{"id":117908,"date":"2021-09-07T15:27:28","date_gmt":"2021-09-07T22:27:28","guid":{"rendered":"http:\/\/www.lankaweb.com\/news\/items\/?p=117908"},"modified":"2021-09-07T15:27:28","modified_gmt":"2021-09-07T22:27:28","slug":"traumatic-brain-injury-among-the-sri-lankan-combat-veterans-2","status":"publish","type":"post","link":"https:\/\/www.lankaweb.com\/news\/items\/2021\/09\/07\/traumatic-brain-injury-among-the-sri-lankan-combat-veterans-2\/","title":{"rendered":"Traumatic Brain Injury Among The Sri Lankan Combat Veterans"},"content":{"rendered":"

Ruwan M Jayatunge M.D.<\/strong>\u00a0<\/em><\/span><\/h2>\n\n\n

A significant number of Sri Lankan soldiers\nsustained head injuries during the Eelam War that lasted from 1983 to 2009.\nThese head injuries mainly occurred due to gunshot wounds, mortar blast injuries,\ngrenade explosions and artillery blasts. Traumatic Brain Injuries increased\nHigh morbidity and mortality rates among the Sri Lankan combatants. Traumatic\nBrain Injury (TBI) had been one of the signature injuries of the Eelam\nWar.  <\/p>\n\n\n\n

Traumatic brain injury has short and long term\nconsequences. It affects the physical, social, psychological and occupational\naspects of a combatant’s life.  The combatants with severe TBI have\npermanent neurobiological damage with profound psychosocial problems. TBI has been\nidentified as one of the disabling conditions among the combatants.<\/p>\n\n\n\n

Traumatic brain injury (TBI) refers to a\nphysiologically significant disruption of brain function resulting from the\napplication of external physical force, including acceleration\/deceleration\nforces (Silver et al, 2009). The victims experience emotional lability, sensory\nimpairments, neuro- cognitive deficits and spasticity following traumatic brain\ninjuries.<\/p>\n\n\n\n

Traumatic brain injury is a\ncommon cause of neurological damage and disability among civilians and\nservicemen (Aux\u00e9m\u00e9ry, 2012). Schneider and colleagues (2009) elucidate that\nbehaviorally the military population in general is considered to be a high\nrisk group for TBI.  According to Scherer et al., (2013) within the\nlast decade, more than 220,000 service members have sustained traumatic brain\ninjury (TBI) in support of military operations in Iraq and Afghanistan.<\/p>\n\n\n\n

In Sri Lanka from 1983 to 2009 over\n200,000 military personnel were deployed in the operational areas and\nconsiderable numbers sustained mild to severe head injuries following enemy\nattacks. In a convenience sample of 824 Sri Lankan Army servicemen who were\nreferred to the Psychiatric ward Military Hospital Colombo during August 2002\nto March 2006 time period 29 combatants (3.51%) were diagnosed  with\nTBI. These diagnoses were based on International Classification of\nDiseases- Tenth Revision (ICD-10) criteria and done by the Consultant\nPsychiatrist of the Sri Lanka Army. <\/p>\n\n\n\n

The Immediate Impact of TBI<\/strong><\/p>\n\n\n\n

Traumatic brain injury has\nimmediate impacts. TBI combines mechanical stress to brain tissue with an\nimbalance between cerebral blood flow and metabolism, excitotoxicity, oedema\nformation, and inflammatory and apoptotic processes (Werner & Engelhard,\n2007). The immediate effect of head trauma could be loss of consciousness\nfollowed by headaches and dizziness. Sometimes confusion and\ndisorientation could occur from mild to moderate form of head injuries. In\na severe form of TBI prolonged periods of loss of consciousness, seizures and\nparalysis could occur.<\/p>\n\n\n\n

