Browsing by Author "Paranitharan, P."

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The autopsy in medical education
(South East Asia Regional Association for Medical Education (SEARAME), 2021) Edussuriya, D.H.; Paranitharan, P.; Perera, W.N.S.; Thilakarathne, M.G.N.I.; Wijesiriwardena, W.M.S.Y.; Nanayakkara, C.
No Abstract Available
Beyond autopsies: treading new horizons
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2014) Paranitharan, P.; Perera, W.N.S.; Hulathduwa, S.R.
A Clinical case of an 'alleged assault': are they fabricated injuries?
(Faculty of Medicine, University of Peradeniya, 2010) Rajapaksha, W.R.A.S.; Paranitharan, P.; Perera, W.N.S.
No Abstract Available
A current need for modern instruments in forensic pathology: a way forward
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2016) Paranitharan, P.; Hulathduwa, S.R.
Routine dissection of the cadaver followed by mandatory and ancillary investigations is still the most widely used method in forensic autopsy throughout the globe. In contrast to most other disciplines of medicine, instruments used in routine autopsy work remain plain, simple, unsophisticated and virtually unchanged for over a century. Incorporation of modern technology to improve these instruments to meet the new challenges such as minimizing the risk of bio-hazards, acquisition of precision in dissection, facilities for simultaneous imaging, sampling and archiving the information and finally making the dissection a less cumbersome a task with lesser degree of dependability on individual human skills has become the need of the day. The authors briefly discuss few initiative steps taken along this long pathway.
Deaths following drowning in Sri Lanka - a retrospective study
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2020) Paranitharan, P.; Perera, W.N.S.; Lakmal, S.; Priyanath, D.C.; Senanayake, T.A.A.W.; Kumari, M.K.J.K.
INTRODUCTION: Deaths following drowning are a common occurrence in Sri Lanka. Individuals drown in different circumstances like suicides, accidents and homicides. A study of this nature would be useful for prevention of such incidences and as a baseline for future studies. OBJECTIVES: With regard to victims of drowning to determine; the demographic profile, circumstances, autopsy findings and contributory factors for drowning. METHODOLOGY: Information was extracted from records of 59 drowning cases in the years 2008-2017. Data were analysed using the statistical package SPSS Version 22. RESULTS: Majority of deaths (37.3%) were within the age of 11-30 years. Twenty-six-point five percent (26.5%) of accidental deaths were within the age group 11-20 years. The circumstances were accident (57.6%), suicide (22 %) and not known whether accident or suicide (20.3%). The common places of accidental drowning were sea (20%), Tank (20%) and canal (18 %.) The well was the most common place for suicides (54%). Majority of victims were unemployed (37%) and labourers (25%). Froth in the nostrils (54.2%), Emphysematous expanded lungs (63%), rib indentation on the lungs (61%) froth in the airways (61%) and pulmonary oedema (66%) were observations which were suggestive of drowning. Environmental factors (41%) and alcohol consumption (20%) are among the possible contributory factors. CONCLUSION: Majority of the deaths are accidental. Environmental factors and alcohol consumption may play contributory roles. Awareness programmes targeting young adults will minimize accidental deaths. KEYWORDS: Circumstances, Contributory factors, Deaths, Drowning
Deaths on rail roads: a study from Colombo North Teaching Hospital, Sri Lanka.
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2018) Paranitharan, P.; Perera, W.N.S.
ABSTRACT: In Sri Lanka railway related deaths are reported throughout the year. Most accidental deaths occur due to negligent behaviour of pedestrians and drivers. Fatal train impacts cause extensive visceral and musculoskeletal injuries due to the nature of the object as well as the amount of force transmitted during impact. A study of this nature would help ascertain demographic details of victims, characteristics of the incident of fatal train crashes and recognize the injury profile. An autopsy based retrospective study was done using postmortem reports of 10 years. Seventy autopsy reports from Colombo North Teaching Hospital between July 2006 and July 2016 were analyzed. Data regarding demographic details of victim and incident, external and internal injury distribution, cause and manner of death as determined at autopsy were extracted. Majority of victims were males between 20-39 years (43.7%, n=32) of age and were married (64.3%, n=45). Most victims of accidents were trespassers 68.8% (n=33). 68.6% (n= 48) and 31.4% (n=22) respectively were due to accidents and suicide. The highest number of fatalities 64.3% (n=45) were observed between 2 pm to 10 pm. The number of external injuries were more in accidents than suicides. The most common cause of death was multiple injuries. Majority of the deaths were accidental. Transections of neck, chest and traumatic amputations of extremities were common in suicides than accidents.
