Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Analysis of medicolegal examination in alleged sexual abuse presented to a tertiary care hospital in Sri Lanka(Wolters Kluwer - Medknow, 2023) Kitulwatte, I.D.G.; Wijewardena, H.P.; Edirisinghe, P.A.S.; Senarathne, U.D.Forensic experts are often expected to provide an opinion on alleged physical or sexual contact between individuals following medicolegal examination of a case of sexual abuse (SA). There are many factors influencing the opinion. A retrospective descriptive study was performed to study the factors influencing the medicolegal opinion in SA forensic examination using medical and medicolegal records of alleged SA victims to extract data. Records of 441 victims were studied. A majority, 180 (40%), presented due to the guardian’s concerns – 302 (68%) presented for medicolegal examination 72 h after the incident. Recent injuries were observed in only 15% of the victims. Genital injuries were observed in 74% of the victims brought due to concerns of the guardians, with 12 victims having recent injuries. Of the 172 victims who complained of vaginal intercourse, 21% had recent injuries. A firm positive medicolegal opinion could be given in 63% of all cases. In 124 individuals, a firm positive or negative opinion could not be given. A majority (n = 90, 73%) of these individuals did not have any injuries, while 23% had healed injuries. According to the nature of the complaint, in a significant number of victims (53%), no scientific evidence was present to make a firm opinion. The nature of the sexual act and the absence of injuries influence the medicolegal opinion on SA, making it a challenging task for forensic experts.Item A Study on victims of intimate partner violence reported to Colombo North Teaching Hospital, Sri Lanka during 2019-2021(Academic Forensic Pathology International, La Jolla, CA, 2022) Muthulingam, T.; Edirisinghe, P.A.S.; Wijewardhane, H.P.; Thivaharan, Y.; Jayasundara, M.M.S.; Borukgama, N.; Kulathunga, D.L.; Alwis, D.N.; Govinnage, P.S.; Kitulwatte, I.D.G.Introduction: Intimate partner violence (IPV) is a common issue in any society and the reported cases are just the tip of an iceberg as most of the victims are reluctant to come to the criminal justice system. Forensic experts are often encountering the victims who chose to seek justice. Evaluation of the nature, consequences, and underlying factors are needed in planning preventive measures. Objectives: To describe the patterns and associated factors of IPV among victims who reported to Office of the Judicial Medical Officer of Colombo North Teaching Hospital and to specifically describe the patterns prior and during the COVID-19 pandemic. Methods: A retrospective descriptive study based on 471 medicolegal records of the victims who had undergone medicolegal examination following IPV during last two years (March 2019 to February 2021). Results: Out of 471, 206 cases were reported prepandemic and 265 reported postpandemic periods. Even though majority were females there were 21 males. Types of abuse were complex and often interrelated. There were 463 who had experienced physical injuries while there were 20 who had been subjected to sexual violence. Face was the commonest target of assault (63%). Substance abuse was identified as the commonest predisposing factor (56%). Even though repeated abuse was common, 42.5% of the victims had never made any complaints to the police. Despite multiple complains, 39.7% had experienced repeated violence. Conclusion: Victims of IPV are silently suffering for many long years. Failure in the response from authorities was identified. COVID-19 pandemic has become an additional risk factor for IPV. Strengthening of legal and social responses is the need of the hour.Item An Analysis of medicolegal reporting in workman injuries referred for medicolegal examination in a Tertiary Care Hospital of Sri Lanka(Wolters Kluwer Medknow Publications, 2020) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.INTRODUCTION: A reasonable number of workman injuries are reported for medicolegal examination every year. In addition to report on the degree of severity and consistency of the injuries with the historical evidence, the medical officers are expected to opine on degree of disability as well. However, routine Medicolegal Examination Form or Report used in Sri Lanka to report these cases does not carry a section for disability or impairment. Objective: To gain an insight into the pathology of workplace injuries and to evaluate the role of medicolegal examination and reporting among the victims presented with injuries at work. Methods: A retrospective descriptive study was carried out on workmen who were referred for medicolegal examination during a period of 5 years in a Tertiary Care Hospital in the Western Province of Sri Lanka. Results: Out of 172 subjects who got injured at work, none had claimed for a report of compensation. 47% (81) of the injured workers were in the age group of 19–30 years. 81% (139) were males. Factory workers were the most vulnerable workers (34%) followed by drivers (15%). A majority 39% (67) of injuries were located on upper limbs. 52% (90) of the victims had grievous injuries. However, a majority 61% (105) had no permanent disability. Conclusions: Disability is not a direct reflection of the category of hurt. Therefore, testifying on routine medicolegal reports on cases of workman compensation will not serve justice to the patient. KEYWORDS: Category of hurt, disability, injury, medicolegal examination, workmanItem Adequacy and relevance of medical records of patients admitted following Medico-legally significant trauma(College of Forensic Pathologists of Sri Lanka., 2020) Priyanath, D. C.; Dharmadasa, L.S.; de Silva, R.L.S.K.; Gunathilaka, M.M.A.C.C.; Nanayakkara, E.H.H.G.; Shakoor, M.S.; Samarawickrama, S.; Kitulwatte, I.D.G.; Edirisinghe, P.A.S.