Introduction: Motorcycle related accidents account for nearly 40% of total road traffic accidents (RTA) reported in Sri Lanka annually. The objective of this study was to investigate the characteristics of motorcycle accidents and to describe and compare injury patterns of the riders and pillion riders who are admitted to the Teaching Hospital Karapitiya, Materials and Methods: A cross-sectional retrospective study was conducted retrospectively on motorcycle occupants admitted from 1st January 2010 to 31st December 2014. Results: The total number of motorcycle occupants was 812 with a male to female ratio of 5.9:1. Out of that 68% were riders and the highest percentage of (39.8%) of the victims were belonging to the age group of 21-30 years. Sixty-seven percent (n=540) of the accidents were reported during the period of 06.00 hours to 18.00 hours. For both the rider (75%) and the pillion rider (56%), lower extremity was the commonest site of injury. Forty percent of the population had lower limb fractures and 15% had upper limb fractures. The commonest bone to fracture was Tibia (12%). Fifty-four percent of the riders and 52% of the pillion riders had grievous injuries. Conclusion: The young adult males in their productive age group are the most vulnerable group. Injuries to extremities and the head and face are the frequent sites of injury. Both the riders and the pillion riders were found to have similar injury patterns and risk factors. A slightly higher risk for more severe injuries is present for riders. In order to reduce the number of accidents as well as to reduce the severity of injuries, strict enforcement of traffic laws, administration of new guidelines on protective gear and monitoring blood alcohol concentrations of all the motorcyclists admitted to hospitals following accidents are recommended.
{"title":"Characteristics and Factors Associated with Injuries Sustained by Motorcycle Occupants Admitted to Teaching Hospital, Karapitiya, Sri Lanka from 2010 to 2014","authors":"Rathnaweera Rhai, Gunarathna Egun","doi":"10.4038/mljsl.v8i2.7420","DOIUrl":"https://doi.org/10.4038/mljsl.v8i2.7420","url":null,"abstract":"Introduction: Motorcycle related accidents account for nearly 40% of total road traffic accidents (RTA) reported in Sri Lanka annually. The objective of this study was to investigate the characteristics of motorcycle accidents and to describe and compare injury patterns of the riders and pillion riders who are admitted to the Teaching Hospital Karapitiya, Materials and Methods: A cross-sectional retrospective study was conducted retrospectively on motorcycle occupants admitted from 1st January 2010 to 31st December 2014. Results: The total number of motorcycle occupants was 812 with a male to female ratio of 5.9:1. Out of that 68% were riders and the highest percentage of (39.8%) of the victims were belonging to the age group of 21-30 years. Sixty-seven percent (n=540) of the accidents were reported during the period of 06.00 hours to 18.00 hours. For both the rider (75%) and the pillion rider (56%), lower extremity was the commonest site of injury. Forty percent of the population had lower limb fractures and 15% had upper limb fractures. The commonest bone to fracture was Tibia (12%). Fifty-four percent of the riders and 52% of the pillion riders had grievous injuries. Conclusion: The young adult males in their productive age group are the most vulnerable group. Injuries to extremities and the head and face are the frequent sites of injury. Both the riders and the pillion riders were found to have similar injury patterns and risk factors. A slightly higher risk for more severe injuries is present for riders. In order to reduce the number of accidents as well as to reduce the severity of injuries, strict enforcement of traffic laws, administration of new guidelines on protective gear and monitoring blood alcohol concentrations of all the motorcyclists admitted to hospitals following accidents are recommended.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"-1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132938152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Warushahennadi, A. Senavirathne, S. Godakandage, M. Pathirana, U. G. B. Jayarathne, S. Ambepitiya
Introduction: The peri-orbital contusion (PC) is a common injury in day to day surgical casualties. It is a common injury observed in patients who are in an unconscious state following head injuries. The aim of the study is to describe characteristics of PC and understand its relationship with associated injuries, especially with facial injuries and intracranial injuries. Methods: This retrospective study reviewed the medico-legal examination forms (MLEF) of 67 inward patients in Teaching Hospital, Karapitiya and District General Hospital, Matara with peri-orbital contusions following trauma during a period of six months from January 2020 to June 2020. Results: A total number of 67 patients were included with 81% being male patients. The commonest soft tissue injuries around the PCs were abrasions (n=39, 71%) and 25 (38%) of the study sample had fractures of the skull. The majority (n=22, 88%) of them had fractures of facial bones followed by vault and basal skull fractures. The majority of PCs (45%) were blue in colour and only 8% were red. The red colour was observed only in PCs of less than 24 hours. The main cause for PC was due to direct blow to the eye while the rest (n=29, 45%) were due to the indirect blow. A higher incidence of fracture of the head was observed in assaults (39%). Conclusions: The commonest cause for the black eye in the study sample was the direct blow with a blunt force in an assault. The red colour was observed in PC of less than 24 hours duration. The PC had not caused major injuries to the eye but there was frequent involvement of facial bone fractures.
