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.

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.

A case of early pulmonary embolism following blunt trauma to chest and a long bone fracture: a case report.

Background: After substantial trauma, pulmonary embolism (PE) carries a high risk of morbidity and mortality. Early post-traumatic PE in the absence of deep vein thrombosis (DVT) is a distinct entity that might be connected to rare mechanisms or unidentified biochemical processes. Case presentation: A driver of a car was presented with worsening chest pain and shortness of breath (SOB) following a road traffic accident in which he suffered an impact on the chest against the steering wheel and a closed fracture of the right femur. Radiological investigations revealed a pulmonary embolism in the left posterior segment pulmonary artery, without evidence of internal chest injuries or DVT within 12 h from the incident. D-dimer, troponin I, and creatinine kinase were elevated without evidence of myocardial infarction or myocardial injury. Other parameters were within the normal range. Conclusions: Possibilities of early PE in the absence of detectable DVT could be due to hyper-coagulability states, clots from the lower extremity completely getting detached and embolizing to the pulmonary circulation, screening errors, and "de novo" thrombi in the pulmonary circulation. Chest trauma is an identified risk factor for early or late pulmonary embolism. Action of the post-traumatic adrenergic response causing vascular endothelial inflammation and the synthesis of circulating adhesion molecules leading to localized thrombosis have also been suggested as causes for this phenomenon. A greater understanding of rare risk factors for early PE and the possibility of rare complications of chest trauma is useful in detecting and treating them in time, reducing morbidity and mortality.

Death of a child following a superstitious ritual of exorcism.

INTRODUCTION: Diseases, especially those related to the psyche produced by demons, are an accepted belief in many communities. This paper elaborates on the death of a child, a victim of an exorcism ritual, and calls for adequate awareness and preventive measures. CASE REPORT: The deceased, a 9-year-old child, was taken by her mother to an exorcist to 'expel a demon from her body. The exorcist caned the child for two days while giving 'water' to drink. On the second day, the child lost consciousness and was pronounced dead on admission. On direct questioning, it was revealed that the child had been made to consume some medicinal syrups forcefully by the mother and the exorcist. The autopsy revealed multiple abrasions, tram-line contusions and burns on the body. There was mottling and consolidation in the lungs. Blood-stained secretions were found in the trachea, bronchi, and stomach. Musculoskeletal dissection revealed subcutaneous haemorrhages and muscular contusions over the buttocks and limbs. Histology revealed evidence of well-established aspiration pneumonia. There was no other significant pathology, especially no evidence of acute kidney injury due to rhabdomyolysis. Toxicological analysis was negative for common poisons, therapeutic drugs, and heavy metals. The cause of death was concluded as aspiration pneumonia in a child subjected to physical violence. CONCLUSION: With the forceful feeding of the syrup, the child can have aspiration, resulting in aspiration pneumonia. At the same time, it appears that even after the child became symptomatic, she had not been brought for medical treatment but had continued with the same exorcistic therapy. While the caregivers become responsible for the child's death, the lessons to be learnt are enormous. Thus, banning such practices against children is a need of the hour.

A Study on Victims of Intimate Partner Violence Reported to Colombo North Teaching Hospital, Sri Lanka During 2019-2021.

