Medico-Legal Journal of Sri Lanka最新文献

{"title":"Injuries Due to Improvised Explosive Devices","authors":"K. M. T. B. Gunathilake, M. Vidanapathirana","doi":"10.4038/mljsl.v11i2.7486","DOIUrl":"https://doi.org/10.4038/mljsl.v11i2.7486","url":null,"abstract":"Illegal possession of improvised explosive devices (IEDs) is not uncommon. In Sri Lanka, they are commonly used for hunting, protecting cultivation, etc. Further, they are also used to commit homicides. An IED called “Hakka Patas” is produced by the material available in firecrackers and causes pressure-sensitive blasts. Another IED “Ali Wedi”, a kind of larger firecracker, may cause accidental injuries. However, the injuries caused by “Hakka Patas” and “Ali Wedi” are not reported in the forensic literature.Case 1: A child received severe crush injuries of the foot following a “Hakka Patas” explosion while walking. The wound was grossly contaminated and on the second day, a below knee amputation was done. Case 2: A farmer received injuries to his right hand while he was throwing an “Ali Wedi”. Due to gross crush injuries, the right index finger was amputated.Strict rules and regulations should be implemented to control illegal, locally-made explosive devices to prevent morbidity and mortality. Forensic pathologists should be familiar with the atypical patterns of injuries produced by improvised explosive devices.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"4 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatalities Following Fall from Heights Presented to Three Medico-Legal Units in Sri Lanka","authors":"A. Vadysinghe, D. Senasinghe, P. B. Dassanayake, M. Sivasubramanium, E. M. K. B. Ekanayake, B. Premaratne, R. M. I. S. D. Rathnayake, W. Wickramasinghe","doi":"10.4038/mljsl.v11i2.7483","DOIUrl":"https://doi.org/10.4038/mljsl.v11i2.7483","url":null,"abstract":"Introduction: Fall from heights is a common form of unintentional injury. The objective of this study is to determine the pattern of injuries, risk factors, and safety measures employed in relation to such falls.Methods: Data was collected from cases of fatal falls presented to the medico-legal units at Kandy, Peradeniya, and Panadura in Sri Lanka from 2005 to 2016.Results: In the sample considered the majority were males (93%) between 41-60 years (49%). Most were accidental (88%) and 41% sustained injuries by falls from trees. The commonest region of injury was the head and neck (71%) with the site of primary impact being the same. The most common injuries in the head, thorax, and abdomen/pelvis were skull fractures (60%), rib fractures (84%), and liver lacerations (59%), respectively. The main skull fracture was linear (67%), with the commonest site being the temporal (36%) and occipital (36%). With increasing height, the frequency of injuries to the thorax, abdomen, pelvis, and limbs also increased. Most (68%) died after being brought to hospital. Alcohol consumption was estimated as 10% in the sample considered.Conclusion: None had been using any safety equipment. This study underscores the importance of protective devices for people who work at heights to prevent fatalities. Compliance can be further enhanced by creating awareness among the vulnerable groups.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139149483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Medico-legal Death Investigation on Allegations of Elder Abuse in Seattle, Washington","authors":"S. Senathunga, M. Lubin, R. C. Harruff","doi":"10.4038/mljsl.v11i2.7485","DOIUrl":"https://doi.org/10.4038/mljsl.v11i2.7485","url":null,"abstract":"Introduction: Elder abuse is reported in one in six elderly people worldwide, thus, identifying its characteristics is very much crucial. Therefore, this study aimed to describe the characteristics of the decedents, and their complainants and alleged perpetrators in the elderly population in Seattle, Washington over ten years from 2010.Methods: A total of 8,739 medico-legal death investigations in elderly people aged 65 years or older were perused retrospectively at the King County Medical Examiner’s Office in Seattle, Washington. The records (n=161, 002%) contained allegations of elder abuse or neglect and were selected for analysis to describe the characteristics of the decedents, complainants and alleged perpetrators. The data were presented in frequency distributions. The complainants were categorized into five (families, hospice, care facilities, law enforcement and health providers) and alleged perpetrators were categorized into four (families, hospice, care facilities and health providers) and these categories were compared to each other. The presence of pressure ulcers and dementia were described according to the manner of death.Results: Out of 161 cases, the majority (n=97, 60%) were females and the age ranges from 65 to 99 years with a mean of 80 years (standard deviation=6). Most of the deaths were certified as ‘natural’ (n=110, 63%), while, 22 cases (14%) were certified as ‘undetermined’. Most of the complainants were health providers (n=69, 43%). Entities identified as alleged