Amal Nishantha Vadysinghe

• MBBS.DLM.MD.FCFPSL
• Specialist in Forensic Medicine at University of Peradeniya

Background Intimate partner violence (IPV) is a worldwide issue with a high prevalence rate seen in Asia. Aims and Objectives To plan and implement preventive measures, it is important to understand the characteristics, background, and medico-legal significance, especially from the perspective of perpetrators. Materials and Methods This study is...

In Sri Lanka, where a majority follows Theravada Buddhism, there are rituals and norms related to the ordination of monks, as well as a process of certification. An 8-year-old male novice monk was presented for clinical forensic examination following an assault at a temple by several other fellow novice monks. Further investigation revealed that th...

Gloriosa superba (GSb), or Glory Lily, is not an uncommon plant found in Sri Lanka. Every part of the plant is poisonous, especially the rhizome. It contains mainly colchicine and gloriocine which are toxic alkaloids. Fatalities following ingestion are rarely reported with current medical management. A 37-year-old male, with history of cannabis dep...

The objective of this study was to determine the relationship between sex and height and handprint measurements in a Sri Lankan population. A stadiometer was used to measure height of 226 Sri Lankan subjects aged between 20–30 years. Palmar prints were obtained on paper using fingerprint ink. The palmar and axial tri-radii were identified and a cal...

Introduction: Fall from heights is a common form of unintentional injury. The objective of this study is to determine the pattern of injuries, risk factors, and safety measures employed in relation to such falls. Methods: Data was collected from cases of fatal falls presented to the medico-legal units at Kandy, Peradeniya, and Panadura in Sri Lanka...

Injuries due to automobile safety devices have been reported and we report a rare fatality due to a defective airbag system. A compact hybrid car driven by a 37-year-old male at moderate speed had crashed through an unprotected manhole. The car had moved around 200 m before it came to a halt. The passers-by had noticed that the driver was unconscio...

Also published as a case report on doi: 10.1007/s12024-023-00715-1

Introduction: According to statistics, 70% of reported rape cases had happened with the willingness of the female partner, where the law enforcement authorities have charged as the victim is below 16 years. This study evaluated the sexual victimization of such females by their partners in relation to the age gap between the couple.Methodology: This...

Introduction: Sex determination using human skeletal remains is a challenging task for forensic practitioners and foramen magnum is used at lesser extents for this purpose. The aim of this study was to determine the sex by evaluating the parameters of the foramen magnum in a Sri Lankan population using computed tomography (CT). Methods: CT images o...

Explosives are potentially harmful devices that can create an explosion by a rapid release of a pressurized gas consequent to a chemical reaction within the device. They can inflict a variety of injuries, due to the blast wave, fire, and shrapnel. The pattern and severity of injuries will be determined by various factors, including explosive potent...

Vaginal foreign body (VFB) can be a routine presentation to a pediatric unit, especially with associated vaginal discharge. Although it can be rare, this case series highlights that child sexual abuse (CSA) should not be ignored as a possibility when such a presentation is investigated. In the first case, an 11-year-old school girl presented with v...

Objective Morphometry of frontal sinuses has been studied extensively in many countries. However, these findings cannot be generalized due to genetic and environmental factors affecting the skeletal structure. The main aim of this study was to morphometrically analyze the frontal sinuses in patients who underwent non-contrast computed tomography (N...

Also published as case report on doi: 10.1007/s12024-022-00574-2

Background The common causes of early postpartum maternal deaths are cardiomyopathies, obstetric hemorrhage, hypertensive disorders, and sepsis. However, a maternal death from choking together with aspiration of gastric contents is a rare occurrence to be diagnosed at the autopsy examination. Case presentation A 27-year-old previously healthy lady...

Cyber-bullying is a global issue in the current era. The main objective of this study was to identify the prevalence and determinants of cyber-bully victimization and to analyze the impact of COVID-19 pandemic. A self-reported questionnaire collected data from students aged 14–17 years in Sri Lanka in September 2020. Prevalence of any form of bully...

Introduction: Air guns are widely used for recreation and to protect crops from animals. It is a pneumatic weapon capable of inflicting serious life-threatening injuries. The authors present a case of a child subjected to a life-threatening pellet injury to the head due to discharge of an air gun while playing. Case report: A 3 ½ year old male chi...