Introduction: Intimate partner violence (IPV) is a common issue in any society and the reported cases are just the tip of an iceberg as most of the victims are reluctant to come to the criminal justice system. Forensic experts are often encountering the victims who chose to seek justice. Evaluation of the nature, consequences, and underlying factors are needed in planning preventive measures. Objectives: To describe the patterns and associated factors of IPV among victims who reported to Office of the Judicial Medical Officer of Colombo North Teaching Hospital and to specifically describe the patterns prior and during the COVID-19 pandemic. Methods: A retrospective descriptive study based on 471 medicolegal records of the victims who had undergone medicolegal examination following IPV during last two years (March 2019 to February 2021). Results: Out of 471, 206 cases were reported prepandemic and 265 reported postpandemic periods. Even though majority were females there were 21 males. Types of abuse were complex and often interrelated. There were 463 who had experienced physical injuries while there were 20 who had been subjected to sexual violence. Face was the commonest target of assault (63%). Substance abuse was identified as the commonest predisposing factor (56%). Even though repeated abuse was common, 42.5% of the victims had never made any complaints to the police. Despite multiple complains, 39.7% had experienced repeated violence. Conclusion: Victims of IPV are silently suffering for many long years. Failure in the response from authorities was identified. COVID-19 pandemic has become an additional risk factor for IPV. Strengthening of legal and social responses is the need of the hour.

Medicolegal Aspects of Victims of Assault Admitted to a Tertiary Care Hospital in Sri Lanka.

Introduction: Violence with physical assault is a common cause of morbidity and mortality prevalent but not limited to underdeveloped countries. The opinion of the forensic expert is often indispensable in such cases to determine the penalties. This study was planned to describe the pattern of presentation of the victims and evaluate the strengths and limitations in formulating a scientific medicolegal opinion based on the findings of the victim. Methods: A retrospective descriptive study based on the case records of the victims of assault admitted to Colombo North Teaching Hospital, Ragama, Sri Lanka, was conducted for four years. Results: Out of the 400 victims, the majority (72% n = 290) were males and of the age-group of 21 to 40 (n = 216). The reason for assault in the majority was sudden provocation (n = 99, 25%), followed by previous long-duration enmity (n = 89, 22%). The majority (83%) had isolated blunt force trauma, and the injuries were nongrievous (74%). Defense injuries were significantly associated with attempted defense (p = 0.000) and sharp force trauma (p = 0.002). The underlying reason for the assault was not significantly associated with the causative weapon (p = 0.228) or body region injured (p = 0.195). Conclusions: Even though the presentation and the pattern of injures are definitely of value in formulating a scientific opinion, the study identified the limitations of the forensic experts, and the need for a holistic approach at the investigations was highlighted.

Medico-Legal Opinion Based on Autopsy Findings of a Victim of an Explosion Involving Mass Fatality.

INTRODUCTION: Investigation into explosions is one of the major areas in forensic medicine and pathology. Medico legal issues associated with these deaths are diverse and forensic experts are often expected to make clarifications. Assistance of a methodical scientific investigation of such a death in evaluation of unanswered medico legal issues, of an autopsy of one of the victims of Easter Sunday explosions is discussed. CASE HISTORY: The deceased was a 15-year-old girl who was participating in the Easter mass at St. Sebastian's Church - Kattuwapaitya, Negombo, Sri Lanka when a suicide bomber blew himself up. The mother of the deceased noticed the deceased being rushed to the hospital. However, she was pronounced dead on admission. Pre-autopsy radiology revealed spherical shrapnel in the temporal region. At autopsy, the fatal injury was found on the head and a detailed study revealed skull fractures associated with penetration by 3 shrapnels. There was a keyhole lesion among the penetrations. Internal examination revealed an extensive dural tear underlying the compound fracture. The brain was grossly edematous with lacerations on the frontal and parietal lobes associated with localized subarachnoid hemorrhage. There were multiple underlying contusions on bilateral frontal white matter. Small subarachnoid haemorrhage was noted on the basal aspect of the brain. DISCUSSION: Careful evaluation of the autopsy findings assisted in formulating the opinion scientifically on event reconstruction including the proximity of the victim to the epicenter of explosion and nature of explosive device, period of survival, mechanism of causation of skull fractures and the mechanism of death in addition to the cause of death. CONCLUSION: A forensic pathologist following a meticulous autopsy examination, along with a team of ballistic experts and specially trained police personnel play a pivotal task in analyzing a scene of explosion and an autopsy of a victim, in concluding the case and in bringing justice to all the victims and survivors of the catastrophe.