{"title":"Causes and Characteristics of Peri-Orbital Contusions and Their Relationship with Intracranial Injuries in Inward Patients in Two Tertiary Care Hospitals in Sri Lanka","authors":"J. Warushahennadi, A. Senavirathne, S. Godakandage, M. Pathirana, U. G. B. Jayarathne, S. Ambepitiya","doi":"10.4038/mljsl.v8i2.7421","DOIUrl":"https://doi.org/10.4038/mljsl.v8i2.7421","url":null,"abstract":"Introduction: The peri-orbital contusion (PC) is a common injury in day to day surgical casualties. It is a common injury observed in patients who are in an unconscious state following head injuries. The aim of the study is to describe characteristics of PC and understand its relationship with associated injuries, especially with facial injuries and intracranial injuries. Methods: This retrospective study reviewed the medico-legal examination forms (MLEF) of 67 inward patients in Teaching Hospital, Karapitiya and District General Hospital, Matara with peri-orbital contusions following trauma during a period of six months from January 2020 to June 2020. Results: A total number of 67 patients were included with 81% being male patients. The commonest soft tissue injuries around the PCs were abrasions (n=39, 71%) and 25 (38%) of the study sample had fractures of the skull. The majority (n=22, 88%) of them had fractures of facial bones followed by vault and basal skull fractures. The majority of PCs (45%) were blue in colour and only 8% were red. The red colour was observed only in PCs of less than 24 hours. The main cause for PC was due to direct blow to the eye while the rest (n=29, 45%) were due to the indirect blow. A higher incidence of fracture of the head was observed in assaults (39%). Conclusions: The commonest cause for the black eye in the study sample was the direct blow with a blunt force in an assault. The red colour was observed in PC of less than 24 hours duration. The PC had not caused major injuries to the eye but there was frequent involvement of facial bone fractures.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121403279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Encephalitis in otherwise healthy and normal children causes many untimely deaths, giving rise to unexpected complications for physicians, forensic pathologists, and parents alike. Instead of resorting to extensive diagnostic options, aetiology can be identified in only around half of such cases. The case under discussion is a diagnosed case of viral encephalitis and the author attempts to discuss the multiple aspects surrounding the case. The victim was a previously healthy 9-year-old girl who presented with a three-day history of fever, vomiting, and altered consciousness with an episode of convulsion. No causative organism was identified while she was being treated. The histology revealed typical features of viral encephalitis along with other complications. The parental negligence could have been a contributory factor for her demise. Despite high fever with altered consciousness and convulsion, it had taken two days to diagnose her for having encephalitis upon admission. The forensic pathologist was inquired about the cause of her illness many times by the grieving parents. The parental grief was extensive in this case and the establishment of centres to deal with such encounters is suggested.
