Browsing by Author "Abeysundara, P.K."

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Barriers for cataract treatment among elderly in Sri Lanka
(Hindawi Publication Corporation, 2019) Nishad, N.; Hewage, S.A.; Arulmoly, K.; Amaratunge, M.S.; de Silva, J.; Kasturiratne, K.T.A.A.; Abeysundara, P.K.; Wickremasinghe, A.R.
Cataract is still the leading cause of blindness. Many government institutes and voluntary organizations in Sri Lanka are providing free treatment services to patients with cataract. Still people are not patronizing the available free services; thus they have to live with impaired vision or blindness. This paper describes the barriers for cataract treatment among the population over 60 years of age. Out of 470 elders, 379 were found to have some kind of cataract. This study demonstrated lack of awareness and knowledge, socioeconomic factors, and misconceptions as the main barriers for cataract treatment which has led to a lower cataract surgery rate irrespective of the high cataract prevalence reported. Findings of this study highlight the importance of cataract as a common health problem in elderly and need for removal of the barriers for its treatment which should be given due prominence in the formulation of public health policy in Sri Lanka at the earliest.
Efficacy of two sperm preparation techniques in reducing non-specific bacterial species from human semen
(Medknow Publications, 2013) Abeysundara, P.K.; Dissanayake, D.M.A.B.; Wijesinghe, P.S.; Perera, R.R.D.P.; Nishad, A.A.N.
CONTEXT: Artificial reproductive techniques using seminal preparations with bacteria may cause pelvic inflammatory disease and its sequalae. AIMS: To assess efficacy of two sperm preparation techniques to clear bacteria and the effect of bacteriospermia on sperm recovery rates. SETTINGS AND DESIGN: A descriptive cross-sectional study was carried out among males of subfertile couples. SUBJECTS AND METHODS: Semen samples were randomly allocated into swim-up method (group S, n = 68) and density gradient method (group D, n = 50) for sperm preparation. Seminal fluid analysis and bacterial cultures were performed in each sample before and after spermpreparation. STATISTICAL ANALYSIS: McNemar's chi-squared test and independent samples t-test in SPSS version 16.0 were used. RESULTS: Organisms were found in 86 (72.88%) out of 118 samples, before sperm preparation; Streptococcus species (n = 40, 46.51% of which 14 were Group D Streptococcus species), Coagulase negative Staphylococcus species (n = 17, 19.76%), Staphylococcus aureus (n = 13, 15.11%), Coliform species (n = 11, 12.79% of which 09 were Escherichia coli) and Corynebacterium species (n = 5, 5.81%). There was a statistically significant reduction of culture positive samples in raw vs. processed samples; in group S, 49 (72.05%) vs. 16 (23.52%) and in group D, 37 (74%) vs. 18 (36%). In group S and D, mean (SD) recovery rates of culture positive vs. culture negative samples were 39.44% (SD-14.02) vs. 44.22% (SD-22.38), P = 0.39 and 52.50% (SD-37.16) vs. 49.58% (SD-40.32), P = 0.82 respectively. CONCLUSIONS: Both sperm preparation methods significantly reduced bacteria in semen, but total clearance was not achieved. Spermrecovery rate was not affected by bacteriospermia.
Neurological melioidosis complicated by cerebral venous sinus thrombosis
(Ceylon College of Physicians, 2020) Abeysundara, P.K.; Nishad, A.A.N.; Perera, W.N.M.; de Silva, H.; Piyarathne, R.; Rathnayaka, R.M.P.M.; Arulmoly, K.; Umakanth, M.; Premaratna, R.; Tilakaratne, Y.
ABSTRACT: Melioidosis is a systemic disease endemic in Southeast Asia and Northern Australia. The spectrum of the disease varies from asymptomatic infection to severe systemic manifestations. Timely diagnosis and treatment of melioidosis is a challenge due to its atypical presentations. We report a case of melioidosis causing cerebral abscesses and cerebral venous sinus thrombosis. Occurrence of these neurological manifestations in melioidosis is rare and it is a difficult condition to diagnose and treat. Timely diagnosis was a challenge in this patient due to the atypical presentation and the use of empirical antibiotics in the primary care setting. Limited laboratory diagnostic capability also contributed to this delay. KEYWORDS: Melioidosis, Cerebral abscess, Cerebral venous sinus thrombosis
Pseudoainhum associated with lepromatous leprosy: A very rare association in modern world
(Chinese Medical Association Publishing House, 2023) Nishad, A.A.N.; Pathman, M.; Uwyse, S.A.; Mendis, A.; Abeysundara, P.K.; de Silva, A.P.
INTRODUCTION: Pseudoainhum (dactylolysis spontanea) is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation. Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions. Here, we present a rare case of pseudoainhum patient, which describes a very rare association of pseudoainhum with leprosy. CASE PRESENTATION: A 48 year old male with lepromatous leprosy, with resorption of digits, charcot joints and tropical ulcers was seen in the clinic. The forth digit of the left hand had a narrowing due to a fibrous band at the 2nd inter phalangeal joint with shiny tethering distal phalanx. He could not recall the duration of the ainhum. He was not suffering from any pain.DISCUSSION: The current report describes a very rare association of pseudoainhum with leprosy. The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum. CONCLUSION: This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits, especially in leprosy.
Should male doctors in Sri Lanka wear a necktie to be recognized and respected?
