill people are... more Mental disorders are stigmatised in Nepal. There are many instances where mentally ill people are tormented by their family members and society and where patients with mental illness are shackled and kept under house arrest. Physical illness attracts early medical care, but not mental illness. There are no asylums for patients suffering from mental illness. The Nepalese government must prioritise it as a serious health issue and allocate more money and take steps to tackle the stigma and deficiencies associated with it.

Journal of Nepal Medical Association, Nov 2, 2022

Introduction: Road traffic injuries are preventable yet one of the most neglected public health i... more Introduction: Road traffic injuries are preventable yet one of the most neglected public health issues. Road traffic injuries not only impact the health of the victim but also cause financial burden to the entire family. This study aimed to find out the prevalence of road traffic injuries in patients visiting the Emergency Department in a tertiary care centre. Methods: A descriptive study was conducted among patients visiting the Emergency Department in a tertiary care centre from 1 January 2021 to 30 June 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: IRC-LMC 07-J/020). Demographic information of the patients, accident profile and type of intervention at the hospital, and outcome were studied. Point estimate and 95% Confidence Interval were calculated. Results: Among 8,765 patients visiting the emergency department, road traffic injuries were seen in 112 (1.28%) (1.04-1.52, 95% Confidence Interval). Conclusions: The prevalence of road traffic injuries was found to be similar to other studies conducted in similar settings.

Medico-legal Journal, Feb 2, 2022

The nose is a prominent facial structure which is too often overlooked by forensic medicine pract... more The nose is a prominent facial structure which is too often overlooked by forensic medicine practitioners. Studies that consider the role of the nose in forensic practice are scattered throughout scientific literature. We provide a brief review of these.

Journal of Lumbini Medical College, Dec 29, 2019

Introduction: In Nepal, morbidity and mortality from Hymenoptera stings is mainly from three comm... more Introduction: In Nepal, morbidity and mortality from Hymenoptera stings is mainly from three commonly encountered insects: hornets (local: aringal), wasps (local: barulo) and honey bees (local: mahuri). The present study documents the incidence of hymenoptera sting in Western Region of Nepal and explores the cause behind such unprovoked attack upon human subjects. Methods: This hospital-based study included all the patients with history of insect sting attending the Emergency Department of Manipal Teaching Hospital, Pokhara from May 2015 till November 2015. Results: Of total 16 cases during the study period three were brought dead cases. The alleged insect happened to be bee in two cases, hornet in two cases, and wasp in eight cases with a case of unidentified insect sting. Severe burning pain with swelling, redness and itching were the common presenting symptom in all the admitted patients (n=13). Conclusion: Agricultural activity during the day was the cause of most unprovoked stings followed by deliberate destruction of the insect hive. Immediate medical attention in the nearby health care facility to the victims might decrease mortality. The health care facility also needs to have surplus lifesaving medication to counteract the life-threatening anaphylaxis reactions from such stings.

Perspectives in Public Health, Sep 1, 2016

Medico-legal Journal, Mar 10, 2021

There is inadequate research and study into the use of garlic and other herbal medicine in clinic... more There is inadequate research and study into the use of garlic and other herbal medicine in clinical practice; accordingly, the general population should be cautious when using such complementary and herbal treatments. We report a case which highlights the potential complications following the application of garlic-related naturopathic remedies mostly on skin burns.

International journal of gynaecology and obstetrics, Nov 10, 2017

PubMed, Mar 7, 2023

Background: This systematic review collated the literature on the prevalence rate of different ty... more Background: This systematic review collated the literature on the prevalence rate of different types of intimate partner violence (IPV) during pregnancy in South Asia. Methods: Systematic literature searches were conducted in four major databases (Embase, Scopus, PubMed, PubMed Central) to identify relevant articles published from the inception of each database to May 2021, which reported data on the prevalence of intimate partner violence during pregnancy in South Asia. The Joanna Briggs Institute critical appraisal tool for prevalence studies was used to assess the risk of bias in individual studies. A random-effects model was used to calculate the pooled prevalence and corresponding 95% confidence interval due to significant between-study heterogeneity. Results: Thirty-seven studies were reviewed which showed an overall prevalence of IPV from South Asian countries was 23.4% (physical violence: 13.6%; sexual violence: 8.5%; emotional violence: 20.2%). Conclusions: There was a higher prevalence of intimate partner violence during pregnancy reported, with an overall prevalence ranging from 1.7% to 66.4% across studies. Emotional violence was more prevalent form when compared to sexual or physical violence.

Medico-legal Journal, Feb 8, 2023

Air guns used for plinking are weapons with a short range and low velocity. Because of their low ... more Air guns used for plinking are weapons with a short range and low velocity. Because of their low velocity, the ammunition usually enters the body without causing any immediate life-threatening complications. Lead toxicity is a potential side effect of a pellet lodged in the body. However, there are cases where blood lead level was below the reference value even after decades of an air gun pellet remaining in the body. We report a case of 40-year-old man whose X-ray of the skull revealed a metallic foreign body that appeared to be an air gun pellet in the maxillary sinus. The patient recalled receiving a gunshot wound to his left cheek ten years ago. The wound healed, the pain subsided, and the patient was symptom-free, so he did not seek medical attention. The present case study illustrates the incidental finding of impacted foreign body and its medico-legal aspects in the Nepalese context.

PubMed, Jul 1, 2018

Although maggots are unanonymously linked to carcass or dead tissues, there are reports of its in... more Although maggots are unanonymously linked to carcass or dead tissues, there are reports of its infestation into living tissues as well. Myiasis denotes maggot infestation in living tissue. There are two forms of myiasis namely obligate and facultative. Obligate myiasis denotes maggots feeding on living tissue whereas facultative myiasis represents the opportunistic behaviour of the fly taking advantage of wound or necrotic tissue, laying by eggs which hatch into maggots. Decreased physical activity and poor hygiene leads to maggot infestation. Maggot invasion of living tissues is undesirable occurrence which can best be avoided by improving hygiene. People with low living standards in the developing nations are the occasional victims for maggot infestations. We present cases of obligate myiasis for their uniqueness and rarity.

Medico-legal Journal, Apr 24, 2023

Children who experience violence are more prone to develop high-risk behaviour, mental illness an... more Children who experience violence are more prone to develop high-risk behaviour, mental illness and anxiety disorder. Nepalese law is against any form of physical violence but corporal punishment by parents on children continues in patriarchal Nepalese society. We describe a case of a young boy who attempted suicide twice due to maltreatment and discuss the legal and social issues involved.

Medico-legal Journal, Oct 4, 2021

Palliative care, namely the relief of pain, is a priority for cases of incurable diseases in Nepa... more Palliative care, namely the relief of pain, is a priority for cases of incurable diseases in Nepal. However, since oral morphine is not available, pain control is often inadequate. Euthanasia is not permissible by law but could be a better solution in some cases and should be made understandable to patients and physicians as in developed countries. Should euthanasia be legal? If cheap and effective palliative care were easily accessible, most terminally ill Nepalese would avoid pressure to practise euthanasia because it is a cheaper option.

Wilderness & Environmental Medicine