Do the print media help the medical science? An analysis of forensic related contents in newspaper articles
(2012) Paranitharan, P.; Perera, W.N.S.; Ranantunge, I.D.J.; Ratnayake, W.R.A.D.T.D.
General public get a considerable amount of information about medical science related topics from the media. Communicating with the public through the media can be vexing for medical professionals because they lack direct control over the final reporting1.It is the reporter's view of the information and his or her words that reach the public, rather than the scientist's or the clinician's. Moreover, there is a mismatch between the expectations of the scientist and those of the reporter. Scientists expect journalists to share their concern with scientific norms relating to the provisional nature of scientific knowledge and recognition of the collegial nature of scientific endeavour2. However sub specialty such as in forensics there are diverse concerns about published material in the print media. Issues are more or less the same in other specialties as well.
Elder abuse among out patient department attendees in a tertiary hospital
(Sri Lanka Medical Association, 2009) Edirisinghe, P.A.S.; Paranitharan, P.; Perera, W.N.S.; Shehan, W.
BACKGROUND: Abuse of older people is a hidden problem in society. Older people are frightened or embarrassed to report its presence. The extent of the problem is not studied adequately in Sri Lanka. METHODS: A cross sectional descriptive study was conducted at the North Colombo Teaching Hospital, outpatient department on 530 consecutive adults over 60 years of age. The Hwalek-Sengstock Elder abuse screening test which was assessed for face validity and content validity among 50 older persons and modified, was used for data collection along with a brief demographic questionnaire. Those with a mini-mental state examination score of 23 or less were excluded from the study. Data was collected by trained medical officers after informed written consent from the subjects. Confidentiality of the information provided was assured. RESULTS: 348 females (65%) and 182 males (35%) were included in the study. The mean age was 68.5 years. 26 (5.6%) reported physical abuse of whom 14 (2.6%) had been struck, slapped or kicked and five had received medical attention for injuries. Three had made a Police complaint. Up to 136 (25%) had perceived emotional abuse. 53 (10%) had experienced derogatory remarks and 12 (2. 3%) had been threatened with punishment and institutionalisation. 20 (3.7%) claimed neglect and 116 (22%) claimed their caregiver was financially dependent on them. There was no significant difference among the sexes. CONCLUSIONS: Physical, emotional and financial abuse of elders is present in our study population. The numbers although small, may represent only the tip of the iceberg.
Elder abuse--a wake up call
(Sri Lanka Medical Association, 2009) Paranitharan, P.; Edirisinghe, P.A.S.; Williams, S.
Forensic based empirical study on ricochet behaviour of Kalashnikov bullets (7.62mm×39mm) on 1mm sheet metal
(Elsevier, 2020) Nishshanka, B.; Shepherd, C.; Paranitharan, P.
ABSTRACT: Bullet ricochet off a surface in a shooting scene occurs in diverse conditions and affected by array of factors. Therefore ricochet analysis of a particular incident demands case by case analysis supported by the knowledge of existing subject knowledge and empirical testing. In this view, existing empirical test results on bullet ricochet experiments have become always assisted and referred by investigators during scene reconstruction and in Courts. This forensic based research was aimed to understand the ricochet behaviour and related aspects of Kalashnikov bullets (7.62mm×39mm) on 1mm sheet metal. 1mm sheet metal was selected as the target surface of the study, based on its greater possibility of existing in concurrent urban environments as vehicle bodies, electrical appliances, road signs, boundary walls, partitions, walls of mobile houses etc. The research added brand new knowledge to the firearm investigation field in general and specifically to AK shooting investigations and scene reconstruction. The ricochet angles and critical angle of 1mm sheet metal and AK bullets, relationship of different impact feathers and angle of incidences are some of the main findings of the research. The double head impact mark which produces as a result of bullet's interaction with the target and it's specific relationships with the incident angles is the other most important results of the research which has not reported so far in a bullet ricochet study. In addition to the contribution of knowledge to the field of forensic sciences in general and forensic ballistic in particular, this research further emphasises the need for case by case empirical study to understand the ricochet behaviour of different bullet and target combinations. On the other hand, this study very deeply convinced firearms investigators on the risk of applying general bullet ricochet theory on yielding and nonyielding surfaces to reconstruct all bullet ricochet incidents which would result in wrong interpretations, critical errors in shooting scene reconstruction and finally for false testimonies. KEYWORDS: 1mm sheet metal; 7.62×39mm AK; Bullet; Bullet ricochet; Forensic ballistics; Shooting incident reconstruction.