Traumatic Brain Injury in the War Zone<\/strong><\/p>\n\n\n\n

During the Eelam War some of the\ncombatants who sustained head injuries were not immediately evacuated due to\ntechnical difficulties. Intensify heavy fighting and weather conditions\naffected evacuation of the battle casualties. However the wounded received\nfirst aid and then brought back to the rear zone medical aid point where they\nwere examined by a qualified medical officer.  The head injuries were\nassessed and then transferred to the Palali Military Hospital or to a nearby\nhospital. Some battle casualties who sustained severe head trauma were\nairlifted and transferred to major hospitals in Anuradhapura or in Colombo. In\nthese hospitals the war casualties received specialized treatment by the\nNeurosurgeons.<\/p>\n\n\n\n

TBI and Cognitive Impairments<\/strong><\/p>\n\n\n\n

The combatants who sustained serious\nhead trauma later found with cognitive impairments. Neurocognitive impairments\nare prevalent in TBI. Among the debilitating conditions, memory impairments,\ndifficulty with attention and concentration, difficulty with new learning, and\nimpaired problem solving skills are frequently identified. As indicated by\nArciniegas (2003) cognitive impairments are among the most common\nneuropsychiatric sequelae of traumatic brain injury at all levels of severity.\nTraumatic brain injury (TBI) can produce persistent attention and memory\nimpairment that may in part be produced by impaired auditory sensory gating\n(Arciniegas et al., 2000).<\/p>\n\n\n\n

Cognitive dysfunctions associated with\nTBI were known to military psychologists since World War One. The British\nPhysician Frederic Mott (WW1) and Dr Alexander Luria of the Soviet Army (in the\nWW2) extensively studied the impact of combat related head injuries. Caveness ,\nWalker, & Ascroft (1962) believed that World War I, World War II, and the\nKorean war produced a large number of combatants with TBI and other associated\ncomplications. In the Vietnam War 12 to 14 percent of all combat casualties had\na brain injury (Okie , 2005).<\/p>\n\n\n\n

TBI-related cognitive impairment\nis common in veterans who have served in recent conflicts in the\nMiddle East and is often related to blasts from improvised explosive devices\n(Halbauer et al., 2009). The Sri Lankan combat veterans who sustained severe\nform of head injuries reported drastic impairments in memory and concentration.\nSome were found with post-traumatic amnesia.  A large percentage of\ncombatants were found with intellectual disabilities and impaired language\nskills.<\/p>\n\n\n\n

Personality Changes Following Head Injury<\/strong><\/p>\n\n\n\n

Personality change has been reported in\n49% to 80% of patients with traumatic brain injury (Brooks et\nal., 1986). A significant number of Sri Lankan combatants with TBI were\nfound with subsequent Personality changes. Some of the personality changes such\nas agitation, paranoia, mood swings, aggression, lack of inhibition,\ninappropriate sexual activity and impaired self control have caused major\nbarriers to their military and personal lives.<\/p>\n\n\n\n

Prominent behavioral characteristics in\nTBI patients have included altered emotion (including restricted emotions with\noccasional inappropriate or uncontrolled emotional outbursts); impaired\njudgment and decision\u2013making (including difficulty arriving at decisions as\nwell as poor decisions); impaired initiation, planning, and organization of\nbehavior; and defective social comportment (including egocentricity and\nimpaired empathy). These impairments tend to be accompanied by a marked lack of\ninsight. (Fowler, 2011: Barrash et al.,2000). According to Oddy et al. (1985)\ntwo thirds of individuals with TBI experience personality changes for long\nperiods and sometimes over 15 years.<\/p>\n\n\n\n

TBI and Depression<\/strong><\/p>\n\n\n\n

Mood disturbances are common sequelae\nof traumatic brain injury (Hurley &   Taber, 2002). Bay and\ncolleagues (2004) are of the view that Pre-injury factors (such as mood\nand anxiety disorders, psychosocial dysfunction, and alcohol abuse), injury\nfactors (such as left ventrolateral and dorsolateral injury and serotonergic\ndysfunction), and post-injury factors (such as postconcussive symptoms,\npsychosocial dysfunction, and lack of social supports) contribute to the\ndevelopment of depression after TBI, although the relevance of each factor\nvaries among patients.<\/p>\n\n\n\n

Combatants with TBI have a large array\nof psychosocial problems that affect their professional and family lives. Jorge\net al. (2004) observed strong association between posttraumatic depression and\npsychological and psychosocial factors.<\/p>\n\n\n\n

