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}
The following two cases are representative examples to prove that existing legal framework assists in the rehabilitation of the accused even though it is one of the standard yet ‘rather difficult to achieve’ type of objectives of penalty/punishment. New laws are implemented to fit the changing expectations of the society. Two such examples are the Prevention of Domestic Violence Act (No.34 of 2005) and Drug Dependent Persons (Treatment and Rehabilitation) Act (No. 54 of 2007). Unlike judicial medical officers who closely liaise with the judiciary, other clinicians are seldom aware of the rehabilitative strategies mandated by recent changes in law such as the two above mentioned acts. Case 01 is related to persistent domestic violence where the proper and timely implementation of law has resulted in the positive behavioural change of the male partner to the utmost benefit of the whole family. Case 02 refers to a young male who was severely addicted to heroin where compulsory rehabilitation imposed by the courts had changed him back to normal. The authors’ intension is to make the clinicians and relevant stakeholders aware of the existing legal provisions they can utilize as a part and parcel of their treatment and follow-up regimes.
{"title":"Are Laws of Domestic Violence and Rehabilitation of Substance Abusers Satisfactory in Sri Lanka? A Review with Cases","authors":"D. Ariyarathna, S. R. Hulatduwa","doi":"10.4038/mljsl.v7i2.7396","DOIUrl":"https://doi.org/10.4038/mljsl.v7i2.7396","url":null,"abstract":"The following two cases are representative examples to prove that existing legal framework assists in the rehabilitation of the accused even though it is one of the standard yet ‘rather difficult to achieve’ type of objectives of penalty/punishment. New laws are implemented to fit the changing expectations of the society. Two such examples are the Prevention of Domestic Violence Act (No.34 of 2005) and Drug Dependent Persons (Treatment and Rehabilitation) Act (No. 54 of 2007). Unlike judicial medical officers who closely liaise with the judiciary, other clinicians are seldom aware of the rehabilitative strategies mandated by recent changes in law such as the two above mentioned acts. Case 01 is related to persistent domestic violence where the proper and timely implementation of law has resulted in the positive behavioural change of the male partner to the utmost benefit of the whole family. Case 02 refers to a young male who was severely addicted to heroin where compulsory rehabilitation imposed by the courts had changed him back to normal. The authors’ intension is to make the clinicians and relevant stakeholders aware of the existing legal provisions they can utilize as a part and parcel of their treatment and follow-up regimes.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"7 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":"114640082","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}
Maternal death is a preventable tragedy. However, in some instances, a combination of different entities might complicate the case and mislead the diagnosis. This is a case of puerperal sepsis during the early postpartum period in a previously healthy primipara due to a chronic disease that has exacerbated. The postmortem examination revealed mildly infected foci of uterine mucosa, massive hepatosplenomegaly and multiple yellow and pale patches in ventricles confirmed microscopically as myocardial infractions)with patent coronaries. Cause of death was determined as puerperal sepsis complicated with chronic anaemia. Culture-negative septicemia has been reported in chronic disease such as malignancies (eg. lymphoma, paraneoplastic syndrome) etc. Generalized sepsis may rapidly arise from miniature foci of sepsis with undiagnosed predisposing conditions. A higher degree of clinical vigilance combines with necessary investigations are essential to establish the proper diagnosis and prompt management. Thorough antenatal screening of pregnant mothers is vital irrespective of their clinical state to avoid preventable maternal deaths.
