Sunday, January 26, 2020

Follicular Lymphoma Case Study

Follicular Lymphoma Case Study The clinical condition given was a 33 year old patient diagnosed with chemotherapy resistant advance follicular lymphoma. Lymphoma is a type of cancer of the lymphocytes, which belongs to the white blood cell family of the body.1 White blood cells circulate the body through an extensive network of lymphatic systems, illustrated in figure 1, which includes the bone marrows, spleen, thymus and the lymph nodes. Lymphoma is categorized into two, the Hodgkin lymphoma and the non-Hodgkin lymphoma (NHL). Follicular lymphoma belongs to the group of NHL that affects the B-cell lymphocytes, which plays a critical role in immune response by producing antibodies in human body. Under the view of a microscope, follicular lymphoma produces a nodule or follicular structure, as the name suggested. Microscopic image of follicular lymphoma can be seen in figure 2. Diagnosis Diagnosis requires a biopsy of a lymph node, involving the process of obtaining a small amount of tissue for testing in the laboratory.5, 6 However, biopsy alone will not be sufficient to diagnose the lymphoma. Other scans on the abdominal, chest, or pelvic areas by using techniques such as Computer Tomography Scan (CT-Scan), Positron Emission Tomography (PET-Scan), will aid diagnosis as well.7, 8 According to the National Comprehensive Cancer Network (NNCN) Guidelines, laboratory test which is inclusive of full blood count, uric acid level, serum calcium level, as well as liver function test are needed in order to confirm diagnosis.9 Follicular Lymphoma Stages and Classifications Staging is important in patient with follicular lymphoma as it divides patient into group and determines what kind of treatment is needed, or whether treatment is required. Generally, NHLs are divided into four stages, summarized in table 1 below. Follicular lymphomas categorized in stage II, III, and IV are termed as advanced follicular lymphoma, as the case of the patient in the scenario. 5, 6 Table 1: Stages of NHL in terms of regions involved. Stages Descriptions Stage I Only one of the lymph node is involved Stage II Two or more lymph nodes from the same side of diaphragm are involved Stage III Lymph nodes at both sides of the diaphragm are involved Stage IV Involves a number of lymph nodes, tissues or organs Furthermore, lymphomas can generally be described as Low Grade, Intermediate Grade, or High Grade, depending on the speed they grow, based on the Revised European-American Lymphoma (REAL) grading system1, 6. Generally, low grade lymphomas are slow growing, while high grade lymphomas are characterized by rapid growing tumor cell which requires aggressive treatment compared to low grade and intermediate grade lymphomas. Ironically, many High Grade lymphoma can be cured, while low grades lymphoma tends to reappear and contribute to relapses.6 Apart from the general lymphomas grading, follicular lymphomas have their own grading system, which are separated into three grades. According to the World Health Organization (WHO), the follicular lymphomas are categorized according to the number of centroblast (large follicular cell) present while the tumor was scanned by using the highest power of magnification on the microscope.1, 5, 6 The grades were summarized in table 2. Causes A research done by Bosga-Bouwer et al. over 30 patients indicates that genetic factors are the primary causes of follicular lymphomas. The research used southern blotting technique, polymerase chain reaction, and fluorescence in situ hybridization to confirm a translocation in the chromosome 14 and 18, which affects the bcl-2 proto-oncogene, and the main function of bcl-2 genes is to prevent apoptosis of B-cell lymphocytes.10 Overexpression of the bcl-2 gene results in prolonged survival rate of the cell due to the prevention of programmed cell death.1, 10 Signs and Symptoms Symptoms of follicular lymphoma include adenopathy, night sweats, weight loss, and fever. Adenopathy represents painless swelling in one the lymph nodes. Another important indicator includes elevated levels of Lactate Dehydrogenase (LDH), an enzyme that facilitates the conversion of pyruvate to lactate. 