A Forensic-based study on low angled AK rifle bullet entry wounds using a porcine model
(Elsevier, 2020) Nishshanka, M.B.; Paranitharan, P.; Shepherd, C.
ABSTRACT:An entry wound normally carries more macroscopic evidence than found in exit wounds. In addition to common wound characteristics of an entry wound such as an abrasion collar, burn marks etc., large amounts of trace evidences from the bullet and gun such as gunshot residues, powder tattoo, grease ring (bullet wipe) etc., are also present in entry wounds making them a richer source of evidence than exit wounds. This forensic-based study explores the low-angled entry wound characteristics of AK rifle bullets (7,62 mm × 39 mm) on porcine skin. This demonstrated a special entry wound characteristic similar to the commonly reported "abrasion ring" but differs in structure with an abraded area around the entry wounds and more significantly damaged outer margins. A significant inverse relationship between the AK bullet's approaching angle and the length of the external entry wound has also been reported in this work, with each finding contributing new knowledge to the forensic pathology of gunshot wounds. The findings of this study also have the potential to aid in shooting incident reconstructions. KEYWORDS: Gunshot wounds; Low angled entry wounds; Porcine skin; Rifle entry wounds; Wound ballistics.
Innovative instruments in forensic medicine
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2017) Paranitharan, P.; Hulathduwa, S.R.
Innovation is a hallmark of advancement of science. Forensic professionals, together with other experts and equipment manufacturers, can help to design modern and novel equipment to enhance the quality of work and scientific validity. The major branches, such as Clinical Forensic Medicine and Forensic Pathology, need modern equipment as in other disciplines in Medicine. Creative ideas need support and link to the right individuals.
The Interaction of injury and disease in the elderly: a case report of fatal elder abuse
(Elsevier, 2009) Paranitharan, P.; Pollanen, M. S.
We report a case of an elderly demented woman who died of a mitral rheumatic valvular disease in the context of multiple injuries and from elder abuse. History from police investigation indicated that the deceased was found collapsed on the floor in her bedroom for several days prior to death by her son who did not initiate medical care. Autopsy revealed a frail elderly woman with Alzheimer's disease and evidence of multiple healing sublethal blunt impact injuries of the face, mouth, neck, upper chest, and extremities. In addition, there was unwashed dirt encrusted skin, urine/fecal staining of skin and clothing, dirty overgrown toenails, and matting of the hair. This constellation of findings supports the medical diagnosis of elder abuse with neglect. However, the immediate cause of death was the left-sided congestive heart failure from mitral rheumatic valvular disease. Although the underlying cause of death was related to the chronic cardiac condition, the physical abuse and neglect was considered significant contributing factors to death, since physiologically the injuries and lack of medical treatment was thought to have hastened death by exacerbating the underlying heart disease. This case underscores the need for the forensic pathologist to consider contextual variables and sublethal injuries in cases were the causal interpretations benefit from a more holistic approach. Otherwise, cases like such as the one reported can go unnoticed and certified as a simple natural death.
Knowledge of consent for sexual activity among Kelaniya University entrants: is it different depending on study stream?
(University of Kelaniya, 2011) Edirisinghe, P.A.S.; Perera, W.N.S.; Paranitharan, P.; Kitulwatte, I.D.G.; Gunathilake, L.R.K.