{"title":"A Case of Acute Viral Encephalitis: Important Aspects and Related Literature Review of Sri Lankan Studies","authors":"H. Ariyarathna","doi":"10.4038/mljsl.v8i2.7422","DOIUrl":"https://doi.org/10.4038/mljsl.v8i2.7422","url":null,"abstract":"Encephalitis in otherwise healthy and normal children causes many untimely deaths, giving rise to unexpected complications for physicians, forensic pathologists, and parents alike. Instead of resorting to extensive diagnostic options, aetiology can be identified in only around half of such cases. The case under discussion is a diagnosed case of viral encephalitis and the author attempts to discuss the multiple aspects surrounding the case. The victim was a previously healthy 9-year-old girl who presented with a three-day history of fever, vomiting, and altered consciousness with an episode of convulsion. No causative organism was identified while she was being treated. The histology revealed typical features of viral encephalitis along with other complications. The parental negligence could have been a contributory factor for her demise. Despite high fever with altered consciousness and convulsion, it had taken two days to diagnose her for having encephalitis upon admission. The forensic pathologist was inquired about the cause of her illness many times by the grieving parents. The parental grief was extensive in this case and the establishment of centres to deal with such encounters is suggested.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114668286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nanayakkara, A. Vadysinghe, Lakshika S. Nawarathna
Introduction: Intact long bones recovered amongst human skeletal remains, are ideal to reconstruct the stature of unidentified individuals by formulating regression equations. In many forensic situations, long bones are often encountered in different fragmentary states due to decomposition and mutilation. This necessitates the reconstruction of the length of long bone from its fragmentary portions. Method: Standard humeral measurements, the maximum length of the humerus, epicondylar breadth, vertical head diameter, transverse head diameter obtained from 96 humeri belonging to a contemporary Sri Lankan population were analyzed with the aim of generating regression equations to estimate the maximum length of the humerus from the measurements of its fragments. Results: All measurements obtained from those showed a positive correlation with the length of the humerus. The regression models formulated to estimate the maximum humeral length using single variables showed a moderate degree of correlation (0.518-0.669). The vertical diameter of head was the best single variable to predict (r = 0.669, SEE=15.55) the maximum length of the humerus. The multiple regression models formulated using different combinations of variables showed stronger correlations (0.669 to 0.716) with lower error estimates (SEE=14.79– 15.31). Conclusion: The results may contribute to the estimation of the length of the humerus from its fragments, providing valuable information for the purpose of identification of unknown human remains from contemporary Sri Lankan population.
{"title":"Reconstruction of the Length of the Humerus from its Fragments","authors":"Nanayakkara, A. Vadysinghe, Lakshika S. Nawarathna","doi":"10.4038/mljsl.v8i2.7419","DOIUrl":"https://doi.org/10.4038/mljsl.v8i2.7419","url":null,"abstract":"Introduction: Intact long bones recovered amongst human skeletal remains, are ideal to reconstruct the stature of unidentified individuals by formulating regression equations. In many forensic situations, long bones are often encountered in different fragmentary states due to decomposition and mutilation. This necessitates the reconstruction of the length of long bone from its fragmentary portions. Method: Standard humeral measurements, the maximum length of the humerus, epicondylar breadth, vertical head diameter, transverse head diameter obtained from 96 humeri belonging to a contemporary Sri Lankan population were analyzed with the aim of generating regression equations to estimate the maximum length of the humerus from the measurements of its fragments. Results: All measurements obtained from those showed a positive correlation with the length of the humerus. The regression models formulated to estimate the maximum humeral length using single variables showed a moderate degree of correlation (0.518-0.669). The vertical diameter of head was the best single variable to predict (r = 0.669, SEE=15.55) the maximum length of the humerus. The multiple regression models formulated using different combinations of variables showed stronger correlations (0.669 to 0.716) with lower error estimates (SEE=14.79– 15.31). Conclusion: The results may contribute to the estimation of the length of the humerus from its fragments, providing valuable information for the purpose of identification of unknown human remains from contemporary Sri Lankan population.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"267 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126435081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The presence of myocardial fat is not a finding that is infrequent during postmortem examinations. The case under discussion showed an extensive amount of fat, markedly on the right and mildly on the left ventricles. The differentiation of physiological fat from pathological entities is essential. In this case, two entities were initially suspected namely Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia and excessive physiological fat deposition of the heart. A 66-year-old averagely build, a mentally subnormal, previously healthy female was found dead after a nonspecific, mild, general ill-health. Trauma and the possibility of poisoning were excluded. The cause of death was concluded as coronary artery disease with further investigations. The incidental finding of an excessive amount of fat as seen in this case warrants explanations and future research in Sri Lanka.
