Introduction We developed a team at the Mithuru Piyasa and introduced a new system called “Red Dot Identification System”. The main objective was to identify the causative agent or “Red dot” of the problem if available. To illustrate this brand new concept, following five cases were selected from 2328 patients who visited a Mithuru Piyasa for help in 2016. Objectives To assess the importance of “Red Dot Identification System” (RDIS) for Mithuru Piyasa to resolve social problems with medicolegal significance. Background history Case–01: Father suspected that child’s sexualized behaviour could be due to the observation of acts of mother’s extra-marital partner. Mother identified that grandmother misused the child. “Red dot” was the grandmother. Case- 02: Mother faced frequent desertion by her partners and neglected the child. Reason for desertions was her schizophrenia following postpartum psychosis. “Red dot” was the mother. Case-03: Daughters used to sleep with mother. Father developed morbid jealousy. “Red dots” were daughters. Case-04: The reason forquarrelling was morbid jealousy of husband. Case-05: A child was produced following assaults by neighbours.The parents were about to divorce. The child had a hyperactive disorder. Red dot” was the child. Discussion By identifying the Red dot, Mithuru Piyasa managed to counsel, arrange treatment and solve almost all such problems. Further, it enabled to keep families together or help them to separate peacefully. Conclusions The proposed “RDIS” is an effective method of solving such family violence and should be expanded to other hospitals too.
{"title":"Red dot identification system for Mithuru Piyasa to resolve social problems with medicolegal significance","authors":"K. M. T. B. Gunathilake, M. Vidanapathirana","doi":"10.4038/MLJSL.V6I1.7369","DOIUrl":"https://doi.org/10.4038/MLJSL.V6I1.7369","url":null,"abstract":"Introduction We developed a team at the Mithuru Piyasa and introduced a new system called “Red Dot Identification System”. The main objective was to identify the causative agent or “Red dot” of the problem if available. To illustrate this brand new concept, following five cases were selected from 2328 patients who visited a Mithuru Piyasa for help in 2016. Objectives To assess the importance of “Red Dot Identification System” (RDIS) for Mithuru Piyasa to resolve social problems with medicolegal significance. Background history Case–01: Father suspected that child’s sexualized behaviour could be due to the observation of acts of mother’s extra-marital partner. Mother identified that grandmother misused the child. “Red dot” was the grandmother. Case- 02: Mother faced frequent desertion by her partners and neglected the child. Reason for desertions was her schizophrenia following postpartum psychosis. “Red dot” was the mother. Case-03: Daughters used to sleep with mother. Father developed morbid jealousy. “Red dots” were daughters. Case-04: The reason forquarrelling was morbid jealousy of husband. Case-05: A child was produced following assaults by neighbours.The parents were about to divorce. The child had a hyperactive disorder. Red dot” was the child. Discussion By identifying the Red dot, Mithuru Piyasa managed to counsel, arrange treatment and solve almost all such problems. Further, it enabled to keep families together or help them to separate peacefully. Conclusions The proposed “RDIS” is an effective method of solving such family violence and should be expanded to other hospitals too.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"161 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133410782","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 History of any discipline, including medical sciences, is really valuable for us to understand the evolution of the subject through different stages of existence, how the present state of development has been achieved, appreciate the contributions of our ancestors and finally allow us to learn through the mistakes. As it says history helps us to understand the present, teaches us to think contemplating the experience that came before our time. The first available elements of medical science refer back to ancient Egyptian times of 4000 years BC. The English term ‘Forensic’ appeared to be originated in the mid-17 century from Latin term forensis (means in open court or public forum). The forensic medicine at present incorporates clinical forensic investigations, autopsy and supporting disciplines such as forensic science. It appeared from the historical evidence that clinical forensic medicine existed much earlier than the materialization of forensic pathology revolts to the examination of corpses.