Abstract Introduction: Trap guns are a type of home-made firearms common to Sri Lanka. Prevalent in the rural regions of the country, their main purpose is to protect crops from wild animals. It consists of a long metal pipe with a basic firing mechanism which is activated by a trip wire. Although the firing range and capacity to injure are low, th...

Introduction: Many characteristics of the skull bones used in identification are subjective. Since the human skull thickness (HST) can be used as a more objective criterion, it can be used in more accurate identification in forensic anthropology, and according to literature; no such studies were conducted in Sri Lanka. The aim of this study is to a...

Acute appendicitis (AA) in neonates and infants is an infrequent event. In day-to-day practice, death due to AA is hardly ever reported to a coroner or a medical examiner. Here, we report on an 8-month-old infant assigned to the medical examiner as the death occurred within 10 days of a surgical procedure. The cause of death was undetermined. Autop...

BLAST INJURY FOLLOWING LOCALLY MANUFACTURED “HAKKA PATAS”- A CASE REPORT Home-made devices such as “Hakka patas” although having a low explosive potential have the capacity to cause injury greater than expected due to their volatile, unpredictable nature, causing accidental explosions. This can injure unintended targets, resulting in grave conseque...

Background Brake fluid is used for automobiles. It is a mixture of different glycol derivatives including ethylene glycol and diethylene glycol (DEG) which are metabolized into various toxic metabolites. Fatalities following brake fluid ingestion are rare in forensic practice. Here, we report a case of suicide by brake fluid ingestion complicated w...

Introduction: Sexual assault is a global problem with impacts on physical/ mental health. Sexual assault survivors experience negative social reactions such as stigmatization and blame attribution. Negative social reactions can lead to detrimental effects on mental health. It has been shown that negative reactions exist among the service providers...

We report a Case of a medical professional, with a very good knowledge of emergency medical devices, who committed suicide using defibrillator pads to electrocute. The decedent attached the defibrillator pads in the standard position on his chest and manually connected the terminals to an extension cord through an additional switching device. When...

Child abuse is a widely discussed issue that can have a lasting negative imprint on a child’s life. We report a case of castration in an infant of nine months old, perpetrated by the mother, who was a diagnosed with schizophrenia. This case explores a rare form of physical child abuse (PCA) and it also emphasizes the need of a program in the health...

Introduction Postmortem diagnostic guidelines for Covid-19 infection in Sri Lanka include sampling of nasal/throat swabs, tracheal aspirate, femoral blood for polymerase chain reaction (PCR) and rapid antigen test. Positive results label it as a death following Covid-19 infection and warrants disposal without an autopsy. Case scenario A four-month...

Exposure to high doses of ammonia gas can result in lethal injuries to humans. This case series presents 5 fatalities and an injured individual, caused by acute ammonia exposure, which occurred in the rubber industry. One of the fatalities and the survivor were reported in an incident of ammonia gas cylinder explosion, whereas the other 4 fatalitie...

Introduction: Intact long bones recovered amongst human skeletal remains, are ideal to reconstruct the stature of unidentified individuals by formulating regression equations. In many forensic situations, long bones are often encountered in different fragmentary states due to decomposition and mutilation. This necessitates the reconstruction of the...

This prospective analysis is based on clinical forensic examinations and clinical case records of the victims who sustained burns and were admitted during a one-year period since 2017. Of the 90 patients (34 children and 56 adults), 54 % were male with ages ranging from 1 month to 80 years. Males below the age of 20 years (48 %) were highly vulnera...

The intact femur is known to be the best single bone for predicting the ante-mortem stature of an individual from skeletal remains. In many forensic circumstances, the femur is fragmented due to decomposition and mutilation, thus necessitating development and application of regression equations to estimate the length of the femur from its fragments...

Abstract Objective: The foramen magnum (FM) that transmits a large number of vital structures is an important anatomical landmark in neurosurgical procedures and forensic anthropology. The aim of the present study was to determine the dimensions and shape of the FM in a Sri Lankan population. Material and method: Forty-four adult skulls (32 males...

Decapitation is well-documented as an immediately lethal injury that is encountered in medicolegal autopsies. It can be due to an accident, suicide, or homicide. Literature on decapitation reveals that suicide is committed by decapitation using domestic or industrial tools, such as electric saws and drills, and improvised guillotines. Decapitation...