11 However, it is important to note that some of the patient lymphoma will be asymptomatic. Complications Follicular lymphoma will further complicate by increasing tumor bulk and threaten end-organ function. After a given period of time, it might transform into a more rapid growing lymphoma- the diffuse large B-cell lymphoma (DLBCL). In contrast, DLBCL is a much more aggressive form of NHL. According to a research done by Horning and Rosenberg, 25% to 60% of the patient will transform from follicular lymphoma into DLBCL12. A paper done by Lossos et al. suggested that the transformation to DLBCL includes multiple genetic mechanisms no single gene is responsible for the transformation13. Apart from that, another paper by Montoto from Cancer Research UK Medical Oncology Unit, demonstrates that the risk will be significantly higher (P-value = 0.02) if a patient was in an advanced stage of follicular lymphoma, which is the situation present in the case scenario14. It was also found that there are no statistically significant differences between the time of initiation of therapy and chances o f transforming from follicular lymphoma into DLBCL. If a patient with DLBCL is not treated accordingly, it is often fatal 5, 14. Furthermore, tumor of follicular lymphoma might relapse and further develop into chemotherapy resistant follicular lymphoma. Chemotherapy resistant lymphoma occurs when the lymphoma that has been responding to chemotherapy had begun to grow, resisting the effects of the therapy. The resistances are acquired through a number of mechanisms, namely genetic transformation of the B-cells. When this occurs, as seen in the case, the treatment option will be narrowed down, since chemotherapy is no longer an option.15 Incidence, Morbidity, and Mortality Rate Follicular lymphomas have an incidence rate of 2500 cases each year in the UK.16 It exhibits the second highest incidence rate among all the lymphomas, with the first being DLBCL. 17 It dominates 30% of all the NHL and it is the most common type of Low Grade NHL.1, 17 Prognosis Index is used to predict the treatment options and outcome of follicular lymphoma. A Follicular Lymphoma Prognosis Index, developed by Solal-Celigny, is currently being used internationally18. This prognosis index takes into account of 5 factors, which are age (>60 years), stages of follicular lymphoma (stage III IV), hemoglobin levels (low), numbers of lymph nodes/organs affected (>4), and levels of LDH (high) 17, 18. 91% of patient which suffers none of the abovementioned factors will live longer than 5 years. If the patient suffers from two or three of the factors in Follicular Lymphoma Prognosis Index, the rate of living longer than 5 years will drop to 78% and 43% respectively 18. In the UK, the median age of onset of follicular lymphoma was 60 years old, as compared to 67years old in the United States (US) 16, 19. In the US, according to the National Cancer Institute, rate of mortality was the highest among those from 75-84 years old, with a death rate of 33.7%. However, in those patient aged from 20-34 years old (case scenario patient aged 33years) mortality rate was only 1.6%. The average death rate of patient with NHL was 7.1 per 100,000 men and woman per year in the US19. Evidence Based Treatment Options of Follicular Lymphoma Follicular lymphoma can be considered incurable, but fortunately the growing tumors are sensitive to radiation and chemotherapy. Treatment options of lymphomas are highly based on severity of the symptoms and stages of lymphoma.5,20 If patient is asymptomatic, prescribers often employs a wait and watch approach, and according to studies, there is no difference in the survival rate between patients who were treated earlier and patients who were treated according to wait and watch method. 20 Treatments options are summarized in table 3. Treatment options Descriptions Radiotherapy Uses ionizing radiation to destroy cells Chemotherapy Uses drugs to stop or slow down the growth of cells Monoclonal antibody Uses proteins that targets rapid growing cells Radioimmunotherapy Radioactive isotopes combined with monoclonal antibodies Bone Marrow Transplant Transplantation of stem cells Radiotherapy One of the ways to treat follicular lymphoma is by performing radiotherapy, which is also called radiation therapy. It was preferably use in Stage I or Stage II of the lymphomas which are localized.20, 21 The mechanism of radiotherapy includes usage of ionizing radiation such as beta and gamma rays to destroy the tumor cells and impairs their growth, while the body removes them through a natural process. Currently, the method employed in treatment of lymphoma tumor is known as the external beam therapy. 20, 21, 22 External beam therapy is done from a machine outside the patient, which is known and the linear accelerator. Radiation to body parts above the diaphragm is known as Mantle Field radiation, while radiation to parts below the diaphragm is known as Inverted Y-field radiation.22 A study by Aviles has shown that survival rate of a patient treated with radiotherapy for a 5 years period was 48%, and if used together with chemotherapy, the patients survival rate will be increased to 83%.23, 24 According to another research by MacManus, 40% of the radiotherapy patient remained disease free after 10 years. Chemotherapy Chemotherapy involves the usage of drugs to stop or slow down the growth of lymphoma B-cells, hence managing the lymphomas symptoms.5, 6 Chemotherapy drugs only target specific rapid-growing cells such as tumor cells, and impairs their ability to multiply and growth. 