{"title":"Complicated maternal death: puerperal sepsis in a patient with subclinical chronic disease","authors":"S. Arachchi, R. Ruwanpura","doi":"10.4038/MLJSL.V7I1.7390","DOIUrl":"https://doi.org/10.4038/MLJSL.V7I1.7390","url":null,"abstract":"Maternal death is a preventable tragedy. However, in some instances, a combination of different entities might complicate the case and mislead the diagnosis. This is a case of puerperal sepsis during the early postpartum period in a previously healthy primipara due to a chronic disease that has exacerbated. The postmortem examination revealed mildly infected foci of uterine mucosa, massive hepatosplenomegaly and multiple yellow and pale patches in ventricles confirmed microscopically as myocardial infractions)with patent coronaries. Cause of death was determined as puerperal sepsis complicated with chronic anaemia. Culture-negative septicemia has been reported in chronic disease such as malignancies (eg. lymphoma, paraneoplastic syndrome) etc. Generalized sepsis may rapidly arise from miniature foci of sepsis with undiagnosed predisposing conditions. A higher degree of clinical vigilance combines with necessary investigations are essential to establish the proper diagnosis and prompt management. Thorough antenatal screening of pregnant mothers is vital irrespective of their clinical state to avoid preventable maternal deaths.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"18 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":"123617968","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}
Sportsmen abuse Performance-enhancing agents (PEA) to enhance their muscle mass and strength, while the side effects PEA may cause consequences and sudden deaths. However, the relatives usually are not aware of PEA-abuse, because most PEAs are purchased by the sportsmen from black-market. Therefore, the pathologists might miss PEA-abuse and may dispose of the postmortem with a wrong cause of death. This concept introduces a guideline to identify PEA-abuse and to give recommendations for the proper medico-legal investigation of deaths due to PEA-abuse. A 37-year-old bodybuilder who had a healthy-lifestyle died suddenly. Though the relatives were unaware, the Forensic pathologist profiled the findings and suspected PEA-abuse. The scene was visited but did not find PEA. Family physician revealed the abuse of PEA such as testosterone, cutting steroids, insulin-like growth factor and caffeine, and has had elevated liver enzymes. A high-risk autopsy was conducted. The face had acne and heart had concentric hypertrophy. Histopathology showed hypertrophy of the cardiac muscle and lung parenchyma and fatty liver. Therefore, we propose a postmortem guideline to identify PEA-abuse among sportsmen; (1) Establish seven PEA-abuse profiles; Social, physical, psychological, clinical, sports, pathological and toxicological, (2) Before autopsy, to identify the types of PEA (i) Contact the physicians and (ii) visit the scene, (3) At the autopsy, use special approaches; (i) Consider as high-risk autopsy and (ii) If gene doping is suspected, do molecular autopsy. (4) To ascertain COD, consider abuse profiles, scene and autopsy findings. (5) For prevention, organize awareness programmes and (6) to prevent premature deaths recommend to employ a clinical screening tool.
{"title":"Identification of the abuse of performance-enhancing agents in medico-legal investigations; based on a death of a body-builder","authors":"K. M. T. B. Gunathilake, M. Vidanapathirana","doi":"10.4038/MLJSL.V7I1.7389","DOIUrl":"https://doi.org/10.4038/MLJSL.V7I1.7389","url":null,"abstract":"Sportsmen abuse Performance-enhancing agents (PEA) to enhance their muscle mass and strength, while the side effects PEA may cause consequences and sudden deaths. However, the relatives usually are not aware of PEA-abuse, because most PEAs are purchased by the sportsmen from black-market. Therefore, the pathologists might miss PEA-abuse and may dispose of the postmortem with a wrong cause of death. This concept introduces a guideline to identify PEA-abuse and to give recommendations for the proper medico-legal investigation of deaths due to PEA-abuse. A 37-year-old bodybuilder who had a healthy-lifestyle died suddenly. Though the relatives were unaware, the Forensic pathologist profiled the findings and suspected PEA-abuse. The scene was visited but did not find PEA. Family physician revealed the abuse of PEA such as testosterone, cutting steroids, insulin-like growth factor and caffeine, and has had elevated liver enzymes. A high-risk autopsy was conducted. The face had acne and heart had concentric hypertrophy. Histopathology showed hypertrophy of the cardiac muscle and lung parenchyma and fatty liver. Therefore, we propose a postmortem guideline to identify PEA-abuse among sportsmen; (1) Establish seven PEA-abuse profiles; Social, physical, psychological, clinical, sports, pathological and toxicological, (2) Before autopsy, to identify the types of PEA (i) Contact the physicians and (ii) visit the scene, (3) At the autopsy, use special approaches; (i) Consider as high-risk autopsy and (ii) If gene doping is suspected, do molecular autopsy. (4) To ascertain COD, consider abuse profiles, scene and autopsy findings. (5) For prevention, organize awareness programmes and (6) to prevent premature deaths recommend to employ a clinical screening tool.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"33 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":"133185182","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: Alcohol is odour-less and the smell of liquor originates due to additives. Currently, some liquors are also odour-less and chasers also mask the smell. However, the Medical Officers are expected to identify the odours of liquors for medico-legal purposes and an error in the opinion on smelling of liquor may affect medical officer’s career. This research was performed to study the ability to detect the smell of liquor of alcoholic and non-alcoholic beverages by the health personnel. Methods: A cross-sectional descriptive study was performed in a tertiary care hospital with 100 randomly selected doctors, medical students, nurses and minor employees, 25 of each group. Non-named four alcoholic samples (beer, gal arrack, Lemon Gin and pure alcohol) and four non-alcoholic samples (ginger, garlic, lemon and water) were kept in eight rooms. Participants detected the sample and selected the options in the questionnaire. Results: ‘Beer’, ‘gal arrack’ and ‘pure alcohols’ were correctly identified by 94%, 68% and 89% respectively. However, irrespective of high concentration, ‘Lemon Gin’ was detected by 40%. When detection of smell of all liquors was compared with sex and the occupation, the differences were not significant (p>0.05). When detection of liquor smell was compared with the age groups, the difference was not significant for beer and gal arrack (p>0.05) but significant for Lemon Gin (p=0.045 Conclusions: The detection of the smell of liquor is affected by the familiarity, masking effects and age of health personnel. Therefore, medical officers tend to miss the diagnosis of liquor smell and lead to legal and personal consequences. In the absence of special training on detection of smell of liquor, these consequences could not be justified. The smell of liquor is subjective and cannot be reproduced. Therefore, for confirmation, we recommend introducing scientific methods such as blood analysis or non-invasive urine, saliva or sweat analysis. Our data may help to convince medico-legal policymakers to adopt a change.
