Introduction: Sexual abuse is an undesired sexual behavior by one person upon another. In Sri Lanka, all sexual abuse cases are expected to be examined by a medico-legal specialist before the court procedure. This study was conducted to identify the presentation, pattern, and prevalence of injuries among the sexual abuse victims presented to District General Hospital Gampaha. The findings of this study will help to improve the knowledge on different variables that can influence or affect the medico-legal opinion, and the management of victims including prevention. Methodology: A retrospective descriptive study was conducted using medico-legal records of all the cases with alleged sexual abuse reported to DGH Gampaha, during the 10 months from July 2018 to April 2019. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26 with descriptive statistics. Bivariate analysis and multiple logistic regression model used where necessary. Results: A total of 103 alleged sexual assault cases were assessed with 85% females, and remaining 15% were male victims. The median age of victims was 15years. Almost all the perpetrators were males and the mean age is 31 years. There was 92% probability of an abuser become a known person or a relative of the victim. Ten percent (10%) (n=10) of victims sustained non-genital injuries following a sexual assault with injuries in more than one site and 11 % (n=11) victims had genital injuries. About 40% (n=40) of victims gave a history of repeated abuse with no statistically significant difference among the genders (chi-square =2.6, p = 0.105>0.05). On multiple logistics regression, those who had a history of repeated abuse and who became pregnant following the abuse were significantly associated with the length of time to reporting (Exp (B) = 3.082; 95% CI, 1.224 - 7.76; p-value = 0.017 Conclusion: Female sex, and less than 16 years of age, is the most vulnerable group. Early adolescents had comparatively higher genital injury prevalence. Also, the genital injury prevalence was almost four-fold among the victims that presented to the medicolegal examination within one week or less. All the victims, who had anal/perianal injuries, were less than 15-year-old males. History of repeated abuse and presence of pregnancy was significantly associated with the duration of time to report to the hospital. 13% of sexually assaulted unmarried females being presented with pregnancy, is an alarming finding and needs evaluation with further studies.
{"title":"A Retrospective Study on Presentation, Patterns, and the Prevalence of Injuries in Alleged Sexual Assault Cases, Presented to District General Hospital Gampaha from July 2018 to April 2019","authors":"B. Perera","doi":"10.4038/MLJSL.V9I1.7438","DOIUrl":"https://doi.org/10.4038/MLJSL.V9I1.7438","url":null,"abstract":"Introduction: Sexual abuse is an undesired sexual behavior by one person upon another. In Sri Lanka, all sexual abuse cases are expected to be examined by a medico-legal specialist before the court procedure. This study was conducted to identify the presentation, pattern, and prevalence of injuries among the sexual abuse victims presented to District General Hospital Gampaha. The findings of this study will help to improve the knowledge on different variables that can influence or affect the medico-legal opinion, and the management of victims including prevention. Methodology: A retrospective descriptive study was conducted using medico-legal records of all the cases with alleged sexual abuse reported to DGH Gampaha, during the 10 months from July 2018 to April 2019. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26 with descriptive statistics. Bivariate analysis and multiple logistic regression model used where necessary. Results: A total of 103 alleged sexual assault cases were assessed with 85% females, and remaining 15% were male victims. The median age of victims was 15years. Almost all the perpetrators were males and the mean age is 31 years. There was 92% probability of an abuser become a known person or a relative of the victim. Ten percent (10%) (n=10) of victims sustained non-genital injuries following a sexual assault with injuries in more than one site and 11 % (n=11) victims had genital injuries. About 40% (n=40) of victims gave a history of repeated abuse with no statistically significant difference among the genders (chi-square =2.6, p = 0.105>0.05). On multiple logistics regression, those who had a history of repeated abuse and who became pregnant following the abuse were significantly associated with the length of time to reporting (Exp (B) = 3.082; 95% CI, 1.224 - 7.76; p-value = 0.017 Conclusion: Female sex, and less than 16 years of age, is the most vulnerable group. Early adolescents had comparatively higher genital injury prevalence. Also, the genital injury prevalence was almost four-fold among the victims that presented to the medicolegal examination within one week or less. All the victims, who had anal/perianal injuries, were less than 15-year-old males. History of repeated abuse and presence of pregnancy was significantly associated with the duration of time to report to the hospital. 13% of sexually assaulted unmarried females being presented with pregnancy, is an alarming finding and needs evaluation with further studies.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128247078","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}
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}
Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of death related to epilepsy. There is no settled proposition among neurologists, neuropathologists and forensic pathologists as to the exact pathophysiology of SUDEP. Though there is renowned interest about this entity in the developed world, there is little awareness and interest about SUDEP in the developing world. In the developed countries there are established SUDEP awareness programmes run by the state and other scientific organizations. They help in increasing the awareness of this entity among the general public, ensuring safety and well-being of the diagnosed epileptic patients and updating the knowledge among the clinicians and other academics. It is the authors’ view that the judicial medical officers in Sri Lanka too owe a similar responsibility and obligation towards the clinicians and the general public regarding raising the awareness of SUDEP and establishing a clinico-pathologic correlation. Diagnosis of SUDEP is a challenge in forensic pathology. It needs careful exclusion of suicidal, homicidal and accidental circumstances as well as other possible natural causes. This warrants careful study of the scene, history from several sources, meticulous autopsy examination followed by routine and ancillary investigations. We present a case report of SUDEP highlighting some of the deficiencies in Sri Lanka including the absence of a protocol to ensure quality-assured minimal standards in the investigation of suspected SUDEP cases.