A positive and respectful approach to sexuality and sexual relationships is essential to a university entrant because „age‟ coupled with „free environment‟ gives many opportunities to obtain life experiences. Consent is an important concept in sexual relations and lack of knowledge can lead to unhealthy sexual practices and problems related to law. The objective of this study is to assess the level of knowledge on „consent for sexual activity‟ among different study streams of university entrants of Kelaniya University. A cross-sectional, descriptive study was conducted from August to October 2009, based on self-administered questionnaires after obtaining approval from the Ethics Review Committee, Ragama. 150 students from each faculty (Medicine, Science, Commerce & Management, Social Sciences & Humanities) were randomly selected. Core knowledge was assessed by analysis of marks obtained for 7 questions. The results demonstrate that the majority of the study population was above 20 years (86%) with male to female ratio of 1:1.6. 76% stated that they did not have any sexual experience while 10% had „more than adequate experience for their age‟. 73% (n-546) stated that consent is needed before sexual intercourse/any other sexual act, but lesser amount (57%) stated that it is needed once married. The knowledge of consenting age for sexual intercourse resulted in only 5% (n-40) giving the correct answer i.e. 16 years. The analysis of marks revealed that only 1.3% (n-10) get full marks for core knowledge while 63% of medical entrants had adequate knowledge. The least scored were Commerce and Management students (43%) while others scored between 50-59%. There was no significant difference among science and non science streams (p-0.121). The study showed that the knowledge of consent for sexual intercourse among university entrants was poor and many were not aware of the legal age or basics of law related to the concept. Thus, a session on sexual health during the familiarization/orientation course will fill the gaps.
A Maternal death due to an illegal abortion
(Faculty of Medicine,University of Peradeniya, 2011) Perera, W.N.S.; Paranitharan, P.
Medical ethics applied in forensic research: a revisit to ethical guidelines
(College of Forensic Pathologists of Sri Lanka, 2015) Perera, W.N.S.; Paranitharan, P.
The knowledge on recent advances in research ethics is mandatory for the forensic community comprising mainly forensic pathologists, forensic scientists and members from the legal fraternity who support the smooth functioning of the medico-legal system. A revisit to the recent developments in medical ethics and understanding the implications towards forensic research would keep Sri Lanka in equal platform with other countries. The main objective of this paper is to revisit the recent developments in medical ethics and to understand the ethical principles applied in forensic research. The review article briefly explores the ethical aspects of research involving clinical patients, research involving dead bodies and skeletons, laboratory investigations in research and publications of research findings. The existing ethical norms in research practice had evolved over a long period of times. The sound knowledge of the internationally accepted ethical principles would make sure forensic researches are developed according to the accepted standards and be more scientifically valid.
Medical ethics during COVID-19 pandemic: An experience with death investigation.
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2022) Jayasinghe, J.M.Y.K.; Jayasinghe, J.A.G.K.; Perera, W.N.S.; Paranitharan, P.
Introduction Medical ethics is a key element in the practice of medicine. This study highlights the application and conceptualization of those principles in the process of death investigation during the COVID-19 pandemic. Objective To identify different ethical principles and their application in deaths during the COVID-19 pandemic. Methodology Autopsy information of 41 deaths from 2020-2021, which came for inquests with positive Polymerase Chain Reaction (PCR) test for COVID-19 or positive rapid antigen test was analysed. The death investigation process was conceptualized against the ethical principles; justice, autonomy, beneficence, and non-maleficence. Results The majority of deaths (36.59%) were aged between 71-80 years, with less gender disproportion (M:F- 51:48). Home deaths (63.41%) were commoner, while deaths of non-vaccinated people (80.49%) were predominant. PCR was done in <24 hours after death in 36.59% and within 24-48 hours in 58.54%. Comorbidities were present in 78.05%. Cycle threshold (Ct) value <30 group was 75.61% with the primary cause of death being related to COVID-19 infection in 83.87%, while the duration of illness was >3 weeks in 12.9% and 2-3 weeks in 3.23%. Ct value >30 group was 17.07% with COVID-19 infection being a contributory cause of death in 57.14%, while all had a duration of illness of <2 weeks. Conclusion Justice has prevailed in this cohort. The PCR report influences the autonomy in claiming and releasing the bodies to the relatives. A higher Ct value may suggest less infectivity, which may be considered when releasing the body after excluding lung changes in an autopsy. Therefore, more research is needed with regard to Ct values and infectivity of dead bodies.