{"title":"Medicolegal significance of using smell of liquor as an indicator of alcohol consumption","authors":"Tikiri K. M. B. Gunathilake, M. Vidanapathirana","doi":"10.4038/MLJSL.V7I1.7388","DOIUrl":"https://doi.org/10.4038/MLJSL.V7I1.7388","url":null,"abstract":"Introduction: Alcohol is odour-less and the smell of liquor originates due to additives. Currently, some liquors are also odour-less and chasers also mask the smell. However, the Medical Officers are expected to identify the odours of liquors for medico-legal purposes and an error in the opinion on smelling of liquor may affect medical officer’s career. This research was performed to study the ability to detect the smell of liquor of alcoholic and non-alcoholic beverages by the health personnel. Methods: A cross-sectional descriptive study was performed in a tertiary care hospital with 100 randomly selected doctors, medical students, nurses and minor employees, 25 of each group. Non-named four alcoholic samples (beer, gal arrack, Lemon Gin and pure alcohol) and four non-alcoholic samples (ginger, garlic, lemon and water) were kept in eight rooms. Participants detected the sample and selected the options in the questionnaire. Results: ‘Beer’, ‘gal arrack’ and ‘pure alcohols’ were correctly identified by 94%, 68% and 89% respectively. However, irrespective of high concentration, ‘Lemon Gin’ was detected by 40%. When detection of smell of all liquors was compared with sex and the occupation, the differences were not significant (p>0.05). When detection of liquor smell was compared with the age groups, the difference was not significant for beer and gal arrack (p>0.05) but significant for Lemon Gin (p=0.045 Conclusions: The detection of the smell of liquor is affected by the familiarity, masking effects and age of health personnel. Therefore, medical officers tend to miss the diagnosis of liquor smell and lead to legal and personal consequences. In the absence of special training on detection of smell of liquor, these consequences could not be justified. The smell of liquor is subjective and cannot be reproduced. Therefore, for confirmation, we recommend introducing scientific methods such as blood analysis or non-invasive urine, saliva or sweat analysis. Our data may help to convince medico-legal policymakers to adopt a change.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"35 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":"114773906","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}
If firearm injuries involve more than one individual with unknown circumstance, it attracts the interest of the public, media and the law, especially regarding the manner of death. A suicide pact is an agreement between two or more people to commit suicide together at a given place and time. Following discussion is based on two dead bodies; a male and a female found dead with firearm injuries with unknown circumstances with complicated atypical firearm injuries. A male and a female were found dead. They were lovers in their young age and were not allowed to get married. However, both had conflicts in their marriages and they developed an extramarital affair among them for a one-year duration. Father witnessed the male committing suicide with a firearm holding with one hand and triggering using a stick and falling on the dead body of a female. Female had contact 12 bore shotgun injury with a cartridge containing buckshot pellets. Seven exited with shored exits. Of them, 6 recovered from the clothes and the scene and the remaining 8x8mm buckshot pellet recovered from the male. The male had two injuries on the abdomen; one contact 12 bore shotgun injury with 2x2mm birdshot pellets and another superficial non-fatal injury with a buckshot pellet. The first firearm shot was reconstructed and explained by a unique position of the victims; Male leaning behind the female. The accessibility to the trigger could have been achieved by using a stick. Finally, this was a failed suicide pact, ended up as a dyadic death.