20 However, many cell lines in patients such as bone marrow, hair follicles, and the lining of the gastrointestinal tract are rapid-growing cells and therefore, it will be targeted by chemotherapy drugs as well, causing the side effects. Initial responses towards chemotherapy are usually high, and therefore, it is considered as the first line-treatment in treating NHL.20 Many protocols of chemotherapy combination were proposed, with the common ones being the CHOP and CVP. CHOP therapy includes the usage of four drugs- Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone while CVP therapy uses Cyclophospharmide, Vincristine, and Prednisone.5, 6, 20 A research by Fisher had concluded that CHOP should be used as first line treatment for advanced grade non-Hodgkin lymphoma, with a result of 44% survival rate in 1138 patient after a period of 3 years.26 However, a more recent study by Hiddemann suggested that the use of Rituximab, a monoclonal antibody, together with CHOP greatly improves the response rate of patient to 96% (P-value of 0.011), and reduce the chances of treatment failure by 60%. The study, which was done on 2005, proves that R-CHOP is the superior frontline treatment of choice for advanced follicular lymphoma compared to CHOP. According to the British National Formulary 57 (BNF 57), the usage of CHOP will produce side effects such as oral mucositis, hyperuricaemia and tumour lysis syndrome. Nausea and vomiting is also the common side effects of chemotherapy drugs, and it may lead to refusal of further treatment. Bone marrow suppression and alopecia are also of the core problems of chemotherapy drugs. Monoclonal Antibody Therapy Monoclonal antibody therapy works by using antibodies that sticks to the surface of specific groups of cells, such as cancer cells, and trigger the bodys natural immune system to destroy these cells. 5 The advantages of monoclonal antibody compared to chemotherapy is that they are more specific compared to chemotherapy. Rituximab is used to treat follicular lymphoma, due to the mechanism of action of binding to CD20 protein- the abundant protein on the surface of B-cell. Rituximab causes the death of the cell by the induction of apoptosis. 29 According to the BNF 57 and North London Cancer Guideline, Rituximab is used to treat stage III and IV follicular lymphoma, or in those patient that had a relapse after treatment of chemotherapy, or those that other treatment options are exhausted.16, 28 Nice guidelines recommends that Rituximab should be given as a third-line treatment, and should only be given as first line with combination of chemotherapy to patient with stage III and IV follicular lymphoma. A meta-analysis research by Vidal et al. reveals that when Rituximab was given as a maintenance therapy, it significantly improves overall survival rate and the relapse rate of patient, compared to patient that did not have Rituximab as maintenance therapy.29, 30 Another research by Hauprock and Hess indicates that Rituximab improves survival rate if given as relapse therapy and maintenance therapy.31 When given together with CHOP chemotherapy, it greatly improves the overall outcome of a patient. Adverse side effects of Rituximab appears to be infusion related side-effects, namely the cytokine release syndrome, which is characterized by fever, chills, nausea and vomiting, as well as tumor pain. Radioimmunotherapy Radioimmunotherapy consist of one radioactive isotope and a monoclonal antibody to assist specific cell targeting. The radioactive isotope which is attached to the antibody will release radiation once the antibody is bound to the specific cell type, hence killing the cells.21, 32 This method is considered to be a more advance therapy compared to chemotherapy and monoclonal antibody therapy. There are two drugs available now in radioimmunotherapy, namely Bexxar and Zevalin.32, 33 Zevalin consist of two radioactive isotopes called indium-111 and yttrium-90. The purpose of indium-111 in the drug is to enables physician to view the paths of the drug in the body, while yttrium-90 is the therapeutic portion of the drug. Zevalin is administered via the intravenous route together with Rituximab over a time of ten minutes, over a course of a week. The main side effect of Zevalin is lowered blood cell count, normally observed 4-6 weeks after