Sometimes post TBI depression could\n  increases anger, aggression and   suicide risk (Fann , Katon ,\nUomoto & Esselman, 1995). An increased suicide risk has been identified\namong the combatants who fought in the Eelam War.  According to the\nMilitary Spokesperson of the Sri Lanka Army from 2009 to 2012 postwar period\nnearly 400 soldiers had committed suicide (Sriyananda, 2012).<\/p>\n\n\n\n

TBI and Posttraumatic Stress Disorder<\/strong><\/p>\n\n\n\n

Post-traumatic stress disorder (PTSD)\nand traumatic brain injury (TBI) often coexist because brain injuries are often\nsustained in traumatic experiences. In addition evidence suggests that mild TBI\ncan increase risk for PTSD (Bryant, R 2011).<\/p>\n\n\n\n

Some investigators have argued that\nindividuals who had been rendered unconscious or suffered amnesia due to a TBI\nare unable to develop PTSD because they would be unable to consciously\nexperience the symptoms of fear, helplessness, and horror associated with the\ndevelopment of PTSD. Other investigators have reported that individuals, who\nsustain TBI, regardless of its severity, can develop PTSD even in the context\nof prolonged unconsciousness. (Sbordone & Ruff, 2010).<\/p>\n\n\n\n

Despite the discrepancies, a strong\nconnection between Post-traumatic stress disorder and traumatic brain injury\nhas been reported from battlefields around the world. Hoge et al. (2008) point\nout that mild traumatic brain injury (i.e., concussion) occurring among\nsoldiers deployed in Iraq is strongly associated with PTSD and physical health\nproblems 3 to 4 months after the soldiers return home. Elder & Cristian\n(2009) too report high association of mild traumatic brain injury with\nposttraumatic stress disorder among the veterans of the wars in Iraq and\nAfghanistan. A notable number of Sri Lankan combatants have been diagnosed with\nTBI and PTSD during the Eelam War.<\/p>\n\n\n\n

Posttraumatic Epilepsy<\/strong><\/p>\n\n\n\n

Posttraumatic epilepsy is a major source\nof disability following traumatic brain injury (TBI) and a common cause of\nmedically-intractable epilepsy (Guo et al., 2013).  As indicated by\nDiaz-Arrastia and colleagues (2009) posttraumatic epilepsy is a common\ncomplication of traumatic brain injury (TBI), occurring in up to 15-20% of\npatients with severe brain trauma. There are a number of risks associated\nwith Posttraumatic epilepsy. Yeh et al. (2012) hypnotize that the risk of\nepilepsy after TBI varied by patient gender, age, latent interval and\ncomplexity of TBI.<\/p>\n\n\n\n

Combat veterans with head trauma are at\nhigh risk of developing posttraumatic epilepsy. As indicated by Chen and\ncolleagues (2009) both Korean and Vietnam War veterans with\npenetrating TBI had a 53% risk of developing PTE.<\/p>\n\n\n\n

Neurologist Ranjani Gamage (2003)\nreported that in Sri Lanka there were 300,000 persons with epilepsy.\n  This number would have included combatants with epilepsy due to TBI<\/p>\n\n\n\n

Psychiatric Symptoms Followed by TBI<\/strong><\/p>\n\n\n\n

The intersection between traumatic\nbrain injury and Psychosis has become one of the major concerns. Some of the\nSri Lankan combatants with TBI were later found with psychosis and these\nindividuals had disorganized thought and speech, paranoid delusions with loss\nof contact with reality.<\/p>\n\n\n\n

Koponen et al. (2002) suggest\nthat traumatic brain injury may cause decades-lasting vulnerability to\npsychiatric illness in some individuals. In addition they hypnotize that\ntraumatic brain injury seems to make patients particularly susceptible to\ndepressive episodes, delusional disorder, and personality disturbances. In one\nof the studies that was conducted by Deb and colleagues (1999) found that in\ncomparison with the general population, a higher proportion of adult patients\nhad developed psychiatric illnesses one year after a traumatic brain injury.\nFann et al. (1995) point out that psychiatric disorders are a major cause of\ndisability after traumatic brain injury.<\/p>\n\n\n\n