{"title":"Myocardial Fat: Physiological or Pathological? A Case Report","authors":"H. Ariyarathna","doi":"10.4038/mljsl.v8i2.7423","DOIUrl":"https://doi.org/10.4038/mljsl.v8i2.7423","url":null,"abstract":"The presence of myocardial fat is not a finding that is infrequent during postmortem examinations. The case under discussion showed an extensive amount of fat, markedly on the right and mildly on the left ventricles. The differentiation of physiological fat from pathological entities is essential. In this case, two entities were initially suspected namely Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia and excessive physiological fat deposition of the heart. A 66-year-old averagely build, a mentally subnormal, previously healthy female was found dead after a nonspecific, mild, general ill-health. Trauma and the possibility of poisoning were excluded. The cause of death was concluded as coronary artery disease with further investigations. The incidental finding of an excessive amount of fat as seen in this case warrants explanations and future research in Sri Lanka.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130514791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Sanjeewa, M. Vidanapathirana, U. Attygalle, R. Amararatne, D. Senasinghe
Introduction: Histopathology examination is a common and recommended practice among all types of autopsy practitioners; there are few scientific outlooks guidelines or protocols about the number of samples that need to be obtained at autopsy for the histopathology examination. The aim of this study was to evaluate the value of taking multiple samples from the same kidney at autopsy examination. Methodology: A cross-sectional descriptive prospective study was carried out among 108 post mortem reports and histopathology samples at the department of forensic medicine of Base Hospital Panadura and District General Hospital Kalutara and Kegalle. All autopsies with available microscopic samples of kidney irrespective of the cause of death were used for the study. The data collection process was carried out from November 2019 to February 2020 and the ethical clearance was obtained prior to the data collection. Results: Data from the 108 post mortem reports were obtained. The studied sample consists of 69% (n=74) of males and 31% (n=34) females. With regard to the age distribution, the majority of 40% (n=43) cases belonged to the 51-70 age category. 69% (n=74) samples were collected from the left kidney while remaining 31% (n=34) from the right. Considering the macroscopic appearance of the kidney, cortical thickness reduction was noted among 34% (n=37) samples followed by granular contracted kidney of 31% (n=33). In the microscopic findings, the different numbers of pathologies were identified in both samples. However, the 1st sample had a higher frequency of histopathological findings than sample 2 and no significant difference in identification pathologies between 1st sample and 2nd samples were determined (p= 0.784>0.05.) Conclusion: Taking two samples from same kidney during the autopsy does not suggest statistical difference. However, where the resources are available it is suggested that taking two samples is beneficial.
{"title":"Evaluation of the Significance of Obtaining Two Histopathological Samples from the Same Kidney at Autopsy Examination","authors":"H. Sanjeewa, M. Vidanapathirana, U. Attygalle, R. Amararatne, D. Senasinghe","doi":"10.4038/mljsl.v8i1.7404","DOIUrl":"https://doi.org/10.4038/mljsl.v8i1.7404","url":null,"abstract":"Introduction: Histopathology examination is a common and recommended practice among all types of autopsy practitioners; there are few scientific outlooks guidelines or protocols about the number of samples that need to be obtained at autopsy for the histopathology examination. The aim of this study was to evaluate the value of taking multiple samples from the same kidney at autopsy examination. Methodology: A cross-sectional descriptive prospective study was carried out among 108 post mortem reports and histopathology samples at the department of forensic medicine of Base Hospital Panadura and District General Hospital Kalutara and Kegalle. All autopsies with available microscopic samples of kidney irrespective of the cause of death were used for the study. The data collection process was carried out from November 2019 to February 2020 and the ethical clearance was obtained prior to the data collection. Results: Data from the 108 post mortem reports were obtained. The studied sample consists of 69% (n=74) of males and 31% (n=34) females. With regard to the age distribution, the majority of 40% (n=43) cases belonged to the 51-70 age category. 69% (n=74) samples were collected from the left kidney while remaining 31% (n=34) from the right. Considering the macroscopic appearance of the kidney, cortical thickness reduction was noted among 34% (n=37) samples followed by granular contracted kidney of 31% (n=33). In the microscopic findings, the different numbers of pathologies were identified in both samples. However, the 1st sample had a higher frequency of histopathological findings than sample 2 and no significant difference in identification pathologies between 1st sample and 2nd samples were determined (p= 0.784>0.05.) Conclusion: Taking two samples from same kidney during the autopsy does not suggest statistical difference. However, where the resources are available it is suggested that taking two samples is beneficial.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128529209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Priyanath, L. Dharmadasa, R. L. S. K. D. Silva, M. Gunathilaka, E. H. H. G. Nanayakkara, M. Shakoor, S. Samarawickrama, I. Kitulwatte, P. Edirisinghe