the treatment. However, Zevalin is considered to be advantageous in terms of side-effects as it does not exhibits the normal side-effects of chemotherapy drugs, such as alopecia, nausea and vomiting. In a clinical trial involving patients with NHL, Zevalin manage to produce a response rate of 70-80%. Furthermore, in the same trial, Zevalin produces responses in patient who no longer respond to chemotherapy and Rituximab.32 A review by WitZig showed a response rate of 82% to Zevalin in patient with low grade NHL. The advantages of Zevalin Therapy are that it only uses a single dose of radiation and it is being well tolerated by the patient, which was proven in the study.34 In another randomized controlled trial done by WitZig and Gordon et al., Zevalin was proved to be more superior than Rituximab, with an overall response rate of 80% compared to 55% in treating follicular lymphoma. Apart from that, another immunotherapy drug called Bexxar, is a combination of Tositumomab and Iodine I 131 Tositumomab. Tositumomab is a monoclonal antibody targeting the CD20 protein in the B-cell Lymphoma, while Iodine I 131 Tositumomab is a radiolabeled derivative of the monoclonal antibody. Beta-radiation released by Iodine 131 is responsible for killing of the tumor cells. Bexxar is given in two different sets of intravenous infusion, two weeks apart.   Common side-effects of Bexxar include suppression of bone marrow, which is characterized by low blood counts. Bexxar might also cause hyperthyroidism and anti-murine antibody formations.   A research done by Kaminski et al. shows that Bexxar produces a very high response rate of 95% in 76 patients who enrolled in the study. 75% of the patient in the study still had a complete remission even after 5 years. This research of Bexxar rivals any kind of therapy previously used in treating follicular lymphoma, including chemotherapy, as Bexxar therapy will be completed in just one week, and proves to be more effective. Another study, by Jacene, comparing Bexxar and Zevalin, reveals that Bexxar will cause less bone marrow suppression compared to Zevalin, although both were generally well tolerated.   Treatment Recommendation for Patient in Case Scenario According to the patient in the case scenario given, he is currently 33 years-old and he developed chemotherapy resistant advanced follicular lymphoma recently. Advanced follicular lymphoma indicates that his condition is in either stage III or IV, involving lymph node on both sides of the diaphragm and/or organs. In this case, since the follicular lymphoma developed resistance, chemotherapy is no longer an option. According to the BNF and the NICE guideline, Rituximab monotherapy could be given to patients who have relapsed stage III or IV follicular lymphoma, which developed resistance to chemotherapy. 28, 29 It is recommended that the patient takes 375mg/m2 of Rituximab over a period of 21 days, according to the instructions in NICE guideline. The patient has to be on it for 8 cycles which is approximately 6 months.   Rituximab was proved to induce better response and improve overall survival rate in follicular lymphoma patient according to the meta-analysis of randomized trial performed by Vidal et al. and another study done by Hauptrock and Hess (mentioned above in treatment). Another study by Monila further supports the usage of Rituximab as it increase both response rate and survival rate as well as improving the long-term prognosis of follicular lymphoma patient. All these evidence validates the treatment option of using Rituximab in the patient. The cost of Rituximab based on the evaluation of Assessment Group Model in the NICE guideline is approximately  £8500 per life year gained in patient younger than 60 years-old and  £9700 per life year gained in patient aging 60 years-old and above. It is considered cost effective based on the evaluation of the NICE guideline. If treatment using Rituximab proves to be unsuccessful, radioimmunotherapy drug Bexxar will be recommended. Although Bexxar is still considered a new drug, the clinical trials done by Kaminski shows a remission rate of 75%. Bexxar had also been evaluated in one of the study, which shows that 86% of the patient achieved a complete response in Stage III and IV follicular lymphoma. Conlusion In conclusion, patient with chemotherapy resistant advanced follicular lymphoma should be treated with Rituximab, followed by Bexxar and Zevalin. All in all, with the new advances in radioimmunotherapy, the joint effort of health care professionals and the utilizing of guidelines with evidence-based research, patient with the follicular lymphoma, although incurable, will still be able to lead a healthy and fruitful life.