perpetrators were primarily long-term care facilities (n=77, 48%) or families (n=71, 44%). Further, families were less likely to be complainants (n=3, 12%) and more likely to be the alleged perpetrator (n=13, 52%) in deaths certified as ‘undetermined’ (n=25). Long-term care facilities were more likely to be identified as alleged perpetrators in deaths associated with dementia (n=24, 60%). The presence of pressure ulcers was more common (n=14, 56%) than dementia (n=6, 24%) in the ‘undetermined’ manner of death certification.Conclusion: This study demonstrates the importance of a medico-legal death surveillance system. The long-term care facilities and families were identified as alleged perpetrators; therefore, further studies are needed to identify their associated factors. Dementia was under-represented as a potential impetus behind many allegations, thus, conducting prospective studies and neuropathological assessments are recommended. To identify the correlation of racial/socioeconomic disparity, legal consequences on allegations of elder abuse or neglect are required to better understand the context.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"36 11-12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139149829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of the Vehicle of a Hit-and-Run Accident Based on Patterned Evidence","authors":"K. Munasinghe, M. Vidanapathirana, M. Rascon","doi":"10.4038/mljsl.v11i2.7488","DOIUrl":"https://doi.org/10.4038/mljsl.v11i2.7488","url":null,"abstract":"Leaving the scene of the traffic crash without reporting is called hit-and-run collision and tracing the alleged vehicle is the main challenge in delivering justice. However, it is not very difficult to trace the vehicle by using Locard’s principle when a vehicle leaves trace evidence either on the body/ clothing or scene. Hit-and-run collisions are a punishable offence as they delay crash notification thereby delaying emergency response which increases the likelihood of traffic fatalities. The following case discussion is based on a dead body of a foot cyclist found at a bend on a byroad in a rural area.He was a 72-year-old carpenter, non-alcoholic, driving an improvised foot cycle run by a motor, which could run up to 40 Kilometres per hour. There was a tire mark on the back side of his shirt. According to the police, the foot cycle had been found fallen on the road without runover injuries. The autopsy revealed multiple blunt force injuries including grazed abrasions on the head, chest, and limbs. Internal organs did not show any significant evidence of natural illness or intoxication. However, there were no paint, grease, glass fragments, etc., or CCTV record evidence. However, a motorcyclist saw a tractor with a trailer stopped beside the victim and the driver was standing by the side and drove off in a while.The absence of paint or grease on the body suggested that the floorboard of the offending vehicle could be higher. The alleged tractor with the trailer was taken into police custody based on a tipoff. According to the Government analyst’s opinion, the tire mark on the shirt was compatible with the tire tread pattern of the right rear tire of the tractor-trailer. The cause of death was multiple injuries to the head and chest due to run-over by a moving vehicle. The importance of examination of clothing in road crashes especially in hit and run is reemphasized in this case.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"42 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Post-mortem PCR Testing on Lead Time of the Medico-legal Death Investigation. A Retrospective Study During the COVID-19 Pandemic in a Tertiary Care Hospital in Sri Lanka","authors":"H. D. S. C. P. Appuhamy, R. Samaranayake, S. Manjika","doi":"10.4038/mljsl.v11i2.7484","DOIUrl":"https://doi.org/10.4038/mljsl.v11i2.7484","url":null,"abstract":"Introduction: The lead time is defined as the time between the beginning of a process or project and the appearance of its results. A post-mortem nasopharyngeal swab is the preferred specimen and Real-time reverse transcriptase-polymerase chain reaction-based assays remain the “gold standard” for the detection of severe acute respiratory syndrome coronavirus 2. Although the RT-PCR provides a relatively rapid result (average 6 hours) the process of post-mortem specimen collection, transportation, and real-time polymerase chain reaction testing lead to the increased time duration of releasing the deceased to the next of kin. This study aims to assess the effectiveness of the institutional policies governing autopsies adopted during the COVID-19 pandemic at the medico-legal unit of Matale in decreasing the lead time of medico-legal death notification.Methods: This study was conducted at the medico-legal unit of District General Hospital Matale, Sri Lanka. All data was collected from the post-mortem reports and records maintained at MLU of Matale from May 2021 to December 2021. All the post-mortems conducted by the author (442 autopsies) were included.Results: The study population comprised of 283 (64%) males. The majority (30%, n=134) of the decedents were more than 80 years. The mean age of the deceased was 69.20 years and the standard deviation was 17.881. The majority (66%, n=291) of the descendants were Sinhala. The majority of inquests (n= 423, 96%) were conducted by inquire into deaths. In the months of August and October number of autopsies performed had increased 4 times and 3 times respectively to that of the same period in previous years and the following year. Out of the autopsies, 23% (n= 101) of the lead time of autopsy was on the same day of death. In the majority (64 %, 85) of the deaths lead time of autopsy was the next day of the death.Conclusion: During the COVID-19 pandemic, excess mortality was detected, lead time of autopsy was reduced due to the policies adopted by the medico-legal unit. Lessons learned during the pandemic may help improve resource utilization without negatively influencing outcomes in a low-resource setting.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"20 s7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quality-Assured Medico-Legal Service Through Human Resource Management in the Medico-Legal Unit of Sri Lanka","authors":"P. Appuhamy","doi":"10.4038/mljsl.v11i2.7482","DOIUrl":"https://doi.org/10.4038/mljsl.v11i2.7482","url":null,"abstract":"A specialist in forensic medicine has a dual role in Sri Lanka. These are conducting autopsies on death and the medico-legal examination of living cases of physical and sexual assault, poisoning or alcohol intoxication, etc. To deliver a quality-assured forensic service human resources play a pivotal role. The present workforce of a medico-legal unit consists of a specialist in forensic medicine, a medical officer medico-legal, a development officer, a morgue assistant, and a female healthcare assistant. Due to the lack of necessary professional skills among non-medical staff members and the lack of proper job descriptions for the non-medical staff members some pivotal functions in the medico-legal unit are handled by the less qualified staff members. We suggest that the relevant professional bodies in collaboration with ministries, develop standardized job descriptions and allocation of roles for non-medical staff members across the medico-legal units in the country so that the institutions and all the stakeholders adhere to the duties specified to improve the desired quality of the medico-legal unit.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"73 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amniotic Fluid Embolism: A Case Report","authors":"K. Munasinghe, M. Vidanapathirana","doi":"10.4038/mljsl.v11i1.7481","DOIUrl":"https://doi.org/10.4038/mljsl.v11i1.7481","url":null,"abstract":"Amniotic fluid embolism (AFE) is known to cause a serious reaction triggered by the entry of amniotic fluid or other debris into the maternal circulation.[1] It has been recently suggested that amniotic fluid embolism is an anaphylactic syndrome of pregnancy involving the complement system, causing vasospasm, oedema, and early onset disseminated intravascular coagulation (DIC), which is one of the causes of sudden death in obstetrics.[1] Suspicion of (AFE) should be considered in any antepartum or postpartum collapse if no obvious cause is known. We present a case of a 35-year-old mother at 35 weeks of gestation who collapsed during her early labour with no clue about the diagnosis and died soon after the admission despite vigorous resuscitation.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"57 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114003282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modified Cosmetic Technique for Head and Neck Dissection in Autopsy Especially for Bald-headed Deceased","authors":"P. Appuhamy","doi":"10.4038/mljsl.v11i1.7472","DOIUrl":"https://doi.org/10.4038/mljsl.v11i1.7472","url":null,"abstract":"The autopsy is a specialized procedure in which a pathologist performs a thorough external and internal examination including dissection of the organs from different body cavities such as cranial, thoracic, abdominal, and pelvic. In such dissection of an intact dead body, disfiguration and destruction are likely. When viewed during a funeral service, the currently practiced conventional autopsy dissection techniques can result in minimal tell-tale autopsy marks on the body of the deceased, in exposed areas of the head and neck even when the other areas of the body are covered with clothing. We propose a modification to the conventional skin incision over the head and neck in a way that the incision is placed over the back of the head and neck compared to the conventional incision over the sides of the head and sides of the neck. In this way, the incisions and their stitch marks are hidden, making them cosmetically sound. Although the exposure gained through the proposed method is similar to the conventional method additional incisions over the back of the neck with the additional turning of the body from supine to prone can increase the time duration of the autopsy compared to the conventional method. Moreover, in this method, the incisions are invisible even in a bold-headed deceased as the head incision is placed over the back.