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. KEYWORDS: Medico-legal issues, Medical record keeping, Adequacy, Investigations, BHTItem Ethical dilemmas in forensic medical practice(Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, 2019) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.ABSTRACT: Forensic practitioners need to ensure that basic medical obligations towards individual patients, judiciary and the public are met while balancing their responsibilities to these parties. Unlike in clinical practice the patient does not present for treatment but for forensic evaluation. Even so, medical practitioners are expected to ensure that ethical standards like for any other medical discipline are maintained in medicolegal practice. At a forensic medical examination, there is an obligation to act in the best interest of the patient and to attend to his/her critical needs. However, attending to the needs of the patient may be viewed as taking undue interest or being fractional by the judiciary. On the other hand, in medical practice, responsibility to patients should overide the interests of third parties. In examination of the dead for medico-legal purposes, the question that can arise is whether there is actually a doctor patient relationship since the examinee is already dead. While there is a duty towards the judiciary to find out the truth about the cause and manner of death there is a duty towards the relatives of the deceased to reveal the true findings especially after having contact with them at the preliminary inquiry. Many of the conclusions made in forensic practice are matters of opinion, and therefore, disagreement is expected which can lead to personal friction specially in handling cases of medical negligence. If forensic practitioners follow the basic principles of medical ethics, while maintaining the highest standards based on scientific evidence they can overcome the majority of the conflicting issues and can perform their duty in the administration of justice. KEYWORDS: Ethics, Forensic medicine and pathology, Best interest, Doctor patient relationship, JudiciaryItem Profile of suicidal hanging presented to a tertiary care hospital: a descriptive study(Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, 2019) Edirisinghe, P.A.S.; Senarathne, U.D.; Pratheepa Mendis, H.K.N.L.; Wijesinghe, P.R.; Fernando, A.; Kitulwatte, I.D.G.ABSTRACT: When a body is found suspended, the forensic pathologist is expected to give an opinion on the manner of death excluding or confirming possible criminal involvement. Conclusion is easy when findings are classic. However, it is a dilemma when there are atypical findings. OBJECTIVES: To analyze the autopsy findings in deaths due to hanging and to have an insight into the typical and atypical findings in order to appreciate the difficulties in interpretation. METHODS: A retrospective descriptive study on post mortem records of the victims of hanging during a period of three years, brought to a tertiary care hospital. The findings of death investigation including background information, scene, and autopsy examination were analysed. RESULTS: Total of hundred and twelve records of deaths due to suicidal hanging were perused and 97 (86.6%) out of them were males. The majority of victims (37%) were in the age group of 21 to 40 years. The complete suspensions was identified in most cases (79.5%). The commonest ligature material (25%) was the coir rope. Sixty-nine were having a ligature mark rising to an inverted ‘V’. Classic signs were observed in 47% and the presence of classic signs was significantly associated with partial suspension (p<0.001). Internal injuries were observed in 34% and the majority were fractures. Internal injuries had no significant association to the degree of suspension (p=0.11). KEYWORDS: Hanging, Ligature material, Ligature mark, Classic signs, Internal injuries, FracturesItem Usage of digital photographs in forensic work in Sri Lanka(Sri Lanka Journal of Forensic Medicine, Science & Law, 2018) Nadeera, D.R.; Edirisinghe, P.A.S.; Kitulwatte, I.D.G.ABSTRACT: Forensic photography refers making of images to record objects, scenes and events to be used in the legal process. With popularization of digital cameras, forensic photography is being increasingly used as a tool in record keeping as well as evidence. The objective of this study was to evaluate available facilities and current practice of using digital photographs in forensic work by medico-legal doctors in Sri Lanka. A cross sectional descriptive study was conducted using a self-administered questionnaire among doctors engaged in forensic work in Sri Lanka. The study was conducted as an on-line survey from October 2018. Out of 102 doctors who participated in the survey, 51% (n=52) used camera-phones instead of DSLR cameras to take forensic photographs, although 72% (73) had a DSLR camera in the institution. The majority (96%) used a measuring scale in their photographs, but only 43% used a colour scale. 66% took more than two photographs for a single injury but only 26% used an external light source. 