Saturday, January 18, 2020

Misuse of Anti Dowry Law

Misuse of anty dowry laws in India- the other side of the coin. Synopsis: I] Introduction II] Justification of study. III] Scope of study. IV] Methodology adopted. V] Chapterisation. a)Meaning of dowry & its historical background in Indian society b) Consequences of dowry on society. c) Legal provisions about dowry. d) Misuse of anty dowry laws. e) Public opinion about antidowry laws VI] Conclusion. -: Introduction:- Normally Dowry is considered as the poison of the marital life, life taking thing in the name of traditional practice. Mostly media and newspaper daily colour the events of dowry deaths and cruelty against wife for obtaining maximum TRP for their channels and newspaper and as the press and media are the fourth pillar of democracy engrave the negative impact about the male members of the society. Every death after marriage is unfortunately to be considered by the society as the dowry death and cruelty by the families of the husband. No doubt there are many laws are there in various Acts made by the legislature for the protection of the women against dowry and cruelty from the husband and his family members. But, does the legal machinery analyse if the anti dowry laws made by the Indian parliament are being misused by the wives to extort money from the families of their husband or not? Hence one must also have to look at the other side of the coin also. II]-: Justification of study:- Every Law enacted by the parliament is the sword of both edged. It can help the society for eradicating the evils of the society also to remove the inhuman traditions prevailing in the society but it can be misused by the society to a greater extent. Hence the main reason for choosing this topic for research by the researcher is to study the social impact of anti dowry laws in Indian society and to trace are the anti dowry laws are being used in a positive way by the society in order to eradicate the evils or is being misused just only to extort money from the husband and his relatives & to harass them mentally. III] Scope :— The scope of this research will be limited to study the present impact of anti dowry laws enacted by the parliament on the society and to find out how far the anti dowry laws are used to eradicate the evils in the society or is being misused only to extort money from the husband and his relative and to put this issue before the NGO’s and all types of legal and non legal authorities for the purpose of prevention of anti dowry laws from its being misused. -:Methodology adopted:- There are two main kinds of methodologies which are used in research they are as follows: I. Doctrinal or traditional or non-empirical legal research. & II. Non doctrinal or empirical legal research. Doctrinal or traditional or non-empirical legal research:- A doctrinal research means a research that has been carried out on a legal proposition or propositions by the way of analyzing the existing statutory provision and cases by applying the reasoning power. According to S. N. Jain doctrinal research involves analysis of case law, arranging ordering and systematizing a legal prepositions and study of legal institutions through legal reasoning or rational deductions. Ascertaining a legal rule for the purpose of solving problem is one of the purposes of traditional legal research. This has been achieved by the original sources of law the acts of parliament and the acts passed by legislatures fall under this category of precedents. The secondary sources like text books on law, commentaries do not possess as much authority as the original sources possess. Hence, quality of doctrinal research depends upon the source material on which the researcher depends upon his study. The doctrinal research attempts to verify the hypothesis by a firsthand study of authoritative sources. A doctrinal researcher should know how to use a law library for the major portion of his research methodology concern with the identification of authoritative sources and use of techniques to find them out. Doctrinal research looks at the following issues:- 1)The aim of preferred values, 2)The problems posed by the gap between the policy goal and the present state of achievement, 3)Availability of alternative choice for the implementation of goals 4)The predictions and consequences that were made. Following are the characteristics of doctrinal research:- 1) The study is mainly based on propositions, ) The sources of data for a doctrinal, Researchers are the reports of appellate Courts and conventional legal theory. 