Chronic Traumatic Encephalopathy in\nCombatants <\/strong><\/p>\n\n\n\n

Chronic Traumatic Encephalopathy (CTE)\nis thought to be a neurodegenerative disease associated with repeated\nconcussive and subconcussive blows to the head (Mez ,Stern & McKee ,\n2013).  During military training soldiers repetitively sustain mild head\ntrauma that has a negative impact on their mental health. According\nto Zhang et al. (2013) subconcussive blows can result in cognitive\nfunction changes that are consistent with mild traumatic brain injury of the\nfrontal lobes.<\/p>\n\n\n\n

The soldiers who served in the artillery\nbatteries during the Eelam War were frequently exposed to blast impacts.\nFurthermore they faced artillery attacks, mortar fire, grenade and claymore\nblasts initiated by the enemy. Although a large number of combatants did not\nsustain any head trauma a considerable percentage experienced the blast\nshockwaves.  The shock waves   may have had a negative\ncumulative effect on them. A considerable fraction of combatants who were\nexposed to   blast shockwaves complain of chronic headaches, tremors\nand generalized body pain.  This factor was evident in the numerous\nbattles that were fought in different countries.<\/p>\n\n\n\n

Military physicians of World War One\nbelieved that artillery blasts could cause miniature hemorrhages in the brain\ncausing tremors and long lasting headaches in soldiers. Teland,& Huseby\n(2102) of the Norwegian Defence Research Establishment  (FFI)\nhypothesize  that  military personnel who are exposed to blast waves\nduring training and combat are at a significant health risk.<\/p>\n\n\n\n

The combat-related traumatic brain\ninjuries (TBI) resulting from exposure to explosions is highly prevalent among\nmilitary personnel who have served in current wars. Blast trauma can\nbe understood as experiencing a shockwave on the brain and as a\npsycho-traumatic event (Aux\u00e9m\u00e9ry, 2012). Chronic pain is a common complication\nof TBI. It is independent of psychologic disorders such as PTSD and depression\nand is common even among patients with apparently minor injuries to the brain.\n(Nampiaparampil, 2008).<\/p>\n\n\n\n

Head trauma could cause degenerative\nchanges in the brain tissue. Byrnes et al. (2012) point out that traumatic\nbrain injury initiates biochemical processes that lead to secondary\nneurodegeneration.  Traumatic brain injury causes\nprogressive neurodegeneration associated with chronic microglial\nactivation (Xue et al, 2013). Atrophic changes of the brain that are resulted\nby TBI can have a lasting impact on soldiers. Symptoms can range to prolong\nheadaches to severe neurological and psychological consequences.<\/p>\n\n\n\n

Treatment Options<\/strong><\/p>\n\n\n\n

TBI has drastic impacts on independent\nliving skills of the combatant. The survivors need effective psychosocial\nrehabilitation. The outcome and impact evaluation following combat related TBI\nis highly essential in the rehabilitation process.  The concept of the\noutcome of brain injury\u201d needs to be viewed in the context of a dynamic and\nchanging series of events which occur throughout a person\u2019s life Gainer, 2010).<\/p>\n\n\n\n

Various risk factors for poor outcome\nafter TBI have been identified. Most of these are fixed at the time of injury\nsuch as age, gender, mechanism of injury, and presenting signs (Glasgow Coma\nScale and pupillary signs), but some such as hypotension and hypoxia are\npotential areas for medical intervention (Moppett, 2007).<\/p>\n\n\n\n

Cerebral metabolic derangement and\nexcitotoxicity play critical roles in the evolution of traumatic brain injury\n(Hwabejire et al., 2013). Expert opinion suggests that combination therapies\nwill be necessary to treat any stage of TBI recovery (Shear & Tortella,\n2013). Drug management is important in seizure control. Chen and colleagues\n(2009) are of the view that optimal seizure control is essential to the\nphysical and emotional health of veterans with TBI and to their\nability to lead productive lives.<\/p>\n\n\n\n