{"title":"Historical landmarks of the evolution of forensic medicine and comparative development of medico-legal services in Sri Lanka","authors":"R. Ruwanpura, M. Vidanapathirana","doi":"10.4038/MLJSL.V6I1.7366","DOIUrl":"https://doi.org/10.4038/MLJSL.V6I1.7366","url":null,"abstract":"Introduction History of any discipline, including medical sciences, is really valuable for us to understand the evolution of the subject through different stages of existence, how the present state of development has been achieved, appreciate the contributions of our ancestors and finally allow us to learn through the mistakes. As it says history helps us to understand the present, teaches us to think contemplating the experience that came before our time. The first available elements of medical science refer back to ancient Egyptian times of 4000 years BC. The English term ‘Forensic’ appeared to be originated in the mid-17 century from Latin term forensis (means in open court or public forum). The forensic medicine at present incorporates clinical forensic investigations, autopsy and supporting disciplines such as forensic science. It appeared from the historical evidence that clinical forensic medicine existed much earlier than the materialization of forensic pathology revolts to the examination of corpses.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127934978","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}
Alcohol is associated with a significant number of sudden deaths per year in the UK and deaths from alcohol-related causes are increasing at an alarming rate. These deaths are more common among white men who are over 50 years with fatty changes rather than the cirrhotic liver. The only findings at postmortem are fatty liver and a negative or low blood alcohol level. The mechanism of death is uncertain in most of the instances but there are some theories related to the suggested mechanism. Sometimes, pre-existing minor causes are incorrectly diagnosed as the cause of death. Therefore, forensic pathologist experiences major difficulties in ascertaining the cause of death. Awareness of the association between alcohol-related fatty change and sudden death is essential to give a correct cause of death at the autopsy examination. A 63-year-old man was found dead in his bathroom by his partner. There was no past medical history of diabetes mellitus, hypertension and alcohol withdrawal. He consumed 5-6 bottles of wine per day over the past 9 months. Postmortem examination revealed slight jaundice, pallor, mild atheromatous changes in coronary arteries, mild left ventricular hypertrophy and marked fatty changes in the liver. Microscopic examination of the liver revealed severe steatosis, predominantly macrovesicular. In addition to that, there was no evidence of chronic disease or pathology. Toxicology analysis revealed 113mg/dl of blood alcohol reset of investigations were unremarkable. Limited biochemical analyses were done. They did not show any evidence of significant electrolytes imbalances or hypo or hyperglycemia. Excluding all the possibilities and considering macroscopic and microscopic features, and toxicological investigations, the cause of death was ascertained as sudden unexpected death in alcohol misuse (SUDAM).
{"title":"Sudden unexpected death in alcohol misuse: a case report","authors":"R. K. Sanjeewa, D. G. Pittius, M. Vidanapathirana","doi":"10.4038/MLJSL.V6I1.7373","DOIUrl":"https://doi.org/10.4038/MLJSL.V6I1.7373","url":null,"abstract":"Alcohol is associated with a significant number of sudden deaths per year in the UK and deaths from alcohol-related causes are increasing at an alarming rate. These deaths are more common among white men who are over 50 years with fatty changes rather than the cirrhotic liver. The only findings at postmortem are fatty liver and a negative or low blood alcohol level. The mechanism of death is uncertain in most of the instances but there are some theories related to the suggested mechanism. Sometimes, pre-existing minor causes are incorrectly diagnosed as the cause of death. Therefore, forensic pathologist experiences major difficulties in ascertaining the cause of death. Awareness of the association between alcohol-related fatty change and sudden death is essential to give a correct cause of death at the autopsy examination. A 63-year-old man was found dead in his bathroom by his partner. There was no past medical history of diabetes mellitus, hypertension and alcohol withdrawal. He consumed 5-6 bottles of wine per day over the past 9 months. Postmortem examination revealed slight jaundice, pallor, mild atheromatous changes in coronary arteries, mild left ventricular hypertrophy and marked fatty changes in the liver. Microscopic examination of the liver revealed severe steatosis, predominantly macrovesicular. In addition to that, there was no evidence of chronic disease or pathology. Toxicology analysis revealed 113mg/dl of blood alcohol reset of investigations were unremarkable. Limited biochemical analyses were done. They did not show any evidence of significant electrolytes imbalances or hypo or hyperglycemia. Excluding all the possibilities and considering macroscopic and microscopic features, and toxicological investigations, the cause of death was ascertained as sudden unexpected death in alcohol misuse (SUDAM).","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130452692","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 nose and maxilla are components of the danger triangle. Due to the special nature of the blood supply to the human nose can lead to cavernous sinus thrombosis, meningitis or brain abscess. Frontal and maxillary sinus infection leads to early and delayed complications. In this case, lack of information had been given to the patient by the clinicians on discharge regarding review examination. An elderly alcoholic was admitted to a tertiary care hospital following road traffic trauma. He had received fractures of right maxillary bone and frontal sinus with frontal lobe brain contusion. CT scan showed fluid levels in the bilateral maxillary sinus. He was treated inward for two weeks and was discharged. He was advised to come for review examination in one week but defaulted and had not also taken antibiotics regularly. Two weeks later, he was re-admitted with spiky fever for three days. On admission, he was drowsy and had neutrophil leukocytosis. He died two days after admission. The autopsy revealed yellow pus and abscesses on the brain surface. Other organs showed septic features. The cause of death was brain abscesses and meningitis following blunt force trauma to head. The brain abscesses and meningitis were complications of sinus fracture following road traffic accident of an alcoholic who had not followed proper medical advice. A multidisciplinary approach and a proper follow up is needed to prevent such deaths due to late complications. We highlight that adequate information should be given to both patient and relatives especially when the patient is an alcoholic to prevent the late complications and death.
