Retrospective analysis of factors affecting rate of skeletonization within a tropical climate.

Estimating the post mortem interval (PMI) in skeletonized cases is an extremely challenging exercise. Sri Lanka lacks adequate taphonomic research which is a serious limitation when assessing PMI in forensic death investigations. Methods that have been proposed to estimate PMI using the total body score (TBS) and accumulated degree days (ADD) are mainly based on data from continental and temperate climates and have shown less reliability in tropical climates. With the intention of developing a region-specific, evidence-based guide which would be applicable to tropical climates like Sri Lanka, we selected thirteen skeletonized remains with known PMIs from forensic case records and analysed their taphonomy in relation to selected weather data. We also compared the ADD values within our dataset with reference ranges calculated using published formula. All except one were found from outdoor locations. The TBS ranged from 24 to 32 and had a weak positive correlation with the PMI. The earliest appearance of skeletonization was 15 days in a body found indoors. The highest rate of skeletonization was seen in a body with a TBS of 32 and a PMI of 23 days. The average daily temperature and relative humidity were similar across all the cases however, the amount of rainfall varied. Bodies exposed to monsoon rains (n = 6) had a lower mean rate of skeletonization compared to those that were not exposed (n = 4) suggesting lower rates of decomposition during periods of heavy rainfall. No correlation was found between ADD and TBS. In 9 (69.2%) cases, the actual ADD was much lower than reference ADD ranges for TBS values, indicating poor applicability of TBS and ADD based formulae in estimating PMI within the Sri Lankan climate. Our study shows a strong need for taphonomic and entomological research in tropical climates to further explore the impact of monsoons on biotic and abiotic factors affecting skeletonization.

The establishment of a population-specific reference value for the ruler drop test for the clinical assessment of reaction time.

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.

Survey on postmortem screening and management of COVID-19 related deaths.

The COVID-19 pandemic is associated with a high case fatality rate in some countries even thought the majority of cases are asymptomatic. Scientific studies on this novel virus is limited and there is uncertainty regarding the best practices for death investigations both in terms of detection of the disease as well as autopsy safety. An online survey was conducted to identify how different institutions responded to the screening and management of dead bodies during the early phase of the pandemic from January to May. A questionnaire was developed using Google Forms and data was collected from 14 different forensic and pathological institutions in 9 countries. None of the institutions had performed any screening prior to March. Four institutions stated that screening was done routinely. In total, 322 cases had been screened using RT-PCR, out of which 40 positive cases were detected among four institutions. The commonest types of samples obtained were nasopharyngeal and oropharyngeal swabs which also had the highest rates of positivity followed by tracheal swab. Blood, swabs from cut surfaces of lung and lung tissue also gave positive results in some cases. Majority of the positive cases were > 65 years with a history suggestive of respiratory infection and were clinically suspected to have COVID-19 before death. Except for one institution which performed limited dissections, standard autopsies were conducted on all positive cases. Disposal of bodies involved the use of sealed body bags and labelling as COVID positive. Funeral rites were restricted and none of the institutions advocated cremation. There were no reports of disease transmission to those who handled COVID positive bodies.