Patient’s knowledge, attitudes and practices on informed consent in a clinical setting; A study done at Colombo North Teaching Hospital in Sri Lanka
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2021) Perera, W. N. S.; Perera, B. P. P.; Paranitharan, P.
Introduction: The signing of a consent form is a process with legal and ethical implications. It is required that informed written consent be obtained from a patient for an invasive procedure after proper explanation of the risks, benefits and alternative procedures. Objective: To determine knowledge, attitudes and practices related to informed consent among patients. Materials and Methods: A cross sectional descriptive study was carried out over a period of one year in a Tertiary care hospital in Sri Lanka. The participants were medical or surgical inward patients who were 18 years or above, who had consented to invasive procedure or surgery. The quantitative data of 420 patients were analyzed. Results: Majority (96%) agreed that consent is important in medical practice. Many (61%) were of the view that it helps to make an informed decision. Majority (92%) preferred a doctor, who can explain more in the consent process than a nursing officer (11%). However, 61% were of the view that consent should be taken from the patient and relatives both, even if the patient is competent of giving consent. Majority of the participants (84%) wanted to discuss with family members before giving consent. Conclusion: Majority of patients were aware of the concept of consent in medical practice and preferred the doctor and family members to be involved in the decision-making process. This finding is important to adopt a doctor-patient-family model in the consent taking process while respecting the patient’s wishes.
Perceptions of medical students on autopsy and its significance as a teaching-learning method
(The Kandy Society of Medicine, 2021) Edussuriya, D.H.; Paranitharan, P.; Perera, W.N.S.; Thilakarathne, M.G.N.I.; Wijesiriwardena, W.M.S.Y.; Nanayakkara, C.
BACKGROUND: Performance of autopsies as a learning experience for undergraduate medical students is declining in most developed countries. Sri Lankan universities continue to employ autopsies for teaching purposes. Perceptions of medical students towards this exercise has not been explored in the recent past. OBJECTIVES: To determine perceptions of medical students towards autopsy and its significance as a learning experience. METHODS: An online questionnaire to determine the perceptions of 4th year medical students who had completed the clerkship in Forensic Medicine on autopsy and its significance as a teaching-learning method was administered to students of two faculties of medicine in Sri Lanka. RESULTS: Medical students considered the autopsy as a positive learning experience in terms of learning anatomy and pathology. They felt that they should witness more autopsies and assist in dissections during autopsy. However, a significant proportion was not sensitive to the emotional nature of the experience and a majority were not comfortable in the autopsy environment and process and stated that they would not consent to an autopsy of someone close to them if the need arose. CONCLUSION: It is necessary to make the best use of the undergraduate autopsy experience by increasing exposure to autopsy, allowing students to assist at autopsy and drawing the attention of students to the emotional aspect during the experience and promoting the specialty while highlighting the role of the Forensic Pathologist in ensuring justice.
Points to Ponder: protective gear for Sri Lankan motorcyclist
(Sri Lanka Journal of Forensic Medicine, Science & Law, 2019) Paranitharan, P.
ABSTRACT: Injuries on motorcycle riders admitted after collisions range from minor abrasions to fractures and other major injuries to different regions of the body.1 The motorcyclists who are involved are employed at different institutions. It is imperative that they report back to duty following hospital treatment. Cushioning of major impacts to the body following a collision will minimize the injuries and reduce hospital stay. Further the expenses spent on treating major injuries by the government could be minimized.2 Currently it is illegal to ride a motorcycle without a helmet. The suggested protective gear which is used in other countries can be encouraged in Sri Lanka too. The sport of cricket was played with minimal protection in the past. However, after experiencing several injuries the sport is played with maximum protection to the body. A suggestion is proposed to encourage Sri Lankan motorcyclists to use additional protective gear to minimize injuries to different parts of the body. (Figure 1)