{"title":"Death due to late complication of paranasal sinus fracture following road traffic trauma","authors":"M. Kogulshankar, M. Vidanapathirana","doi":"10.4038/MLJSL.V6I1.7371","DOIUrl":"https://doi.org/10.4038/MLJSL.V6I1.7371","url":null,"abstract":"The nose and maxilla are components of the danger triangle. Due to the special nature of the blood supply to the human nose can lead to cavernous sinus thrombosis, meningitis or brain abscess. Frontal and maxillary sinus infection leads to early and delayed complications. In this case, lack of information had been given to the patient by the clinicians on discharge regarding review examination. An elderly alcoholic was admitted to a tertiary care hospital following road traffic trauma. He had received fractures of right maxillary bone and frontal sinus with frontal lobe brain contusion. CT scan showed fluid levels in the bilateral maxillary sinus. He was treated inward for two weeks and was discharged. He was advised to come for review examination in one week but defaulted and had not also taken antibiotics regularly. Two weeks later, he was re-admitted with spiky fever for three days. On admission, he was drowsy and had neutrophil leukocytosis. He died two days after admission. The autopsy revealed yellow pus and abscesses on the brain surface. Other organs showed septic features. The cause of death was brain abscesses and meningitis following blunt force trauma to head. The brain abscesses and meningitis were complications of sinus fracture following road traffic accident of an alcoholic who had not followed proper medical advice. A multidisciplinary approach and a proper follow up is needed to prevent such deaths due to late complications. We highlight that adequate information should be given to both patient and relatives especially when the patient is an alcoholic to prevent the late complications and death.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130092042","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}
K. M. T. B. Gunathilake, Sisira H. D. M. K. Dissanayake, M. Vidanapathirana
Some stab injuries are atypical. However, the careful examination of the injuries provides valuable information which may lead to the identification of the profile of the weapon. The following discussion is based on a fatal atypical stab injury with an unusual knife. An adult male from a rubber cultivation area had an argument with another from the same locality. He was stabbed once on his shoulder and the suspect escaped with the knife. He was rushed to the hospital but was dead on admission. At the autopsy, the shirt worn by the deceased had a patterned cut injury, an inverted ‘Flat bottomed U-shaped’ cut, 2.5cm x 0.5cm. Underlying gaping stab injury on the right shoulder was 2cm x 1.5cm. The front margin was 2cm and was sharp and taut. Inner and outer ends were 0.5cm each and were perpendicular to the front margin. The rear margin was sharp but lax. On dissection, the track had parallel margins up to the distal end and the width was 2.5cm. It ran forwards and downwards severing the right subclavian artery. The cause of death was haemorrhagic shock due to stab injury. A rubber tapping knife was produced after 3 days. The blade was 9cm x 2.5cm, thin, with a ‘flat-bottomed U-shaped’ cross-section. The edges were parallel with 0.5cm thickness. The distal end was V-shaped. Features of the atypical stab injury were compatible with the rubber tapping knife allegedly used for stabbing. Photographic documentation and familiarity with the injuries caused by atypical weapons that are available in the locality will be helpful in injury interpretation.