{"title":"Sudden Unexpected Death in Epilepsy: a Case Scenario to elaborate the need of awareness and a protocol for local setup","authors":"H. Ariyarathna, S. Hulathduwa","doi":"10.4038/mljsl.v8i1.7408","DOIUrl":"https://doi.org/10.4038/mljsl.v8i1.7408","url":null,"abstract":"Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of death related to epilepsy. There is no settled proposition among neurologists, neuropathologists and forensic pathologists as to the exact pathophysiology of SUDEP. Though there is renowned interest about this entity in the developed world, there is little awareness and interest about SUDEP in the developing world. In the developed countries there are established SUDEP awareness programmes run by the state and other scientific organizations. They help in increasing the awareness of this entity among the general public, ensuring safety and well-being of the diagnosed epileptic patients and updating the knowledge among the clinicians and other academics. It is the authors’ view that the judicial medical officers in Sri Lanka too owe a similar responsibility and obligation towards the clinicians and the general public regarding raising the awareness of SUDEP and establishing a clinico-pathologic correlation. Diagnosis of SUDEP is a challenge in forensic pathology. It needs careful exclusion of suicidal, homicidal and accidental circumstances as well as other possible natural causes. This warrants careful study of the scene, history from several sources, meticulous autopsy examination followed by routine and ancillary investigations. We present a case report of SUDEP highlighting some of the deficiencies in Sri Lanka including the absence of a protocol to ensure quality-assured minimal standards in the investigation of suspected SUDEP cases.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"1 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":"131249466","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}
Introduction: Road traffic accidents involving the pedestrian are very high. This study was conducted to identify the socio-demographic characteristics, injury patterns, risk factors of pedestrians collided with motor bicycles. Methodology: The pedestrians who get admitted to the Teaching Hospital Karapitiya following collision with motor bicycles were included. Results: Total numbers of 432 pedestrians were included. Majority (50%) were over 50 years. The commonest primary impact site was the legs (51%) and the commonest injury was the compound fractures (19%). The majority (34%) did not have visible primary impact injuries.65% had the primary impact injuries and those were placed 20cm to 30cm above the heel. Abrasion is the commonest injury present on other anatomical areas of the body. Vision and hearing problems are the risk factors of the pedestrians over the age of 70 years (29%).The pedestrians (56%) had collided with motor cycles while crossing the road. The majority of accidents (67%) had occurred during the afternoon. Conclusion: Elder pedestrians with vision and hearing problems collide with motor cycles. The common primary impact injury was found on the legs and often there were no visible injuries. The majority of the accidents occurred in the evenings while crossing the road.
{"title":"Injury Patterns of Pedestrians Collided with Motor Bicycles Admitted to Teaching Hospital Karapitiya","authors":"C. Mahanama, J. Warushahennadi, D. D. Silva","doi":"10.4038/mljsl.v7i2.7395","DOIUrl":"https://doi.org/10.4038/mljsl.v7i2.7395","url":null,"abstract":"Introduction: Road traffic accidents involving the pedestrian are very high. This study was conducted to identify the socio-demographic characteristics, injury patterns, risk factors of pedestrians collided with motor bicycles. Methodology: The pedestrians who get admitted to the Teaching Hospital Karapitiya following collision with motor bicycles were included. Results: Total numbers of 432 pedestrians were included. Majority (50%) were over 50 years. The commonest primary impact site was the legs (51%) and the commonest injury was the compound fractures (19%). The majority (34%) did not have visible primary impact injuries.65% had the primary impact injuries and those were placed 20cm to 30cm above the heel. Abrasion is the commonest injury present on other anatomical areas of the body. Vision and hearing problems are the risk factors of the pedestrians over the age of 70 years (29%).The pedestrians (56%) had collided with motor cycles while crossing the road. The majority of accidents (67%) had occurred during the afternoon. Conclusion: Elder pedestrians with vision and hearing problems collide with motor cycles. The common primary impact injury was found on the legs and often there were no visible injuries. The majority of the accidents occurred in the evenings while crossing the road.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"1 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":"128736337","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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