Browsing by Author "Kitulwatte, I."

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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.
Comparative analysis of the pattern of intimate partner violence against women admitted to a tertiary hospital in Sri Lanka during and after the periods of COVID-19 lockdown
(Humana Press, 2024) Kitulwatte, I.; Gangahawatte, S.; Thanushan, M.; Thivaharan, Y.; Edirisinghe, A.; Dissanayke, C.; Jayathilaka, R.; Wijayarathne, P.
Lockdown measures during the COVID-19 pandemic resulted in restrictions on people's ability to move, allowing more time for intimate partners-this increased opportunities for intimate partner violence (IPV), especially against women. The study aimed to evaluate the characteristics of IPV against women during and after the lockdown period. A prospective, descriptive study on female victims of IPV presented from March 2020 to February 2022 to a leading teaching hospital in Sri Lanka. Out of the 876 patients admitted during the period, details could be obtained from 300 victims. Ninety-four (31%) were during the lockdown, while 206 (69%) were post-lockdown admissions. The mean age of the victim in both groups was 33.5 years. Even though physical abuse was high throughout, the prevalence of sexual abuse was significantly higher (p < 0.0001) during the lockdown period (31.9%) than during the post-lockdown period (3.4%). Financial problems (46.6%), followed by substance abuse (35%), were the most common risk factors during the post-lockdown period, while morbid jealousy (34%) was the most common risk factor, followed by extramarital relationships (33%) during the lockdown. Psychological consequences due to IPV were observed in 76.5% of victims during the lockdown period and only 11.2% during the post-lockdown period. The prolonged lockdown has significantly influenced mental and sexual health, changing the pattern of IPV against women. The need to have services to ensure the mental and sexual well-being of the community was highlighted.
Electrical injury of the neck and cardiac air embolism: a novel mechanism of death
(Humana Press, 2009) Kitulwatte, I.; Pollanen, M. S.
We report a case of air embolism in an industrial worker complicating a deep electrical injury in the neck. He was found dead in an upright position while his chest and head were resting on top of a live transformer. At autopsy, there were multiple electrical burns involving the face, neck, chest, and arms. There was a deep electrical burn associated with hemorrhage in the neck involving the skin, underlying subcutaneous tissue, strap muscles, and the thyroid gland. The internal examination showed a prominently bulging right atrium, which was filled with air and not blood. At autopsy, when the pericardium was filled with water and the right atrium opened, a large number of bubbles emerged. We concluded that death was due to air embolism complicating electrical damage to the neck veins. This case illustrates that acute complications of electrical burns rather than electrocution-related cardiac arrhythmia can be the mechanism of death in rare electricity-related deaths. It also reveals the difficulties encountered by the pathologist in determining the exact mechanism of death when there are competing mechanisms.
The establishment of a population-specific reference value for the ruler drop test for the clinical assessment of reaction time
(Elsevier, 2023) Rajapaksha, S.; Kitulwatte, I.; Senarathne, U.; Edirisinghe, A.; Perera, P.
BACKGROUND: Reaction time (RT) is the interval between a stimulus and an appropriate voluntary response in an individual. Alcohol is known to result in delayed RT. In Sri Lanka, an alleged drunken driver is legally subjected to a medico-legal examination to confirm or exclude impairment. The guideline for examining a drunk person in Sri Lanka includes the ruler drop test (RDT) as a test of RT. RDT is a simple test of visual reaction time in which the subject attempts to stop a falling ruler, and the height fallen is used to determine the time taken to react to the event. However, a formal study has yet to be carried out to establish population-specific reference values to interpret RDT results. METHODS: A cross-sectional descriptive study was conducted using 903 adults ≥18 years. A nonparametric approach was applied for deriving the reference values based on an inter-percentile interval. RESULTS: The study population consisted of 56.6% females, and the mean age of the participants was 41.6 years. Most (95%) of the study population could catch the ruler at or less than 40.0 cm of average height. The average height on RDT increased from younger to older age groups. However, subgrouping based on other variables, including sex, age, and alcohol consumption, did not show any statistically significant difference. CONCLUSIONS: The population-specific cut-off limit to identify alcohol intoxication by RDT in a Sri Lankan adult is 'average height' >40 cm.
A Study on the knowledge and attitudes on examination of patients for drunkenness among doctors involved in such examinations
(College of Forensic Pathologists of Sri Lanka, 2022) Appuhamy, H.D.S.C.P.; Kitulwatte, I.; Vaasuthevaa, K.; Shanker, K.; Senarathna, U.; Gangahawatte, S.D.S.
Introduction: Driving after consumption of alcohol is an offence in Sri Lanka according to the Motor Traffic Act. When a police officer suspects that the driver of a motor vehicle on the highway has consumed alcohol, he may request such person to submit himself immediately to a breath test for alcohol or to an examination by a government medical officer. Hence, the knowledge and attitude of doctors who perform examinations for drunkenness play a crucial role in the administration of justice. The objectives were to study knowledge and attitudes on examination of patients for drunkenness among doctors with different levels of expertise/experience who are engaging in such examinations. Study design: A cross-sectional descriptive study was performed using an interviewer-administered questionnaire, on doctors who engage in an examination of people for drunkenness. The knowledge was assessed by 8 comprehensive questions on the procedures and subjects scoring ≥75% were considered as having ‘satisfactory’ knowledge on the matter. Results: Out of the 306 doctors who participated in the study, 80% (n=246) were ordinary medical officers while there were 9.5% (n= 29) postgraduate trainees in Forensic Medicine and 10% (n = 30) specialists. One-third 34% (n=105) believed that their knowledge on examination procedures is poor. The procedure to be followed in the finger nose test was correctly identified by a majority 95% (n= 290) while only 35% (n= 107) were aware of the procedure to be followed in the one-leg stand test. Conclusions: According to this study, ordinary medical officers who perform a majority of medico-legal examinations for drunkenness in Sri Lanka were found to have poor knowledge on examination procedures. This can adversely affect the results of the tests in the examination of drunk and hence can lead to wrongful convictions. Thus, it is high time to fill the gaps in their knowledge through special professional training programs and by introducing a guideline.