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130459659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Death Certification of Cause of Death in Home Deaths by Grama Niladhari in Selected Divisional Secretariat Areas of Sri Lanka","authors":"P. Appuhamy, R. Samaranayaka, S. Manjika","doi":"10.4038/mljsl.v11i1.7475","DOIUrl":"https://doi.org/10.4038/mljsl.v11i1.7475","url":null,"abstract":"Introduction: Accurate and complete medical data on the cause of death are critically important for designing and evaluating health programs and policies. Mortality medical data on deaths that occur inside a healthcare facility are certified by medical officers and therefore they are considered to be reliable and accurate. However, approximately one-half of the 130,000 deaths which occur each year in Sri Lanka take place outside a healthcare facility. There are several death certification systems existing for getting a death registered after determining the cause of death and obtaining the death certificate in home deaths in Sri Lanka without the involvement of a medical officer. Those systems involve either Inquire into Sudden Death, Grama Niladhari, Police Officer, or Estate Superintendent as the individual responsible for stating the cause of death. Few studies have analysed the causes of death stated by the ISD however, there are no published studies that have analysed the cause of death stated by Grama Niladharies on home deaths in Sri Lanka.Methods: This retrospective cross-sectional descriptive study was carried out on home deaths that occurred between September 2021 and September 2022 in the Matale and Ukuwela divisional secretariat areas of Sri Lanka using secondary data collected from B 24 forms which were filled by Grama Niladhari of respective divisions.Results: The study included 230 home deaths. 72% of medical records were of poor quality to assign a cause of death. In all these death certificates, the cause of death was not stated according to the WHO format of the cause of death. Fifty-four percent used an ill-defined condition as the underlying cause of death. Cancer was the cause of death in 11% of adults and accounted for the highest number of cases.Conclusions: Grama Niladhari in Sri Lanka has difficulties in completing the cause of death accurately. They routinely made errors in death certification because of these inaccurate causes of death. This situation needs rectifiable measures as home death data is very vital for certain healthcare decisions.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126264270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Victims of Interpersonal Violence Presented to Emergency Department, Teaching Hospital, Karapitiya","authors":"Wijenayaka, C. Wijesinghe, P. Ruwanpura","doi":"10.4038/mljsl.v11i1.7473","DOIUrl":"https://doi.org/10.4038/mljsl.v11i1.7473","url":null,"abstract":"Introduction: Violence is a universal phenomenon and timely data is of paramount importance in prevention through community interventions.Objectives: To identify predispositions of interpersonal violence, injury characteristics, and outcomes of victims presented to the emergency department (ED) of Teaching Hospital, Karapitiya (THK).Methodology: A cross-sectional study was conducted among 385 victims of interpersonal violence admitted to ED, THK using an interviewer-administered questionnaire and medical documents which were analysed using SPSS. The mental state of victims was assessed using MMSE.Results: The majority was male (77%), aged 30-49 years (36%), and from lower social classes (77%). The commonest places of violence were home (28%) and community (26%). The majority reported physical/verbal violence (96%). Sexual violence was less common (2%) and significantly associated with female-gender (p=0.001). The frequent assailant was an acquaintance (65%). The commonest reasons were property (33%) and financial (31%). The commonest weapon was blunt objects (81%) and the least common was firearms (1%). Common predispositions were peer (49%) and alcohol (37%) related, while 27% had kids with criminal records. Contusions (40%) were the most prevalent injury followed by abrasions (33%). Head and face (41%) and upper limbs (38%) were common sites. The commonest category of hurt (COH) was non-grievous (61%) followed by grievous (24%), Fatal (FIOCN) (3%), and endangering (1%). Approximately, 45% underwent surgeries, 2% were admitted to ICU and 1% died. COH was significantly associated with the mental state (p<0.001) and smelling of alcohol (p=0.002).Conclusion: Physical/verbal-violence was common in males, whereas sexual-violence was strongly associated with females. A considerable proportion had grievous injuries which were significantly associated with mental state.","PeriodicalId":446761,"journal":{"name":"Medico-Legal Journal of Sri Lanka","volume":"159 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116393682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}