Introduction: Details mentioned in Bed head ticket (BHT) and investigations are taken into consideration when an opinion is made with regards to the medico legally significant trauma. Shortfalls of documents can lead to misdiagnosis or wrongful diagnosis. This study was conducted to find out the adequacy of records on BHTs and availability of investigations on patients who had been admitted following trauma with medico legal significance. Methods: A prospective descriptive study was carried out on patents who were admitted following medico-legally significant trauma during a period of one year, from Aug 2017 to Aug 2018 by perusing their records. The adequacy of the documentation was assessed according to a pre-prepared scale. Results: Analysis of on admission historical and preliminary details revealed that out of 1102 records, only 26% (n=286) had mentioned the time duration since the incident. Recorded cardiovascular stability on admission was above 86% (n=950) though level of consciousness was not mentioned by 19% (n=211). Nature of the injuries were correctly recorded by 65% (n=720) while the location of them were correctly recorded only by 29% (n=316). Surgical procedures were adequately mentioned only among 39% (n=425). Conclusions: The study revealed that there are gross inadequacies with regard to the records on BHTs made by the doctors. This can lead to limitations in addressing medico-legal issues and sometimes can result in wrong opinions leading to injustice. Need for continuous professional training with special attention to record keeping is highlighted. Further, the quality of records can be further improved with regular audits, continuous professional developmental activities and introducing a common format for documentation in admission, surgical procedures and investigations.
{"title":"Adequacy and Relevance of Medical Records of Patients Admitted Following Medico-Legally Significant Trauma","authors":"D. Priyanath, L. Dharmadasa, R. L. S. K. D. Silva, M. Gunathilaka, E. H. H. G. Nanayakkara, M. Shakoor, S. Samarawickrama, I. Kitulwatte, P. Edirisinghe","doi":"10.4038/mljsl.v8i1.7397","DOIUrl":"https://doi.org/10.4038/mljsl.v8i1.7397","url":null,"abstract":"Introduction: Details mentioned in Bed head ticket (BHT) and investigations are taken into consideration when an opinion is made with regards to the medico legally significant trauma. Shortfalls of documents can lead to misdiagnosis or wrongful diagnosis. This study was conducted to find out the adequacy of records on BHTs and availability of investigations on patients who had been admitted following trauma with medico legal significance. Methods: A prospective descriptive study was carried out on patents who were admitted following medico-legally significant trauma during a period of one year, from Aug 2017 to Aug 2018 by perusing their records. The adequacy of the documentation was assessed according to a pre-prepared scale. Results: Analysis of on admission historical and preliminary details revealed that out of 1102 records, only 26% (n=286) had mentioned the time duration since the incident. Recorded cardiovascular stability on admission was above 86% (n=950) though level of consciousness was not mentioned by 19% (n=211). Nature of the injuries were correctly recorded by 65% (n=720) while the location of them were correctly recorded only by 29% (n=316). Surgical procedures were adequately mentioned only among 39% (n=425). Conclusions: The study revealed that there are gross inadequacies with regard to the records on BHTs made by the doctors. This can lead to limitations in addressing medico-legal issues and sometimes can result in wrong opinions leading to injustice. Need for continuous professional training with special attention to record keeping is highlighted. Further, the quality of records can be further improved with regular audits, continuous professional developmental activities and introducing a common format for documentation in admission, surgical procedures and investigations.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116096262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aortic dissection (AoD) is a very rare but potentially fatal entity during pregnancy. The incidence of acute aortic dissection during pregnancy is about 0.4 cases per 100 000 persons yearly. A 28-year-old 38-week primi was referred to the hospital following sudden onset of burning epigastric pain which developed while returning from the routine visit to the cardiologist. She was treated for gastritis in the ward and a few hours later she developed shortness of breath, tight chest pain and tachycardia. Emergency LSCS was done and a live baby was delivered and she had sudden cardiac arrest soon after the extubation, in spite of the intensive resuscitation measures including six units of blood transfusion. She was diagnosed with mild aortic regurgitation and trivial mitral regurgitation before the pregnancy and was referred to the cardiologist during the first trimester and was confirmed with low cardiac risk. She was seen by the cardiologist during all 3 trimesters and was concluded with low cardiac risk. The autopsy revealed 2750 ml of blood in the chest cavity and 750 ml of blood in the abdominal cavity. There was a collection of blood which was infiltrated into the mediastinal tissues around the aorta. There were macroscopic features of aortic dissection and the microscopy of the aorta revealed degeneration of tunica media, a through and through tear on intima with leakage of blood into the surrounding tissues. This case report illustrates that the pregnancy itself is a risk factor for the development of AoD which leads to the catastrophic disorder in pregnancy.
