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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 A retrospective descriptive study on deaths due to firearm injuries in Western Province, Sri Lanka(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2023) Alwis, D.N.; Govinnage, D.P.S.; Kulathunga, D.L.; Perera, W.N.S.; Paranitharan, P.INTRODUCTION: The use of firearms is a well-recognized method of committing a homicide. In Sri Lanka, the use of firearms was prominent among terrorists and underworld criminals. The analysis of the injury pattern will help to find the trends related to firearm injuries. Deaths that deviate from the routine pattern of injuries will be highlighted. OBJECTIVES: The objective of the study was to identify injury patterns in firearm-related deaths and the methods used to identify the range. METHODS: The data from 40 firearm-related autopsies conducted at Offices of the Judicial Medical Officer at Colombo North Teaching Hospital, Colombo South Teaching Hospital, and Office of the Judicial Medical Officer, Colombo from 2000 to 2019 were collected from the post-mortem reports using pre-formed questionnaires and entered into the SPSS statistical package for analysis. RESULTS: The majority were between 21 and 40 years of age (75%) and male (97.5%). Head alone was involved in 25% of deaths and head in combination with other regions was involved in 45% of the deaths. Cause of death (COD) in 50% of cases was head injuries alone and in 12.5% of cases, COD was from head injuries in combination with other injuries. The commonest circumstance was homicide in 72.5% of cases. Rifled firearm was the most common weapon used (90%). Range or the distance of fire was in the distant range in 65% of cases followed by close range in 17.5% of cases. Distance of fire was decided by the history, if available, the appearance of the entry wound, and other observations. CONCLUSIONS: Scientific evaluation of deaths following firearm injuries demands proper assessment of the range or the distance of fire based on modern technology. This becomes more relevant if there is an incompatibility with the history and the appearance of the wound, especially when deciding the circumstance of death.Item 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.Item 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.Item A retrospective descriptive study on deaths due to firearm injuries(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Alwis, D.N.; Govinnage, D.P.S.; Kulathunga, D.L.; Perera, W.N.S.; Paranitharan, P.Introduction: Using firearms is one of the methods of committing a homicide. In Sri Lanka use of firearms was prominent among terrorists and underworld criminals. The analysis of the injury pattern will help to find the trends related to firearm injuries. Deaths that deviate from the routine pattern of injuries will be highlighted. Objectives: The objective of the study was to identify injury patterns in firearm related deaths. Methods: The data from 40 firearm related autopsy reports belonging to the investigators from the years 2000 to 2019 were entered to SPSS statistical package for analysis, based on a pre-prepared questionnaire. Results: Majority were in between 21 and 40 years (75%) and male (97.5%). Head alone was involved in 25% of deaths and head in combination with other regions was involved in 40% of the deaths. Cause of death (COD) in 50% of cases was head injuries alone and in 12.5% cases COD was from head injuries in combination of other injuries. Main motive was homicide in 72.5% of cases. Rifled firearm was the commonest weapon (90%). Range was distant in 65% of cases followed by close range in 17.5% of cases. Range was decided by the history, if available, appearance of entry wound and other observations. Conclusions: Scientific evaluation of deaths following firearm injuries demands proper assessment of range based on modem technology. This becomes more relevant if there is an incompatibility with the history and the appearance of the wound, especially when deciding circumstance of death.Item 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 AvailableItem 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.Item 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, DrowningItem Revising curricular on medical ethics: a way forward(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2020) Paranitharan, P.; Perera, W.N.S.ABSTRACT: In this modern era practicing medical ethics has become more demanding. The advancement of science with new technologies, new therapies and complex clinical trials has resulted in a situation where the current principles and concepts of medical ethics alone are not adequate in situations. Therefore, teaching ethics to medical students in a broader way as medical bioethics would cover the implications that result following treatment or research and is more beneficial for patients or participants. This paper illustrates the need of transforming the teaching of medical ethics to medical bio ethics as a way forward. KEYWORDS: Medical ethics, Medical bio ethics, practice, transformationItem 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)Item A Retrospective analysis of facial injuries in victims of road traffic fatalities.(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2018) Paranitharan, P.; Perera, W.N.S.; Perera, A.A.B.S.; Paranavithana, S.S.; Samanpura, L.ABSTRACT: Facial injuries play a significant role when it comes to medico-legal interpretation, category of hurt, cause of death and for compensation purposes. Road traffic accidents had been identified as a major contributor towards facial injuries. The main objectives were to identify the different facial injuries such as abrasions, contusions, lacerations and fractures, injury pattern, the distribution and to correlate the facial injuries with vulnerable road users. A pre-prepared questionnaire was used to extract information from the autopsy reports of road traffic accidents involving 59 victims covering a period from 2005 to 2014. Majority of the victims were males (79.7%) and belonging to the age group of 21-30 (22%) and 41-50 (22%). The vulnerable road users were mostly pedestrians (39%), followed by motorcycle riders (28.8%). Only few (6.8%) of the victims had teeth injuries. Most of the victims had injuries on the right forehead (44%) and right peri-orbital area (37.3%). The commonest type of facial injuries were abrasions which were 44 (grazed abrasions 30.5% and other types of abrasions 44.1%) followed by lacerations 38 (64.4%). The most common injuries on the right forehead were abrasions (20.3%) and lacerations (16.9%) while on the right peri-orbital area it was contusions (18.6 %). Majority of the victims were pedestrians and motor cycle riders. Most of the injuries were observed on the right forehead and right peri-orbital region and the commonest facial injury type was abrasions. A specific type of injury pattern was not identified to retrospectively suggest the involvement of a pedestrian or others.