80% took photographs in all magisterial autopsies but only 48% incorporated them in their reports. Majority (74%) knew that forensic photographs are admissible in courts. Basic technical knowledge of functions of a camera was poor in a majority (85%) of doctors. Although basic technical knowledge of photography was poor in doctors engaged in medicolegal practice, many use photographs to compliment autopsy reports. Since comprehension of events using visual images is better than verbal descriptions, improving the quality of photographs submitted to courts should be the way forward. Therefore, forensic photography training should be encouraged.Item Elderly victims dying of unnatural causes: a retrospective descriptive study from Ragama, Sri Lanka(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2018) Kitulwatte, I.D.G.; Paranavithana, S.S.; Perera, A.A.B.S.; Edirisinghe, P.A.S.Even though life expectancy among the elderly has been improving health hazards due to unnatural causes are a significant medical and social issue among this group. The objective was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. A retrospective descriptive study conducted for a period of 3 years, at a tertiary care hospital of Sri Lanka where information was collected from hospital records and post mortem reports of persons above 60 years of age, who died due to unnatural causes revealed that a majority of deaths were due to road traffic accidents of pedestrians.Item Study on the pattern of unnatural deaths of women brought for medico-legal autopsy(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2017) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.; Pratheepa Mendis, H.K.N.L.; Wijesinghe, P.R.; Fernando, A.; Abeyrathna, A.A.R.M.INTRODUCTION: An unnatural death is an intentional or unintentional death due to external causes. This can often be violent, mutilating or destructive. When the unnatural death involves a female, it shatters the lives of the survivors or the family. Traumatic injuries among females remain under-reported globally and studies on this area are scarce. We planned a retrospective descriptive study to find the epidemiologic patterns of trauma- related mortality among females for the first time. OBJECTIVES: The aim of the study was to analyze the traumatic deaths among females to determine the circumstances, causes and epidemiology of these deaths and also to find the factors influencing them. METHODOLOGY: A retrospective descriptive study was conducted on the post mortem records of the female victims of trauma during last 3 years (2013-2015) reported to a tertiary care hospital of Sri Lanka. The historical details, scene findings, findings of autopsy: external and internal examinations, the results of the post-mortem investigations and the opinion and conclusions given were obtained to fill the pro-forma. RESULTS: Out of the 139 deaths reported for medico- legal examination during the period, the majority 71(51%) were less than 40 years of age. The commonest manner of death was accidents 56 (40%), especially road accidents, followed by suicides amounting to 45 (32%). Poisoning was the commonest method of suicide 14 (31%) followed by hanging 12 (26%). Sharp injuries accounted for the majority of murders 13 (39%). Family disputes and love affairs were the main reason for 21 (47%) suicides and 13 (39%) murders. CONCLUSIONS: Comprehensive research into occurrence of unnatural fatalities assists authorities in the prevention of such deaths. The study highlights the importance of timely interventions on road safety and the need for effective and timely counseling services on family matters to prevent most intentional deaths of women.Item A man with ischemic heart disease after consuming alcohol found collapsed while eating: a café coronary and intoxication. Which cause preceded the others?(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2017) Gangahawatte, S.; Edirisinghe, P.A.S.; Kitulwatte, I.D.G.INTRODUCTION: Complete and abrupt upper airway obstruction by a bolus of food, with sudden onset of symptoms simulating acute myocardial infarction was described as ‘Café coronary’ in early 60s. Victims are speechless and breathless; thus, without assistance (e.g.Heimlich manoeuvre) they will die. A typical ‘café coronary’ was an obese middle aged man dying, while eating having a chest pain, with eye witness accounts of ‘choking on a piece of meat’ which was hurriedly eaten. Though various theories were postulated at that time regarding the mechanism, later studies showed that multiple factors could be associated. We report a death of an alcoholic with a history of ischemic heart disease found with a bolus of food lodged at the pharynx and larynx. CASE REPORT: 51 year-old male after having 1½ bottles of illicit liquor, quarreled with the wife and left home, was found dead two (2) hours later in a partly built house. The examination of the scene revealed half a bottle of alcohol, a partly consumed loaf of bread, a beef curry and a roasted chicken thigh beside. Autopsy revealed obstruction of the mid larynx with a piece of bread, mild laryngeal oedema, myocardial fibrosis, 80% narrowing of the anterior descending artery and a liquor smell from stomach. The toxicological screening revealed 200mg/dlethyl alcohol in the blood, while histology revealed fibrosis of the myocardium. CONCLUSION: Although obstruction of the airway with a food bolus was the apparent cause of death at autopsy, the high blood alcohol level with myocardial fibrosis pauses questions regarding the mechanism of death i.e. which caused which? Therefore, a forensic pathologist should not be hurried to arrive at conclusions during the autopsy without further investigations.
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