{"title":"Unpreventable Maternal Death In Spite Of the Advances in Antenatal Care; a Case Report","authors":"J. Warushahennadi","doi":"10.4038/mljsl.v7i2.7384","DOIUrl":"https://doi.org/10.4038/mljsl.v7i2.7384","url":null,"abstract":"Aortic dissection (AoD) is a very rare but potentially fatal entity during pregnancy. The incidence of acute aortic dissection during pregnancy is about 0.4 cases per 100 000 persons yearly. A 28-year-old 38-week primi was referred to the hospital following sudden onset of burning epigastric pain which developed while returning from the routine visit to the cardiologist. She was treated for gastritis in the ward and a few hours later she developed shortness of breath, tight chest pain and tachycardia. Emergency LSCS was done and a live baby was delivered and she had sudden cardiac arrest soon after the extubation, in spite of the intensive resuscitation measures including six units of blood transfusion. She was diagnosed with mild aortic regurgitation and trivial mitral regurgitation before the pregnancy and was referred to the cardiologist during the first trimester and was confirmed with low cardiac risk. She was seen by the cardiologist during all 3 trimesters and was concluded with low cardiac risk. The autopsy revealed 2750 ml of blood in the chest cavity and 750 ml of blood in the abdominal cavity. There was a collection of blood which was infiltrated into the mediastinal tissues around the aorta. There were macroscopic features of aortic dissection and the microscopy of the aorta revealed degeneration of tunica media, a through and through tear on intima with leakage of blood into the surrounding tissues. This case report illustrates that the pregnancy itself is a risk factor for the development of AoD which leads to the catastrophic disorder in pregnancy.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125525532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takayasu arteritis is a rare, large vessel disease. It commonly affects aorta and its main branches. The characteristic features are absent or diminished pulse, vascular bruits, hypertension, chest pain, retinopathy, and dyspnoea. Some studies have shown that there is an association between hypothyroidism and Takayasu arteritis. We report a death of a 56-year-old female with suggestive symptoms of Takayasu Arteritis. She was diagnosed to have diabetes mellitus and ischaemic heart disease for 10 years. Lately, she was suffering from upper and lower limb pain. Three days before she died she developed severe limb pain and swelling of the body including upper and lower limbs. She was admitted to the tertiary care hospital and died on the following day. The electrocardiography showed subtle ischemic changes. Laboratory investigations were performed due to body swelling which confirmed hypothyroidism. At autopsy, there were severe occlusions of the left subclavian artery and severe stenosis of all coronary arteries. Histological examinations were performed since these findings are commonly seen in Takayasu arteritis. However, microscopy of Haematoxylin and Eosin stains revealed the occlusions in the left subclavian artery as atherosclerotic. Cause of death was given as atherosclerotic heart disease.