Psychotherapy is an important component\nof the treatment of neuropsychiatric problems following TBI (Arciniegas et al.,\n2000).  Cognitive rehabilitation may also be useful for the treatment\nof impaired attention, interpersonal communication skills, and executive\nfunction following TBI (Arciniegas et al., 2002).  B\u00e9dard et al. (2003)\nsuggest mindfulness-based intervention to improve quality of life among\nindividuals who sustained traumatic brain injuries. In addition occupational\ntherapy, speech language therapy and physiotherapy play a key role in the\nrehabilitation process.<\/p>\n\n\n\n

 Case Discussion<\/strong><\/p>\n\n\n\n

1)    Private SNX764\njoined the Army in 1991 and served in the operational areas. He took part in\nseveral major military operations against the LTTE. In 1995 he was posted to\nMallakam -Jaffna. There he had to face fierce enemy attacks. Once the enemy\nattacked them with mortars. Following nonstop mortar attacks, Private SNX764\nwas stunned and disoriented. His bunker was damaged severely and he wanted to\ncrawl to a safe area.  When he tried to reach the next bunker an incoming\nmortar blasted a few meters away from him. Suddenly he could feel bleeding from\nhis ears and he lost consciousness. After a few hours of fighting the enemy\nretreated.  Then he was evacuated and taken to the Palali military hospital.\nHe was treated for a head injury. Although he survived the mortar blast his\nspeech was impaired. He experienced severe intermittent headaches and insomnia.\nBy 1996 he had intrusions, flashbacks and marked avoidance for combat related\nsettings.   His mental health started deteriorating further. Several\ntimes Private SNX764 had tried to commit suicide while serving in the\noperational areas. Finally he was referred for a psychological evaluation and\nfound with chronic PTSD.<\/p>\n\n\n\n

2)    Capt. KXXC385 was\nan experienced field officer who participated in numerous commando operations.\nHe sustained a head injury as a result of a parachuting accident. He was\nunconscious for over two weeks and treated at the Neurological unit. \nAfter the acute phase he was referred for rehabilitation therapy. After years\nof treatment he returned to his unit as a completely changed person. He had\ndifficulty in concentration, Emotional lability and cognitive impairments. His\npersonality changed tremendously after the head trauma.  Once a skillful\nprofessional soldier turned into a dependent unsteady person with marked\npsychosocial dysfunctions. His professional and private life fell apart. \nHis decision\u2013making and initiation were significantly deteriorated and\nsometimes he engaged in socially inappropriate behavior failing to detect\nsocial cues. Capt. KXXC385 was diagnosed with Personality changes following\nhead injury.<\/p>\n\n\n\n

3)    Major WXX856\nsustained a head injury due to a grenade blast in a training mission. He was\nunconscious and treated at the Neurosurgical unit of the National Hospital\nColombo. Major WXX856\u2018s injury was reordered as a moderate type of head injury\nbased on the Glasgow Coma Scale (GCS). After the injury he experienced frequent\nheadaches and irritability. He had low frustration tolerance and often became\nvery impulsive. His family members observed drastic changes in his behavior.\nFrequently he engaged in family violence. His personality started to change\nwith head trauma. The senior officers found that Major WXX856 was neglecting\nhis duties. A number of times he was reprimanded. To displace his psychosocial\ndifficulties Major WXX856 started to drink alcohol in large quintiles in daily\nbasis. His treatment schedule was interrupted and eventually in the final two\nyears he did not receive any treatment at all. Major WXX856 became more and\nmore isolated and had homicidal urges. In 2004 Major WXX856 committed several\nmurders secretly and enjoyed the brutal acts. He took his final victim \u2013 a cab\ndriver to his remote camp and intoxicated him and then killed him by cutting\nthe victim\u2019s throat. He had no remorse or any regrets after committing these\nmurders. Major WXX856 was looking for more victims to fulfill his homicidal\nurge.  In his final attempt he tried to abduct a victim near a remote tea\nestate but the attempt was unsuccessful. Some estate workers alerted the\nPolice. Hence he was arrested and sent to the remand prison. The investigators\nfound several other murders that were committed by Major WXX856. While his\ntrial was pending Major WXX856 committed suicide by hanging.<\/p>\n\n\n\n

