Browsing by Author "Senarathne, U.D."

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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.
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.
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.
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.
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.
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, Fractures
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.
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.