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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Blood alcohol concentration in motorcycle fatalities reported to a tertiary care hospital in Sri Lanka(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Senarathne, U.D.; Edirisinghe, P.A.S.; Kitulwatte, I.D.G.BACKGROUND: Motorcycle, the common man’s vehicle in Sri Lanka when crashes is fatal due to its inherent instability and absence of an outside shield to absorb energy during a collision. Managing an unstable vehicle after consuming alcohol, a central nervous system depressant, increases the risk of a fatal collision. Research on motor-cycle fatalities and blood alcohol concentrations has not been reported from Sri Lanka earlier. OBJECTIVES: To describe the contribution of blood alcohol concentrations (BAC) to fatal motorcycle accidents. METHODS: A retrospective descriptive study based on post-mortems of motorcycle fatalities referred to a tertiary care hospital from 2010-2014 was done using a pro-forma. RESULTS: Out of 180 motorcycle accidents reviewed, 166(92%) were riders, 14(8%) were pillion riders. 171(95%) were males and majority (n=142, 79%) were between 20-60 years of age. BAC was requested for 88(49%) and reports were available only for 76(86%) victims. Out of them 34(45%) had BAC >80mg/100ml. The highest BAC reported was 428mg/100ml with the mean value being 104mg/100ml. Cause of death (COD) given for 78(43%) victims was head injury for 69(38%) multiple injuries. Presence of >25 injuries (p=0.028) and COD given as multiple injuries (p=0.029) were significantly associated with BAC >80mg/100ml. CONCLUSIONS: Having BAC >80mg/100ml significantly contributes to the motorcycle rider being subjected to more injuries in a collision. Since less than half the cases were subjected to BAC analysis, actual magnitude of the problem could be greater than illustrated by the study.Item A study on factors influencing medico legal opinion in alleged sexual abuse(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kitulwatte, I.D.G.; Wijewardena, H.P.; Edirisinghe, P.A.S.; Senarathne, U.D.BACKGROUND: Aim of medico-legal examination in alleged sexual abuse is providing an opinion on physical/sexual contact between individuals. Supportive scientific evidence is often absent and experts are in a dilemma. OBJECTIVES: To identify the limitations of medico legal opinion in alleged sexual abuse and the factors influencing these limitations. METHODS: A retrospective descriptive study based on medico-legal case records of females who had been referred to a Teaching Hospital in the Western province of Sri Lanka following an allegation of sexual abuse during a period of 3 years (2012-2015). Data analysis was done with Statistical Package for Social Sciences (SPSS). RESULTS: Out of 441 medical records perused, the main complaint (n=180, 40%) was related to concerns of the guardians. Majority (n=302, 68%) had presented for medico-legal examination 72-hours after the incident. Giving a firm positive medico legal opinion as per the complaint had been possible in 280(63%). A firm opinion could not be given in 19 (86%) out of 22 victims reporting intracrural intercourse and for 22 (79%) out of 28 victims complaining of fingering. Out of 376 victims with no recent injuries, 276 (73%) presented late. Out of the 128 victims who had experienced physical threats, only 35 (27%) had supportive injuries. CONCLUSIONS: Many factors including late presentation and type of complaint influence the medico legal opinion in a case of sexual abuse and therefore it is a challenge to the forensic expert. Thus, proper administration of justice needs an insight into these factors, challenges and the limitations.Item Injuries in the vulnerable road user fatalities; a study from Sri Lanka(Elsevier, 2014) Edirisinghe, P.A.S.; Kitulwatte, I.D.G.; Senarathne, U.D.Vulnerable Road Users defined as people at risk in traffic due to absence of an outside protective shield to absorb energy during a collision are mainly pedestrians, bicycle riders and motor cyclists. In low income countries, deaths of VRUs outnumber vehicular drivers and occupants. A forensic pathologist not only reports the cause of death but also forms opinions on type of road user. We attempted to find whether pedestrians could be differentiated from other types of VRUs. A retrospective descriptive study, based on case records of VRUs fatalities from 2005 to 2012 referred to a tertiary care unit for post-mortem examination, was conducted. A pro-forma was developed to extract data from the post-mortem reports and toxicology reports. Data was analysed using SPSS version16. Out of the 328 cases 48% (n = 157) were pedestrians while 45% (n = 147) were riders/pillion riders of two wheeled vehicles and 5% (n = 16) were drivers/occupants of three-wheelers. The majority (87%) was males and 43% of pedestrians were elderly. 59% had 10–25 injuries and 87% had external injuries in the head, face and neck. The majority of skeletal injuries were in the skull followed by ribs. Analysis of different variables of pedestrians to other types of VRUs showed that the variables of, elderly male, road crosser, skull injuries, brain injuries, cause of death being head injuries and multiple injuries were significantly greater among pedestrian group (p: <0.001). The traffic hours (peak and off peak), number of injuries, rib injuries, limb injuries, crushed/run over injuries or lung and liver injuries had no significant association. Although some features helped in determining a pedestrian, many other factors were not associated to differentiate a pedestrian from other VRUs. Therefore, a forensic pathologist has to be cautious in expressing opinions when other corroborative evidence is lacking.Item A Study into blood alcohol concentration in fatal accidents among vulnerable road users in a tertiary care hospital Sri Lanka(Informa Healthcare, 2015) Edirisinghe, P.A.S.; Kitulwatte, I.D.G.; Senarathne, U.D.Reckless driving behaviour associated with alcohol has been well known. In Sri Lanka, research on blood alcohol concentration (BAC) in roadfatalities is scares. Thus, we studied the BAC in vulnerable road users (VRUs) encountered in medico-legal autopsies. A retrospective descriptive study based on case records of VRU fatalities from 2005 to 2012 referred for a tertiary care unit for post-mortem examination was conducted. A pro-forma was developed to extract data from the post-mortem blood alcohol reports. Data were analysed using percentages and p-values. There were 119 cases from the 328 autopsies to investigate blood alcohol tests. A total of 51% (n = 61) out of 119 had BAC above 80 mg/100 ml and mean level was 103 mg/100 ml. 2/3 of pedestrians had a BAC above 80 mg/100 ml with a mean level of 139 mg/dl. The highest mean blood alcohol (158 mg/dl) was reported from three-wheeler users. Majority of cases with more than 80 mg/100 ml BAC was reported in the age group of 40-60 years, while 40% of the elderly too had a BAC above 80 mg/100 ml. The comparison between pedestrians having above 80 mg/100 ml of BAC with that of other VRUs (active road users) showed a significant statistical difference (p = 0.017). Thestudy results suggest that alcohol influence among pedestrians represent a significant risk factor for fatal road traffic accidents.