4)     Private\nKXXT342 met with a landmine explosion in Chunnakam \u2013Jaffna in 1996 while\ntravelling in a military vehicle. Some of his buddies got killed due to the\nblast. He could only remember the black smoke and fatal outcry of his buddies.\nThe soldiers from the second vehicle took the wounded to the hospital\nimmediately. Private KXXT342 sustained a head injury and was treated at the\nPalali military hospital and then referred to the National Hospital -Colombo.\nHe underwent treatment for several months. He had impaired hearing, slurred\nspeech and loss of coordination after the injury. In addition he suffered\nepileptic fits. Private KXXT342 was diagnosed with Posttraumatic Epilepsy. After\nbecoming a battle casualty Private KXXT342 experienced a number of psychosocial\nproblems which affected his life. He was treated with antiepileptic drugs and\nCBT. Following treatment he was able to overcome most of his psychosocial\nproblems.<\/p>\n\n\n\n

5)    Corporal BXVX486\nserved in an artillery battery for over 9 years. During this time period his\nteam had fired a large number of artillery rounds. Although he was physically\nunharmed throughout the war his luck changed dramatically. Corporal BXVX486\ncomplained of tremors in both hands, frequent headaches and myalgia after\nserving lengthy years in the artillery battery. The physicians who examined him\nfound no organic factor associated with his condition. There were no\nElectroencephalography (EEG) changes and his brain scan and other reports were\nnormal. He was suspected as a malingerer at one point but later found that his\nsymptoms were real. Corporal BXVX486 poorly responded to the painkillers. His\ncondition started to improve with relaxation therapy and EMDR.<\/p>\n\n\n\n

6)    L\/ Cpl AXXCX831\nsustained a TBI following a gun short injury. After he became a battle casualty\nL\/ Cpl AXXCX831 experienced a number of psychosocial problems. He could not\ncontrol his anger and became extremely hostile. He used to physically abuse his\nwife and children. He had depression and several times he planned to end his\nlife. Once he took poison and immediate hospitalization saved his life. He was\ntreated with Selective serotonin reuptake inhibitors (SSRI ) and mood\nstabilizers with CBT. Following drug therapy and psychotherapy L\/ Cpl\nAXXCX831\u2019s condition improved notably.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

Although Traumatic Brain Injury has\nimpacted a large number of Sri Lankan combatants who fought in the Eelam War,\nthe psychological sequelae of brain trauma were not adequately studied. The\ncombatants who sustained TBI have persistent headaches, memory impairments,\nsleep difficulties, low frustration tolerance, impaired life skills, emotional\ndifficulties, impaired decision making and behavioral changes.TBI has caused\nprofound psychosocial problems among the veterans. These problems affect their\nprivate and professional lives. The combatants with TBI need effective\npsychosocial rehabilitation to overcome their current difficulties. Further\nresearch is needed to estimate the overall impact of TBI among Sri Lankan\ncombat veterans.<\/p>\n\n\n\n

Acknowledgements<\/strong><\/p>\n\n\n\n

1)    Dr. Rolf B. Gainer\n\u2013 Consultant Neurologist \u2013 Brookhaven Hospital Tusla Oklahoma<\/p>\n\n\n\n

2)    Professor Daya\nSomasundaram \u2013 University of Adelaide Australia<\/p>\n\n\n\n

3)    Dr. (Mrs) N.K\nAriyarathne \u2013 Consultant Physician \u2013 Military Hospital Colombo.<\/p>\n\n\n\n

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Ruwan M Jayatunge M.D.\u00a0 A significant number of Sri Lankan soldiers sustained head injuries during the Eelam War that lasted from 1983 to 2009. These head injuries mainly occurred due to gunshot wounds, mortar blast injuries, grenade explosions and artillery blasts. Traumatic Brain Injuries increased High morbidity and mortality rates among the Sri Lankan combatants. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-117908","post","type-post","status-publish","format-standard","hentry","category-dr-ruwan-m-jayatunge-m-d"],"_links":{"self":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/117908","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/comments?post=117908"}],"version-history":[{"count":0,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/117908\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/media?parent=117908"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/categories?post=117908"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/tags?post=117908"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}