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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 case report on inconsistent postmortem thyroid functions between femoral blood and vitreous fluid biochemistry(Walter de Gruyter, 2021) Senarathne, U.; Dias, V.; Kularathne, S.; Halangoda, S.; Jayasekara, V.D.; Kitulwatte, I.; Wijewardene, H.; Dayanath, B.BACKGROUND-AIM : Postmortem biochemistry can provide important information in determining the cause of death (COD). Out of postmortem specimens, vitreous fluid is ideal for postmortem biochemical analysis, as it is relatively isolated and less affected by postmortem changes (redistribution, hemoconcentration). However, equilibration of some analytes between blood and vitreous fluid can be affected by its anatomical location, as observed in this case, where postmortem femoral blood and vitreous fluid thyroid functions were used to conjecture premortem thyroid status of the patient in the absence of premortem values. METHODS: The postmortem specimens of femoral blood and vitreous fluid were obtained during the autopsy and analysed for thyroid hormones in the absence of premortem thyroid hormone values. RESULTS: A 28-year-old pregnant woman admitted at 26-weeks of gestation due to tachypnea and palpitations for 3-days. She had tachycardia (200bpm), with supraventricular-tachycardia on electrocardiogram, and poor left-ventricular function on echocardiography. She underwent an emergency hysterotomy to terminate her pregnancy but suffered a sudden death 6-hours after surgery. During the postmortem to ascertain her COD, vitreous biochemistry revealed a hyperthyroid picture with suppressed TSH and elevated free-T3 [TSH: 0.108mIU/L(0.465-4.68), free-T4: 13.22pmol/ L(10-28.2), free-T3: 12.74pmol/L(4.26-8.1)], while femoral blood had a euthyroid picture [TSH: 1.32mIU/L, free-T4: 13.3pmol/L, free-T3: 4.54pmol/L]. Postmortem thyroid histology showed detached follicular-epithelial-cells (autolytic changes), excluding autoimmune thyroiditis causing hyperthyroidism thus supraventricular-tachycardia as the COD. Her COD was confirmed as acute on chronic myocarditis by postmortem cardiac histology. CONCLUSIONS Based on the clinical presentation, hyperthyroidism was a differential diagnosis in this case leading to postmortem thyroid investigations. T3-toxicosis on vitreous biochemistry was confounding with detached follicular-epithelial-cells mimicking lymphocytes, misleading towards autoimmune thyroiditis. Differences in thyroid hormone transportation between compartments explain the inconsistency of thyroid status between femoral blood and vitreous fluid. This case highlights the need to interpret postmortem biochemistry cautiously and arrive at conclusions with a holistic approach. Due to the lack of literature on the correlation of postmortem to premortem biochemistry, the postmortem specimen type best representative of premortem thyroid function requires further research.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 unnatural childhood deaths presented to North Colombo Teaching Hospital, Sri Lanka(Sage Publishing, 2014) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.INTRODUCTION: Unnatural childhood deaths are not only associated with intense trauma and separation distress, but also relate to a sense of neglect to protect children from harm. Accurate information on causes and circumstances of such deaths through a process of medico-legal investigations is essential in creating an awareness among the policy makers and educators/caregivers, to prevent these tragic deaths. OBJECTIVE: The aim of the study was to determine the causes and the circumstances of unnatural deaths of children among the medico-legal autopsy population presented to North Colombo Teaching Hospital, Sri Lanka. STUDY DESIGN: A retrospective descriptive study was carried out based on Reports of Postmortem Examination performed in a Tertiary Care Hospital, on children who died of unnatural causes during the period from 2009 to 2011.RESULTS: Out of 48 unnatural childhood deaths, 24 (50%) children were older than 10 years of age. The most frequent circumstance of death was accidental 39 (81%), while the most frequent cause of death was drowning 16 (33%). Fifteen died due to accidental drowning while one was a homicidal drowning. Suicidal deaths were found only among the children older than 16 years of age. Fifty-four percent of the accidental deaths had taken place at or around the home. CONCLUSION: Accidents accounted for the majority (or greatest number) of tragic childhood deaths. The presence of drowning as the most common cause of death indicates that an immense responsibility lies with the parents and caregivers to prevent such deaths