{"title":"Death due to severe occlusion of the subclavian artery; a case report","authors":"Wijesinghe Arachchilage Chamila Lakmali, Solangarachchige Don Channa Perera, Mahesh Asanka Neththi Kumara, Samarahewa Thiwanka Piyumalie Chethiya, Nakandalage Dona Mayumi Radhika, Ranbanda Arachchi Dewayalage Heshani Gayesha Randunna","doi":"10.4038/MLJSL.V7I1.7393","DOIUrl":"https://doi.org/10.4038/MLJSL.V7I1.7393","url":null,"abstract":"Takayasu arteritis is a rare, large vessel disease. It commonly affects aorta and its main branches. The characteristic features are absent or diminished pulse, vascular bruits, hypertension, chest pain, retinopathy, and dyspnoea. Some studies have shown that there is an association between hypothyroidism and Takayasu arteritis. We report a death of a 56-year-old female with suggestive symptoms of Takayasu Arteritis. She was diagnosed to have diabetes mellitus and ischaemic heart disease for 10 years. Lately, she was suffering from upper and lower limb pain. Three days before she died she developed severe limb pain and swelling of the body including upper and lower limbs. She was admitted to the tertiary care hospital and died on the following day. The electrocardiography showed subtle ischemic changes. Laboratory investigations were performed due to body swelling which confirmed hypothyroidism. At autopsy, there were severe occlusions of the left subclavian artery and severe stenosis of all coronary arteries. Histological examinations were performed since these findings are commonly seen in Takayasu arteritis. However, microscopy of Haematoxylin and Eosin stains revealed the occlusions in the left subclavian artery as atherosclerotic. Cause of death was given as atherosclerotic heart disease.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126319202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Kodithuwakku, P. Nanayakkara, I. S. Pallemulle, T. Ranasinghe, P. Ranasinghe, S. Prathapan, S. Hulathduwa
Background: The importance of knowledge, attitude and practice of medical personnel in medico-legal aspect of healthcare has been raised with the development of health care system in Sri Lanka. Objective: To determine knowledge, attitude and current practices among interns in maintaining legally important medical records at selected hospitals of Colombo district. Methods: A descriptive cross-sectional study was conducted among IMOs of two teaching hospitals (TH1 and TH2) and a Base hospital (BH) in Colombo district, Sri Lanka. A self-administered questionnaire was used to assess the knowledge, attitude and current practice and marks were given and categorized as either poor (less than 50%) or good (more than and equal to 50%). The Study was carried out among all the 81 IMOs of the selected hospitals. Results: The BH had the highest percentage (69%) of IMOs with good knowledge whereas TH1 had 42% and TH2 had 47%. However, there were no statistically significant differences seen among the three hospitals (p= 0.238). Majority (82%) of all the IMOs had good attitudes and best attitudes were seen among the IMOs of TH2 (94%). Out of all the IMOs, 64% had good practice. Mean values related to knowledge were compared and the graduates from the 4thUniversity had the highest percentage in terms of knowledge (85%), attitude (82%), current practice (15%) and overall performance (47%) as well. Conclusions: There is good knowledge regarding legally important medical documents among IMOs with a good overall performance regarding legally important medical documents.
{"title":"Knowledge, attitudes and current practices of intern medical officers in Colombo District regarding legal importance of medical records","authors":"R. Kodithuwakku, P. Nanayakkara, I. S. Pallemulle, T. Ranasinghe, P. Ranasinghe, S. Prathapan, S. Hulathduwa","doi":"10.4038/MLJSL.V7I1.7387","DOIUrl":"https://doi.org/10.4038/MLJSL.V7I1.7387","url":null,"abstract":"Background: The importance of knowledge, attitude and practice of medical personnel in medico-legal aspect of healthcare has been raised with the development of health care system in Sri Lanka. Objective: To determine knowledge, attitude and current practices among interns in maintaining legally important medical records at selected hospitals of Colombo district. Methods: A descriptive cross-sectional study was conducted among IMOs of two teaching hospitals (TH1 and TH2) and a Base hospital (BH) in Colombo district, Sri Lanka. A self-administered questionnaire was used to assess the knowledge, attitude and current practice and marks were given and categorized as either poor (less than 50%) or good (more than and equal to 50%). The Study was carried out among all the 81 IMOs of the selected hospitals. Results: The BH had the highest percentage (69%) of IMOs with good knowledge whereas TH1 had 42% and TH2 had 47%. However, there were no statistically significant differences seen among the three hospitals (p= 0.238). Majority (82%) of all the IMOs had good attitudes and best attitudes were seen among the IMOs of TH2 (94%). Out of all the IMOs, 64% had good practice. Mean values related to knowledge were compared and the graduates from the 4thUniversity had the highest percentage in terms of knowledge (85%), attitude (82%), current practice (15%) and overall performance (47%) as well. Conclusions: There is good knowledge regarding legally important medical documents among IMOs with a good overall performance regarding legally important medical documents.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122032335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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