{"title":"Complex patterns of shotgun injuries in a Suicide Pact; a Case Report","authors":"K. M. T. B. Gunathilake, M. Vidanapathirana","doi":"10.4038/MLJSL.V7I1.7391","DOIUrl":"https://doi.org/10.4038/MLJSL.V7I1.7391","url":null,"abstract":"If firearm injuries involve more than one individual with unknown circumstance, it attracts the interest of the public, media and the law, especially regarding the manner of death. A suicide pact is an agreement between two or more people to commit suicide together at a given place and time. Following discussion is based on two dead bodies; a male and a female found dead with firearm injuries with unknown circumstances with complicated atypical firearm injuries. A male and a female were found dead. They were lovers in their young age and were not allowed to get married. However, both had conflicts in their marriages and they developed an extramarital affair among them for a one-year duration. Father witnessed the male committing suicide with a firearm holding with one hand and triggering using a stick and falling on the dead body of a female. Female had contact 12 bore shotgun injury with a cartridge containing buckshot pellets. Seven exited with shored exits. Of them, 6 recovered from the clothes and the scene and the remaining 8x8mm buckshot pellet recovered from the male. The male had two injuries on the abdomen; one contact 12 bore shotgun injury with 2x2mm birdshot pellets and another superficial non-fatal injury with a buckshot pellet. The first firearm shot was reconstructed and explained by a unique position of the victims; Male leaning behind the female. The accessibility to the trigger could have been achieved by using a stick. Finally, this was a failed suicide pact, ended up as a dyadic death.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"40 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":"121828988","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}
It may not be possible to determine the manner of death, in circumstances such as death following fall from height. When a dead body is found in front of a tall building, the ascertainment of the manner of death is difficult and in this case, the importance of a psychological autopsy in such circumstance is discussed. Middle-aged female with bronchial asthma, arterial hypertension, chronic venous insufficiency, Forestier disease, hyperlordosis of lumbar spine and vitamin D deficiency developed bilateral leg swelling and rash following 14 hours of air travel. Duplex scan excluded lower limb venous thrombosis. She did not have past history of psychiatric disorder but suddenly developed aggressive abnormal behaviour, confusion and bizarre activities. She removed her clothes and finally jumped off from 6th floor of her residency. She was succumbed to death due to multiple injuries following fall from height. No suicidal letter was recovered from the scene. The manner of death was ascertained as suicide based on eyewitness evidence. Her sudden onset of abnormal and violent behaviour may be an act of automatism without volitional control due to undiagnosed inorganic or organic disease of the brain. The witnessed suicidal behaviour was reverted to accident as a manner of death. The importance of psychological autopsy and teamwork between Forensic Pathologist and Forensic Psychiatrist in suspicious circumstances to ascertain the manner of death is highlighted. Labelling as suicide will end up in negative social stigma and loss of insurance claims.
{"title":"Importance of a psychological autopsy to identify the manner of death; a case of fall from height","authors":"S. Raveendran, M. Vidanapathirana","doi":"10.4038/MLJSL.V7I1.7392","DOIUrl":"https://doi.org/10.4038/MLJSL.V7I1.7392","url":null,"abstract":"It may not be possible to determine the manner of death, in circumstances such as death following fall from height. When a dead body is found in front of a tall building, the ascertainment of the manner of death is difficult and in this case, the importance of a psychological autopsy in such circumstance is discussed. Middle-aged female with bronchial asthma, arterial hypertension, chronic venous insufficiency, Forestier disease, hyperlordosis of lumbar spine and vitamin D deficiency developed bilateral leg swelling and rash following 14 hours of air travel. Duplex scan excluded lower limb venous thrombosis. She did not have past history of psychiatric disorder but suddenly developed aggressive abnormal behaviour, confusion and bizarre activities. She removed her clothes and finally jumped off from 6th floor of her residency. She was succumbed to death due to multiple injuries following fall from height. No suicidal letter was recovered from the scene. The manner of death was ascertained as suicide based on eyewitness evidence. Her sudden onset of abnormal and violent behaviour may be an act of automatism without volitional control due to undiagnosed inorganic or organic disease of the brain. The witnessed suicidal behaviour was reverted to accident as a manner of death. The importance of psychological autopsy and teamwork between Forensic Pathologist and Forensic Psychiatrist in suspicious circumstances to ascertain the manner of death is highlighted. Labelling as suicide will end up in negative social stigma and loss of insurance claims.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"875 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":"120878636","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}
{"title":"El Paso County Office of the Medical Examiner","authors":"K. Munasinghe","doi":"10.4038/MLJSL.V6I2.7377","DOIUrl":"https://doi.org/10.4038/MLJSL.V6I2.7377","url":null,"abstract":"","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121877423","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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