(Open Learning on Enteric Pathogens, 2019) Abeysundara, P.K.; Nishad, N.; Balendran, K.; Pabasara, M.; Bandara, P.K.; Perera, N.M.; de Silva, H.; de Silva, S.; Umakanth, M.; Wijesinghe, P.
INTRODUCTION: European cultural norms have influenced physicians' attire in Sri Lanka. The necktie is one such item of clothing which is worn to be recognized and respected as professionals. This study was carried out to assess the perceptions of doctors and patients towards male doctors wearing neckties while providing patient care. METHODOLOGY: A descriptive cross-sectional study was carried out at the National Hospital of Sri Lanka. An interviewer-administered questionnaire was used to collect data from doctors and patients. RESULTS: The study included 105 doctors (57% males) and 333 patients (54% males). Mean ages of the doctors and patients were 37 years (95% C.I. 36-39) and 47 years (95% C.I. 45-49) respectively. Sixty-nine percent of the patients had completed secondary education or above. None of the patients were aware of the risk of spreading infections by wearing a necktie. Of the 41% of doctors who thought it was unnecessary to wear a necktie, 95% believed the necktie can spread infections. Ninety-five percent of patients believed doctors should wear neckties to be identified and respected and to maintain trustworthiness.CONCLUSIONS: None of the patients were aware of the possible risk of spreading infections by wearing a necktie, while most of the doctors who thought neckties were unnecessary also believed neckties can spread infections. Almost all patients thought that doctors should wear a necktie to be recognized and respected. Therefore, implementing a change in dress policy for doctors is a challenging task in Sri Lanka. KEYWORDS: doctors; hospital infections; neckties.
Xanthogranulomatous salpingitis and oophoritis associated with endometriosis and uterine leiomyoma presenting as intestinal obstruction
(Informa Healthcare, 2012) Abeysundara, P.K.; Padumadasa, G.S.; Tissera, W.G.; Wijesinghe, P.S.
Xanthogranulomatous inflammation is a rare form of chronic granulomatous inflammation. Bacterial infections, immunosuppression, chronic inflammatory conditions, luminal obstruction, endometriosis, leiomyoma, abnormal lipid metabolism, ineffective antibiotic therapy, ineffective clearance of bacteria by phagocytes and chronic irritation of the urachal remnant have been implicated in the pathogenesis. There are very few reported cases of xanthogranulomatous salpingitis and oophoritis. We present such a case in a 34-year-old female, with primary subfertility for eight years, endometriosis, uterine leiomyoma, type II diabetes mellitus and a history of surgery for endometriosis and fibroids and surgical wound infection, who presented with symptoms of intestinal obstruction. The patient underwent emergency laparotomy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology revealed xanthogranulomatous salpingitis and oophoritis. Chronic inflammation due to inadequate treatment of bacterial infection, coupled with pelvic endometriosis and uterine leiomyoma may have led to xanthogranulomatous salpingitis and oophoritis.
Zinc supplementation in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study. (ZisCKDu-P)
(Ceylon College of Physicians, 2020) Abeysundara, P.K.; Nishad, N.; de Silva, S.T.; Dassanayake, R.T.; Galabada, D.P.; Jayawardane, U.G.W.; Premawardana, N.P.; Kumara, G.M.S.S.; Dilani, P.M.; Herath, H.M.T.D.; Wijesinghe, P.S.
INTRODUCTION: It was hypothesized that the antioxidant properties of zinc retard the progression of chronic kidney disease of unknown etiology in the North Central Province of Sri Lanka. METHODS: The pilot study was a randomized, placebo-controlled, single blinded, parallel group, single-center clinical trial with two arms (Z and P) and a 1:1 allocation ratio. Participants in group Z (n=20) received 60 mg of elemental zinc daily, in the form of zinc sulfate, and group P (n=21) received a starch tablet per day. Clinical, hematological parameters and kidney function were measured at the baseline and following three months of the intervention. RESULTS: A total of 86 CKDu patients were screened; only 35 males and 6 females were selected. Mean age and estimated glomerular filtration rate of the study population were 51.2±6.2 years and 38.9±8.8 mL/min/1.73 m2 respectively. At the end of three months there was non-significant increase in urine protein creatinine ratio (Z arm: 65±54 vs. 82± 86 mg/mmol; P=0.46, P arm: 72.4±113 vs. 120± 209 mg/mmol; P=0.36) and non-significant decline in estimated glomerular filtration rate (Z arm: 40.9±10.4 vs. 39.7±9.2 mL/min/1.73 m2; P=0.31, P arm: 37.1±6.8 vs. 36.4±10 mL/min/1.73m2; P=0.31) in both groups. Body mass index was significantly reduced (23±4 vs. 22.7± 3.9 kg/m2; P=0.01) and diastolic blood pressure was significantly increased (78±6 vs. 86±10 mmHg; P=0.001) in the placebo arm. Haemoglobin levelshowed a decline in the study group; 0.33±1 g/dl, while there was an increase in the placebo group, 0.34±0.7 g/dl, (P=0.02). There were no major side effects. CONCLUSIONS: The change of urine protein: creatinine ratio and estimated glomerular filtration rate did not show a significant difference between the two groups. A future trial should test effectiveness of same dose of zinc for a similar duration of time in a larger sample. Extended follow-up of the study subjects for one year after the intervention would be useful to assess the long-term effects of zinc on kidney function and side effects.