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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Milky pleural effusion in a neonate and approach to investigating chylothorax(BMJ Publishing Group, 2021) Senarathne, U.D.; Rodrigo, R.; Dayanath, B.K.T.P.Neonatal chylothorax is a rare presentation leading to significant respiratory distress, thus requiring timely diagnosis. A preterm neonate was resuscitated and ventilated, following which she clinically improved but subsequently developed respiratory distress with a right-sided pleural effusion. Interestingly, thoracentesis fluid appeared 'milky' with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24 mmol/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients.Item 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 Forensic Medical Examination in Female Children Alleged to be Sexually Abused(Research Evolution Technology Press (Revotech Press), 2015) Kitulwatte, I.D.G.; Wijewardena, H.P.; Edirisinghe, P.A.S.; Senarathne, U.D.INTRODUCTION: Child sexual abuse is a global public health problem and the medico legal examination is directed to provide an objective, unbiased opinion on alleged sexual contact. There are many factors influencing such opinion. Objective: The aim was to study the factors influencing the medico legal opinion in female children who alleges sexual abuse. METHODOLOGY: A retrospective descriptive study was done based on medico-legal case records of female children who had been referred for medico legal examination following alleged sexual abuse during past 3 years to the Teaching Hospital Ragama, Sri Lanka. Data analysis was done with Statistical Package for Social Sciences (SPSS). RESULTS: We studied the records of 353 child victims for this research. The main presenting complaint was concerns of the guardian 168 (48%). Majority, 261 (74%) presented for medico legal examination 72 hours after the incident. The perpetrator was known to the victim in 339 (96%) cases. Recent injuries were observed only in 40(11%) victims while there were 184(52%) victims with old injuries. 122 (73%) out of 168 victims who were brought due to concerns of the guardians had genital injuries and of them only 11 (9%) had recent injuries. Psychological impacts were observed among 149 (42%) children. Out of the 74 victims who had experienced physical threats, only 12 (16%) had supportive injuries. Firm positive medico legal opinion as per the complaint was given in 218 (62%). CONCLUSIONS: Paucity of medical evidence is well observed in child sexual abuse and is a challenge to the medical expert. The mere absence of physical findings does not necessarily exclude the allegations of sexual abuse. Proper insight in to the presentation, pattern and factors influencing medical opinion is needed for proper administration of justice.