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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item 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 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.