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Introduction: All cases of child sexual abuse (CSA) are expected to be examined by specialists in Forensic Medicine in Sri Lanka. Further, management should not be confined to medico-legal aspects but ensure the psychosocial management of child and family. Therefore, this study was conducted to identify and describe patterns of abuse and strategies of management of children affected with CSA. Methods: Retrospective descriptive study was conducted on all the victims of child sexual abuse reported to Base Hospital, Puttalam, Sri Lanka over 20 months from Nov-2014 to June-2016. Results: There were 183 children affected and of them, 168 (92%) were girls. Out of incidents occurred at home, 52% were committed by relatives (p=0.000). All abusers were male and none were strangers. Known non-relatives abused 64% of females and almost all male victims (p=0.02). In more than 10 years old female victims, 80% had hymenal tears (p=0.000). One-third of both males and females had anal penetration. Only five (05) had associated physical abuse. Eighty percent were referred to STI and 84% to psychiatrist. Institutional case conference was held in 20%. It was held in 8% of anal and 20% of genital penetrations (p=0.8).Conclusions: Physical abuse was rarely associated with child sexual abuse. Majority of incidents were committed by male relatives. Known non-relatives are the most potential abusers. Girls more than 10 years are the most vulnerable for penetration. None were given STI prophylactic treatment. Mere presence of injuries were not indications for case conference. However, the follow-up reports of psycho-social managements were not available.

Introduction: After the defeat of terrorism in May 2009, a significant change in the pattern of crime has been observed in Sri Lanka. Further, no in-depth studies have been conducted on male victims of sexual assault. This study was conducted to describe the nature of injuries and characteristics of male victims of sexual assaults during civil strife and compare those with after civil strife. Methods: A cross-sectional study on male victims of sexual assault was conducted at selected tertiary care hospitals in Sri Lanka. All Medico-legal examination forms (MLEFs) of 6 consented forensic medical practitioners covering 10 year period from May-2004 to May-2014 were studied. Results: Of all the MLEFs (31,210), 102 (0.3%) were male victims of sexual assault. Ages ranged from 03 to 36 years and 68% were 10-19 years of age. Ninety four percent had no injuries. Thirty five percent occurred during civil strife and 65% after it. The circumstances such as time, place, perpetrator and number of incidents had significant difference with the period of occurrence (p<0.05). After civil strife, the referrals to the psychiatrist showed a significant difference (p<0.05). Conclusions: During civil strife, sexual assaults occurred at daytime, outside home, by non-relatives and multiple times. After civil strife, sexual assaults occurred during night, at home, by relatives and one episode. There was no significant difference in the nature of sexual acts. Significant increase in male sexual assaults at home by relatives after civil strife needs further investigations in order to develop evidence based interventions. (Words 241)

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Subdural haemorrhage is almost always traumatic and rarely natural. Traumatic Subdural haemorrhage (SDH) occurs following break of the parasagittal bridging vessels due to shearing movement of the head. Clinical features appear in 3 days in acute SDH, in 3 days to 3 weeks in sub-acute SDH and after 3 weeks in chronic SDH. SDHs are aged macroscopically and histopathologically. A 42 years old female knocked down by a bus was admitted to a base hospital. She was unconscious on admission and had nausea, vomiting and headache. By the next day, almost all symptoms were settled except headache and was discharged. Fifteen days later, she developed sudden onset bilateral lower limb weakness and was re-admitted. She was transferred to a tertiary care hospital immediately. The pre-op CT scan showed left frontal chronic subdural hemorrhage (SDH) and the patient was subjected to a burr hole surgery. She was transferred back to the base hospital and according to the medico-legal examination performed 21 days after the incident, the category of hurt was -fatal in the ordinary course of nature‖. In the remarks column, it was mentioned that it is not clear whether this SDH is due to the fall from the bus or any other incident after that. This chronic SDH also could be following a separate -new incident‖ that took place after the traffic accident. Therefore, without dating the chronic SDH accurately, it is not safe to identify the real causative circumstance.