{"title":"Atypical stab injury with a rubber tapping knife (‘Kiri-Pihiya’)","authors":"K. M. T. B. Gunathilake, Sisira H. D. M. K. Dissanayake, M. Vidanapathirana","doi":"10.4038/MLJSL.V6I1.7372","DOIUrl":"https://doi.org/10.4038/MLJSL.V6I1.7372","url":null,"abstract":"Some stab injuries are atypical. However, the careful examination of the injuries provides valuable information which may lead to the identification of the profile of the weapon. The following discussion is based on a fatal atypical stab injury with an unusual knife. An adult male from a rubber cultivation area had an argument with another from the same locality. He was stabbed once on his shoulder and the suspect escaped with the knife. He was rushed to the hospital but was dead on admission. At the autopsy, the shirt worn by the deceased had a patterned cut injury, an inverted ‘Flat bottomed U-shaped’ cut, 2.5cm x 0.5cm. Underlying gaping stab injury on the right shoulder was 2cm x 1.5cm. The front margin was 2cm and was sharp and taut. Inner and outer ends were 0.5cm each and were perpendicular to the front margin. The rear margin was sharp but lax. On dissection, the track had parallel margins up to the distal end and the width was 2.5cm. It ran forwards and downwards severing the right subclavian artery. The cause of death was haemorrhagic shock due to stab injury. A rubber tapping knife was produced after 3 days. The blade was 9cm x 2.5cm, thin, with a ‘flat-bottomed U-shaped’ cross-section. The edges were parallel with 0.5cm thickness. The distal end was V-shaped. Features of the atypical stab injury were compatible with the rubber tapping knife allegedly used for stabbing. Photographic documentation and familiarity with the injuries caused by atypical weapons that are available in the locality will be helpful in injury interpretation.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127404336","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}
Maria Ulnes, Hanna Hultquist, Manjika M. Sithum, M. Vidanapathirana, K. Wijewardene, L. Anderson
Introduction The pattern of intimate partner violence has not been studied in-depth in Sri Lanka. The aim of this study was to investigate the weapons use among women exposed to intimate partner violence (IPV) and to compare with community violence (CV). Method A retrospective, comparative cross-sectional study of women who have undergone medico-legal examination after reporting IPV or CV to a tertiary care hospital, in Colombo, Sri Lanka years from January 2011 to December 2012 was conducted. Of 9000 Medico-Legal Examination Forms, women above 18 years who had reported IPV and CV were studied. Results The prevalence of reported cases of IPV was 2.8%and CV was 5%. Of them, 255 (36%) IPV and 449 (64%) CV were reported. IPV was common among young, married, unemployed women (p 0.05). Assault with a weapon was common at home in the morning and resulted in severe injuries (p Conclusions Women exposed to IPV were young, married and unemployed. Most assaults were due to manhandling while sexual violence reports were fewer than expected. Weapon assaults are common at home in the morning and result in severe injuries but not associated with alcohol abuse. There were many similarities between IPV and CV assaults which indicate that both groups take their basis in a gender-unequal society that breeds violence. The victim knew the abuser, not only in the IPV group as expected but also in the CV group.CV occurs outside the home by known perpetrators using ‘occasional weapons’. CV in Sri Lanka and worldwide is an almost unexplored area that needs to be further investigated in order to develop evidence-based intervention programmes.
{"title":"Weapons used to harm female victims of intimate partner violence and community violence","authors":"Maria Ulnes, Hanna Hultquist, Manjika M. Sithum, M. Vidanapathirana, K. Wijewardene, L. Anderson","doi":"10.4038/MLJSL.V6I1.7367","DOIUrl":"https://doi.org/10.4038/MLJSL.V6I1.7367","url":null,"abstract":"Introduction The pattern of intimate partner violence has not been studied in-depth in Sri Lanka. The aim of this study was to investigate the weapons use among women exposed to intimate partner violence (IPV) and to compare with community violence (CV). Method A retrospective, comparative cross-sectional study of women who have undergone medico-legal examination after reporting IPV or CV to a tertiary care hospital, in Colombo, Sri Lanka years from January 2011 to December 2012 was conducted. Of 9000 Medico-Legal Examination Forms, women above 18 years who had reported IPV and CV were studied. Results The prevalence of reported cases of IPV was 2.8%and CV was 5%. Of them, 255 (36%) IPV and 449 (64%) CV were reported. IPV was common among young, married, unemployed women (p 0.05). Assault with a weapon was common at home in the morning and resulted in severe injuries (p Conclusions Women exposed to IPV were young, married and unemployed. Most assaults were due to manhandling while sexual violence reports were fewer than expected. Weapon assaults are common at home in the morning and result in severe injuries but not associated with alcohol abuse. There were many similarities between IPV and CV assaults which indicate that both groups take their basis in a gender-unequal society that breeds violence. The victim knew the abuser, not only in the IPV group as expected but also in the CV group.CV occurs outside the home by known perpetrators using ‘occasional weapons’. CV in Sri Lanka and worldwide is an almost unexplored area that needs to be further investigated in order to develop evidence-based intervention programmes.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130195784","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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