3) It is concern with what the particular doctrine of law says and not as what made the authority to say so or what has been that impact of that say . II. Non doctrinal legal research or empirical legal research:- Conducting empirical research in law is of recent origin. E mpiric means relying solely on observation and experiment not on theory. The empirical research is carried out by collecting gathering data or information relating to universe by a firsthand study. The empirical research technique is also called as fact research. Explaining the scope of this technique, Arthur Nussabaum observed, by fact research in law we mean the systematic search Into the social, political and the other fact conditions which give rise to individual rules and examination of the social, political and other effects of these rules. Empirical research is an inquiry that attempts to discover and verify general rules allowing us to understand why human beings behave the way they do. The methods like observation,interview,questionnaire,survey and case study are used to discover the human conduct. All inquiries are not suitable to empirical methods. Any inquiry whose objective is to determine what is good and what is evil cannot be empirically tested. The reason for this is that the researcher cannot discover the admissible physical evidence. Research into the value system and moral questions are not amenable to empirical methods. The empirical research is mainly concern with the legal decision process, i. e. researcher’s attention is on variables that influence the decision and the impact of decisions on the society. The empirical decision may be defined as research into relationship of law and other behavioral sciences. here,more importance is given to people,social values andsocial institutions and not to the legal aspects or doctrines. Usually a researcher undertakes some aspects of legal decisions and his more numerical and needed data won’t be available in the library, hence field work has to be done. In American universities, legal researchers have originally employed the empirical research methods in their pre-legislative inquiry. Following are the characteristics of non-doctrinal research:- ) It tries to find out the impact of no –legal events upon the legal decision process. 2) It seeks to identify and appraise the degree of variables which influence the outcome and legal decision-making. 3) It tries to find out the effect the effect of each decision on people and society as such. The field of empirical research is wider and the availability sources are very less which invo lve several new techniques which are known to research. For the purpose of research on this topic the researcher is using here Doctrinal or traditional or non-empirical legal research. :Chapterisation:- a)Meaning of dowry & its historical background in Indian society The beginning of 19th century plays an important role in degrading Indian women till its depth. The fear of insecurity not only envisaged in unmarried young women but also married women. In India, â€Å"family† has always been prime importance. Marriage being an important social institution since Vedic period was biased against women. It was regarded as the social alliance between two families instead of two persons. The bride was expected to serve her husband and his family and ensure their happiness and well being. There was no question of her happiness, expectation or content. There were three main objectives of Hindu marriage: dharma or religious duties to be performed by the couple, proja or procreation, and rati or conjugal love. 1 The exploitation of woman began with the child marriage. A girl too young to take life seriously, a girl too young to understand the meaning of ‘life’ and ‘marriage’, had to step into the world of thorns. She was subjudicated by her mother-in-law and other members of her husband’s family, most of the time including even her husband. She was expected to observe ‘purdah’, not to speak to elders, speak in low voice to younger members of family, not to speak or meet her husband except midnight and bear all harsh words and sufferings for even minor fault and above all never to express her sorrows or utter a word of distress to anyone. A woman had no freedom, neither personal nor economic. Traditionally, the Hindu woman had distinct economic right called ‘stridhan’. 2 In order to partially set off the disability suffered under the notion of joint ownership by male members, the smritikars assigned a special category of property to women termed as ‘stridhana’. The first mention of this term is found in Gautama Dharma sutra. He provided not only for the women’s separate property but also distinct and separate rules for its succession. But the definition of ‘stridhana’ changed over from time to time, granting all the rights and power to husbands. Consent of the gi rl was not considered to be relevant and hence, she was left with no choice, except to accept all pains and marry. The traditional concept of marriage has greatly changed and Hindu marriage is considered to be of dual nature i. e. f both religious sacrament and contract, where mutual consent and benefit of both the parties are duly aided by different legal provisions and reforms. Attempts to bring about changes in the status of women either through legislation or judicial activism can achieve little success without a simultaneous movement to transform the social and economic structures and the culture (values, ideologies and attitudes) of society. 