Drug overdose and herbicide consumption are two common methods that are widely used for self-destruction. This article presents a unique case of self-poisoning by ingestion of Acetaminophen (Paracetamol) followed by herbicide 2-Methyl-4-chlorophenoxyacetic Acid (MCPA). No such a case has been reported in the literature. A 53-year-old male was admit...

Abstract Introduction The Interpretation of postmortem findings is based on internal and external examination of the dead body. Postmortem artifacts (PA) are changes/ features introduced after death that may be confused with features introduced ante mortem. We report a base of skull fracture in an extensively burnt body which was identified as a...

Abstract Introduction: Injuries and death due to road traffic accidents (RTA) are a major public health problem in third world countries like Sri Lanka. Sixteen percent of all vehicles used in Sri Lanka are three-wheelers. Statistics reveal a high incidence of impacts involving three-wheelers in Sri Lanka. Objectives: To determine the nature of th...

Determining the gender identity from an unidentified human skeleton is of crucial importance to forensic anthropologists and bioarchaeologists. The femur is the largest bone in the human skeleton and therefore it is more likely to have forensic value. The main aim of this study is to develop a reliable and accurate method to determine the sex of co...

Self-strangulation should be cautiously determined following a comprehensive death investigation because the circumstance of strangulation is usually homicide. The deceased was a 33-year-old male who suffered from depression and was found missing from a psychiatric unit while on treatment. The deceased was found the following day in the doctors' ca...

Determination of sex from the tibial dimensions has been attempted before in different populations. The formulae developed to determine sex of one population are not appropriate to be applied to another. Seven standard variables including the maximum length of tibia, proximal epiphyseal breadth, distal epiphyseal breadth, minimum circumference of s...

The human body is often used for illegal drug trafficking around the world. This may be done by concealing the drugs inside the body, so-called "body packing". This can lead to life-threatening conditions, mainly by leakage of the illegal substances in lethal amounts into the circulation system, which may cause fatal consequences due to acute drug...

Intimate partner violence (IPV) is a common global healthproblem. The injury pattern and socio-demographic profile of IPVin Sri Lanka may show variations to that seen in a western societydue to socio-cultural differences. The objective of this study wasto identify the injury pattern and the socio-demographic aspects ofIPV in a Sri Lankan context.Al...

Abstract Background Compared to death by hanging, fatal cases due to carbamazapine intake is hardly seen. We are reporting a rare case where the victim had used this combination to terminate life as a complex suicide. Case presentation The deceased was a 16-year-old school girl, who had been on carbamazepine for 10 years for epilepsy. Following a h...

Hydrogen sulfide (H2S) toxicity is a known occupational/industrial hazard in organic decaying disposal, sulfur springs, natural gas well and coal pits. We report two deaths due to acute accidental hydrogen sulfide poisoning. Two males 40 and 36 years old were found dead in two different water treatment plants after spilling of sewage. Autopsy revea...

Child abuse is an area in forensic medicine where detailed information is required for proper management. The authors present a case of physical child abuse, inflicted by the guardian to control voyeuristic behavior of the child. This has not been reported previously. An 11-year-old female, from a poor socioeconomic background, was brought by the p...

We present a unique case of suicidal hanging. The deceased was a 31-year-old male who was found hanging from a tree in a dense thicket, with his lower limbs in contact with the ground (partial suspension). There was an apparatus similar to a facial mask placed around his nose and mouth. A strong chemical smell was emanating from the apparatus, whic...

Background: In Sri Lanka and South Asian countries, three-wheeler vehicles are a popular mode of transportation. However due to poor vehicle safety features and road conditions, this vehicle is more vulnerable to accidents. In this regard, we hypothesize that the occupants of three-wheelers sustain a different pattern of injuries compared to occupa...

Tissue donation and organ transplantation plays a key role in the management of the critically ill patient. The harvesting of organs for transplantation is done according to the legal framework of the country and based on circulars, protocols and guidelines of health and legal authorities. Clear knowledge regarding medico-legal issues and ethical a...

Significant variations exist in the occurrence, form, and position of supraorbital nerve exits through the frontal bone. Detailed knowledge of the positional variations of supraorbital exits is important to ensure safe and successful regional anesthesia, and to avoid iatrogenic nerve injuries during surgery of the orbitofacial region. Supraorbital...

