Artefactual incised wounds due to postmortem predation by the Sri Lankan water monitor (kabaragoya)

Monitor lizards are large reptilian animals mostly seen around water based habitats. Sri Lanka has an endemic water monitor lizard called the kabaragoya (Varanus salvator salvator) which is perhaps the most common large animal scavenger in the country. Scavenging by the kabaragoya can result in postmortem incised injuries which are caused by their sharp pointed claws as they grip or crawl over a dead body. The author presents four cases where these claw marks raised significant medicolegal issues. In one case of a young female they mimicked defense injuries that might be seen in a person that was killed with heavy sharp weapon trauma to the head. In another case, claw marks on the face raised homicidal allegations in an immersion death following intoxication. In a case of suicidal drowning these injuries simulated self-inflicted cuts. The fourth case shows how claw marks complicated the investigation of a dismembered upper limb. Kabaragoya claw marks are mostly seen in decomposed and macerated bodies recovered from water. Injuries are mostly superficial and limited to skin and soft tissues. Bony injuries are not seen. Awareness of the creature’s scavenging habits and careful analysis of the appearance and distribution of the injuries is essential to differentiate claw marks from sharp weapon trauma.     

Anaesthesia in cleft lip and cleft palate surgery of children

Three hundred and fifty children below 5 years of age undergoing surgery for repair of cleft lip and palate received endotracheal halothane anaesthesia. For induction of anaesthesia a mixture of nitrous oxide (N2O), oxygen (O2) and halothane was given by mask. Orotracheal intubation was carried out without administration of relaxants and spontaneous respiration was maintained. Adrenaline infiltration was used to minimise the blood loss. No life-threatening complications were seen during surgery or in the post-operative period. The mortality in this group was zero. The study showed that anaesthesia for cleft lip (CL) and cleft palate (CP) surgery could be given relatively safely in developing countries where facilities and resources available are minimal.     

Pharmacokinetic disposition of inhaled ciclesonide and its metabolite desisobutyryl-ciclesonide in healthy subjects and patients with asthma are similar

OBJECTIVE: To evaluate whether the inflammatory process and bronchial constriction associated with asthma influence the pulmonary distribution and airway penetration of inhaled ciclesonide by investigating the pharmacokinetics of ciclesonide and its active metabolite, desisobutyryl-ciclesonide (des-CIC) in patients with asthma and matched healthy subjects. METHODS: 12 patients with asthma (8 males, 4 females) and 12 healthy subjects matched for age, sex, height, and weight received a single inhaled dose of 1,280 microg (ex-actuator, equivalent to 1,600 microg ex-valve) ciclesonide by metered-dose inhaler in a parallel-group study. Timed blood samples were collected for measurement of serum concentrations of des-CIC and ciclesonide by liquid chromatography with tandem mass spectrometry. RESULTS: There were no differences in the pharmacokinetics of des-CIC between healthy subjects and patients with asthma. Ratio analysis of the primary variable, the area under the concentration-time curve from time 0 to infinity (AUC(0 - inf)) showed equivalence for des-CIC in healthy subjects and patients with asthma, with a ratio of 1.003 (90% confidence interval between 0.815 and 1.234). The mean terminal half-life (t1/2) for des-CIC was also similar in patients with asthma (3.15 hours) and healthy subjects (3.33 hours). Furthermore, the pharmacokinetic parameter estimates for ciclesonide were comparable between the study groups. CONCLUSION: After administration of a single dose of ciclesonide, the pharmacokinetic parameter estimates for des-CIC were equivalent between patients with mild-to-moderate asthma and healthy subjects, suggesting that there is comparable lung deposition and activation of ciclesonide in the 2 populations.     

Geographic Structure of Plasmodium vivax: Microsatellite Analysis of Parasite Populations from Sri Lanka, Myanmar, and Ethiopia

Genetic diversity and population structure of Plasmodium vivax parasites can predict the origin and spread of novel variants within a population enabling population specific malaria control measures. We analyzed the genetic diversity and population structure of 425 P. vivax isolates from Sri Lanka, Myanmar, and Ethiopia using 12 trinucleotide and tetranucleotide microsatellite markers. All three parasite populations were highly polymorphic with 3–44 alleles per locus. Approximately 65% were multiple-clone infections. Mean genetic diversity (H_E) was 0.7517 in Ethiopia, 0.8450 in Myanmar, and 0.8610 in Sri Lanka. Significant linkage disequilibrium was maintained. Population structure showed two clusters (Asian and African) according to geography and ancestry. Strong clustering of outbreak isolates from Sri Lanka and Ethiopia was observed. Predictive power of ancestry using two-thirds of the isolates as a model identified 78.2% of isolates accurately as being African or Asian. Microsatellite analysis is a useful tool for mapping short-term outbreaks of malaria and for predicting ancestry.     

Symptoms and coping in Sri Lanka 20-21 months after the 2004 tsunami

BACKGROUND: The estimated prevalence of clinically significant psychiatric and somatic symptoms in adults >1 year after the 2004 Asian tsunami is unknown. AIMS: To estimate the prevalence of psychiatric and somatic symptoms and impairment in Sri Lanka 20-21 months after the 2004 Asian tsunami, and to assess coping strategies used by tsunami-affected individuals that contribute to post-tsunami adjustment. METHOD: Homes from one severely affected area were randomly selected, and adult respondents were sampled utilising a modified Kish method. Instruments were administered in Sinhala to assess exposure, post-traumatic stress disorder (PTSD), depression, anxiety, somatic distress and impairment. Demographic variables and culturally-relevant coping activities were assessed. RESULTS: The prevalence of clinically significant PTSD, depression and anxiety was 21%, 16% and 30% respectively. Respondents reported a mean of eight persistent and bothersome somatic complaints, which were associated with psychiatric symptoms and impairment. Thinking that one's life was in danger was the exposure item most strongly associated with symptoms and impairment. The majority of respondents found their own strength, family and friends, a Western-style hospital and their religious practice to be the most helpful coping aids. CONCLUSIONS: A large minority of adults in one area of Sri Lanka reported significant psychiatric and somatic symptoms and impairment 20-21 months after the tsunami. Accurate data about risk for and resilience to impairing symptoms >1 year after disasters are necessary in order to develop rational surveillance and interventions.