4 One of those attempts to bring changes in status of women and relieve her from her sufferings, pains and gloomy environment is given under chapter XX-A of Indian Penal Code, 1860. ) Consequences of dowry on society. c) Legal provisions about dowry. Following are some legal provisions about dowry- Chapter XX-A of Indian Penal Code, 1860, refers to ‘cruelty by husband or relatives of husband’ and includes section 498-A. Section 498-A states, that whoever being the husband or relative of the husband of woman, subjects such woman to cruelty shall be punished with the imprisonment for a term which may extend to three years and also be liable to fine. Explanation- For the purpose of this section, â€Å"cruelty† means- (a) Any wilful conduct which is of such nature as is likely to drive the woman to commit suicide or to cause grave injury or danger to life, limb or health (whether mental or physical) of the woman; or (b) Harassment of the woman where such harassment is with view to coercing her or any person related to her meet any unlawful demand for any person related to her to meet such demand. The section was enacted to combat the menace of dowry deaths. It was introduced in the code by the Criminal Law Amendment Act, 1983 (Act 46 of 1983). By the same Act section 113-A has been added to the Indian Evidence Act to raise presumption regarding abetment of suicide by married woman. The main objective of section 498-A of I. P. C is to protect a woman who is being harassed by her husband or relatives of husband. Section 113-A of Indian Evidence Act, reads as follows: Sec. 13-A, Presumption as to dowry death- When the question is whether a person has committed the dowry death of a woman and it is shown that soon before her death such woman has been subjected by such person to cruelty or harassment for, or in connection with, any demand for dowry, the Court shall presume that such person had caused the dowry death. Explanation- For the purpose of this section ‘dowry death’ shall have the same meaning as in section 304-B of the Indian Penal Code (45 of 1860). The object for which section 498A IPC was introduced is amply reflected in the Statement of Objects and Reasons while enacting Criminal Law (Second Amendment) Act No. 46 of 1983. As clearly stated therein the increase in number of dowry deaths is a matter of serious concern. The extent of the evil has been commented upon by the Joint Committee of the Houses to examine the work of the Dowry Prohibition Act, 1961. In some of cases, cruelty of the husband and the relatives of the husband which culminate in suicide by or murder of the helpless woman concerned, which constitute only a small fraction involving such cruelty. Therefore, it was proposed to amend IPC, the Code of Criminal Procedure,1973 (in short ‘the Cr. P. C’) and the Evidence Act suitably to deal effectively not only with cases of dowry deaths but also cases of cruelty to married women by the husband, in- law’s and relatives. The avowed object is to combat the menace of dowry death and cruelty. 5 The act of harassment would amount to cruelty for the purpose of this section. Drinking and late coming habits of the husband coupled with beating and demanding dowry have been taken to amount to cruelty within the meaning of this section, but this section has been held not to include a husband who merely drinks as a matter of routine and comes home late. 6 In a case before Supreme Court it was observed that this section has given a new dimension to the concept of cruelty for the purposes of matrimonial remedies and that the type of conduct described here would be relevant for proving cruelty. d) Misuse of anty dowry laws. e) Public opinion about anti dowry laws

Friday, January 10, 2020

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Thursday, January 2, 2020

Cómo se paga y costo de fianza migratoria en EE.UU.

Si un familiar o amigo es detenido por Inmigracià ³n es posible que el ICE o un juez fijen una fianza y pueda ser liberado mientras espera que se resuelva su caso. La fianza la puede pagar directamente un amigo o familiar del migrante detenido o, si nadie cercano tiene recursos econà ³micos para ello, se puede recurrir a una agencia autorizada. Pago de fianza por amigo o familiar del migrante detenido En estos casos, el amigo o familiar debe encontrase legalmente en Estados Unidos, prefirià ©ndose que sea ciudadano americano o un residente permanente legal. El pago debe hacerse por la totalidad de la cantidad fijada como fianza por el ICE o por el juez de corte migratoria. Se acepta pago en dinero en efectivo o con bonos del Tesoro de los Estados Unidos (bonds, notes). Para hacerse efectivo el pago es necesario cerrar previamente una cita por telà ©fono con la oficina local del ICE (appointment to pay the bond). El dà ­a de la cita acudir al lugar que se ha indicado y a la hora seà ±alada. Es muy importante que solo se presente un familiar o amigo del detenido que tenga estatus legal en Estados Unidos, ya que de encontrase en situacià ³n de indocumentado podrà ­a ser detenido. Ademà ¡s, debe llevar un I.D. và ¡lido, tipo licencia de manejar del estado en el que reside habitualmente, pasaporte estadounidense, tarjeta de residencia, etc. Asimismo, debe llevar la tarjeta original de su Nà ºmero del Seguro Social. No se admite llevar una copia de la misma. Finalmente, ante un oficial el amigo o