Child abuse is a sensitive topic among many medical practitioners and the diagnosis of this entity requires awareness about conditions which can mimic physical child abuse. Here, the authors present a case of a 13-year-old school non-attendee who was referred due to multiple scars, over areas prone to accidental as well as non-accidental injury, wh...

As people age, they may become more vulnerable to injury because of frailty, ill health, or dependency on others. Data from medicolegal death investigation including autopsy and statements from cases reported to 3 medicolegal units in Sri Lanka were analyzed in this study under the strict ethical framework. Of the study population, 265 were male an...

Objectives: The anatomical position of the mental foramen (MF) is variable and the knowledge of its exact location is clinically relevant. Method: Fifty two mental foramina in twenty six dry mandibles were analyzed to ascertain the shape, size, direction, presence of accessory foramina, position in relation to anatomical landmarks in an adult Sri L...

Introduction: The vermiform appendix is a vestigial structure showing extreme variability in its position. Varying symptoms of acute appendicitis reflect this variability making the clinical presentation of appendicitis highly inconsistent. Objective: To observe the anatomical variations of the position of the tip of the appendix and its base, leng...

A unique case of accidental hanging due to compression of the neck of an adult by the branches of a coffee tree is reported. The decedent was a 42-year-old male who was found dead in a semi prone position on a slope. His neck was lodged in a wedge formed by two branches of a coffee tree, with his legs angled downwards on the slope. Autopsy revealed...

Cardiovascular disease is an important contributor to maternal mortality in both developing and developed countries. Systematic search for cardiac disease is usually not performed during pregnancy despite hypertensive disease, undiagnosed pulmonary hypertension and cardiomyopathies being recognized as major health problems in these settings. This a...

Cardiovascular disease is an important contributor to maternal mortality in both developing and developed countries. Systematic search for cardiac disease is usually not performed during pregnancy despite hypertensive disease, undiagnosed pulmonary hypertension and cardiomyopathies being recognized as major health problems in these settings. This a...

Introduction: Trap gun is an illegal, locally manufactured gun with a basic trip system used to hunt wild animals. Case report: The body of a 28-year-old man was found in the jungle in supine position with both legs apart. A trap gun was between the legs pointing toward the cranial side of the body. It had 2 free wires that were not connected to...

Introduction Domestic violence (DV) is a health, legal, economic, educational, and importantly a human rights issue. A fair question arises whether DV is given enough attention in the local context. It should be appreciated with the risk factors contributing to it in the society and effect it has on the society as a whole. Objectives Identify the d...

We report a unique and rare case of child neglect and exploitation and similar case was not found. An infant, born with an imperforate anus, underwent surgery for a temporary colostomy on the day of birth. Surgery for reversal of colostomy with reconstruction was planned at one month of age. However, the guardian did not ensure that the child atten...

Background: Rates of violence and abuse perpetrated on people with intellectual and developmental disability (IDD) have been reported to be significantly higher than on individuals without disability. However, rates of sexual violence against people with IDD in some less industrialized countries, such as Sri Lanka, have not been previously reporte...

The death due to lethal weapons is a growing concerned issue in Sri Lanka. The objective of the study was to examine and compare the deaths caused by lethal weapons during and after civil strife. A cross-sectional study was conducted on deaths caused by lethal weapons over 10 years from May 2004 to May 2014. Periods before and after 19th of May 200...

The present study was conducted to ascertain the shape, size, presence of accessory foramina, direction, and the precise position of the infraorbital foramen (IOF) in relation to the inferior orbital margin (IOM), anterior nasal spine (ANS), nasion (Na), maxillary teeth, and supraorbital foramen/notch (SOF/N) in adult skulls in a Sri Lankan populat...

Death investigation is a legal process involving multiple disciplines where coroners, lawyers and police officers play vital roles. In spite of recent developments in forensic technology and enhancing public interest with regard to death investigation, few steps have been taken to improve the knowledge of the death investigators. In order to ensure...

Introduction : Child abuse is an area in Forensic Medicine where the diagnosis and management could be difficult. A deep history and close inward observation is a must where there is the slightest doubt of child abuse, in order to identify compounding factors and address accordingly. Here we report a case of repeated episodes of hematuria which was...