The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on global health. Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health. METHODS: An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities. RESULTS: During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group. CONCLUSION: The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, healthseeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.

Renal bioaccumulation of trace elements in urban and rural Sri Lankan populations: A preliminary study based on post mortem tissue analysis.

INTRODUCTION: Environmental pollution, especially by toxic trace elements, is a global health concern. Heavy metals such as Cadmium (Cd), Arsenic (As) and Lead (Pb) are associated with numerous disorders and are considered by some as an aetiological factor for the Chronic Kidney Disease (CKDu1) epidemic in Sri Lanka. This study explores patterns of bioaccumulation of six trace elements in kidneys obtained during forensic autopsies from urban and rural regions in Sri Lanka. METHODS: Kidney samples obtained from one urban district (n = 13) and three rural districts (n = 18) were lyophilized, microwave digested and profiled by ICP-MS techniques. RESULTS AND DISCUSSION: The mean age of the sampled population was 47.9 ±â€¯11.3 yrs. Median (IQR) for Cd, As, Pb, Cr, Zn and Se were, 14.67(8.04-22.47) µg/g, 0.44(0.29-0.56) µg/g, 0.11(0.07-0.30) µg/g, 0.15(0.1096-0.3274), 25.55(17.24-39.35) µg/g and 0.52(0.37-0.84) µg/g, respectively. Cd, Zn and Se levels were significantly higher (p < 0.05) among the urban samples compared to that of the rural group. Zn and Se levels were higher among younger age groups. As, Pb and Cr did not show any significant differences between the two cohorts nor any correlations with age. CONCLUSION: This population-specific baseline study provides an insight into the differences in exposure to toxic trace elements and essential elements between urban and rural populations. Residents in CKDu affected rural districts did not appear to be at risk of toxic heavy metal exposure, however their renal bioaccumulation of nephroprotective essential elements was lower than urban residents.