familiar del migrante que deposita la fianza debe firmar los documentos I-305 - original del recibo de haber pagado la fianza- y el I-352 -copia del contrato de fianza. Estos documentos deben de guardarse porque serà ¡ necesario para recuperar la fianza cuando finalice el proceso en contra del migrante. ​Pago de fianza migratoria a travà ©s de una agencia autorizada En ocasiones es conveniente pagar a travà ©s de una agencia de fianzas migratorias, que se conocen en inglà ©s como bond agents. Por ejemplo, porque los familiares y amigos no tienen estatus legal o porque no tienen todo el dinero que piden de fianza para hacer frente a la misma. En estos casos puede decirse con carà ¡cter general que el familiar o amigo que solicita la colaboracià ³n de una agencia autorizada debe pagar entre el 15 y el 20 por ciento del total de la fianza en dinero en efectivo y garantizar el resto con un colateral, como puede ser con una propiedad, con la nà ³mina, el auto, etc. Es muy importante saber cuà ¡nto se tiene que pagar, cuà ¡l es el colateral y otras condiciones econà ³micas, como monto de tarifas no recuperables. Tambià ©n conviene tener en cuenta que los bond agents suelen cobrar como comisià ³n por sus servicios entre el 15% y el 20% del total de la fianza. Asimismo, algunos agentes exigen para pagar la fianza que una vez que son liberados los migrantes lleven unos grilletes de monitoreo electrà ³nico con un GPS incorporado para saber en todo momento dà ³nde se encuentra el migrante. Algunos agentes llegan a cobrar a los migrantes $420 por mes en concepto de arrendamiento por el grillete. Por estas razones es conveniente contactar con varias agencias y comparar las condiciones ofertadas por cada una de ellas y tener mucho cuidado con lo que se firma, particularmente si està ¡ en inglà ©s y no se entiende el compromiso que se adquiere.  ¿Cuà ¡l es el monto de la fianza de migracià ³n? El costo de la fianza depende de varios factores, entre ellos: la gravedad de la acusacià ³n contra la persona extranjerasu historial delictivosi tiene familiares en los Estados Unidossu estatus migratorioposibilidades de desaparecer y no presentarse en las audiencias en la Corte de Inmigracià ³n En là ­neas generales hay dos tipos de fianzas migratorias: las fianzas conocidas como departure bonds se fijan a partir de $500, dependiendo del caso.los deliver bonds tienen un monto que puede ir desde los $1.500 hasta los $10.000 o mà ¡s. Segà ºn datos de la Executive Office of Immigration Review, en el aà ±o fiscal 2019 el monto medio de las fianzas migratorias es de $8.000. Con los deliver bonds el migrante queda en libertad mientras sigue en trà ¡mite su proceso de deportacià ³n. Si falta a alguna cita en corte, pierde el derecho a la libertad y todo el dinero entregado en concepto de fianza. Con los departure bonds el migrante se ha comprometido a abandonar EE.UU. en un plazo determinado y pagando à ©l o ella por los gastos de esta salida. El migrante queda libre despuà ©s de pagar esta fianza para poder arreglar sus asuntos antes de salir del paà ­s. Si no cumple con el plazo establecido, el migrante pierde el dinero de la fianza.  ¿Cuà ¡nto se demora ICE en regresar el dinero de la fianza? Cuando el proceso que se sigue contra el migrante finaliza o cuando el migrante abandona EE.UU. se puede reclamar al gobierno que regrese el dinero depositado en concepto de deliver bond o departure bond. Segà ºn ICE, està ¡n regresando la fianza en el plazo de un mes a partir de la fecha en la que se reclama su devolucià ³n. Sin embargo, datos publicados por la Universidad de Stanford y la Universidad de California, Davis, muestran que frecuentemente la demora es mucho mayor y que, como consecuencia de ello, ICE tiene bajo su custodia $204 millones en finanzas. Ademà ¡s, 18.000 personas jamà ¡s han reclamado la devolucià ³n de la fianza. La complicacià ³n del trà ¡mite impide que muchos migrantes puedan hacerlo sin encontrar ayuda legal cualificada. Pago de fianzas migratorias La posibilidad de pagar fianza y su monto lo establece ICE o un juez de Inmigracià ³nEl pago de la fianza para liberar a un migrante de su detencià ³n puede ser realizada por un familiar o amigo con estatus legal o recurrir a los servicios de un agente de fianzas.Si se utilizan los servicios de un agente, comparar condiciones entre varios, particularmente cuà ¡nto tarde en depositar la fianza, porcentaje de su comisià ³n, tarifa no reembolsable, quà © pide de colateral y si exige que el migrante liberado utilice un grillete electrà ³nico.No es fà ¡cil el papeleo para reclamar a ICE que regrese el dinero de la fianza. Es muy comà ºn que se necesite recurrir a los servicios de un abogado o de una persona con conocimientos sobre este tipo de fianzas. Este es un artà ­culo informativo. No es asesorà ­a legal. Fuentes: Flynn, Meagan, ICE is holding $204 million in bond money, and some immigrants might never get it back The Washington Post. April, 26, 2019.https://www.washingtonpost.com/immigration/ice-is-holding-204-million-in-bond-money-and-some-immigrants-might-never-get-it-back/2019/04/26/dcaa69a0-5709-11e9-9136-f8e636f1f6df_story.html?utm_term.7a18f948b630