Browsing by Author "Mendis, S."

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Assessment of knowledge and attitude towards the palliative care among nurses in Sri Lanka: A hospital- based study.
(Sage Publishing, 2023) Wijesinghe, T.; Gunathilaka, N.; Mendis, S.; Udayanga, L.
OBJECTIVE: Palliative care is an intervention that improves the quality of life of patients. Nurses have a primary role in providing palliative care. Their knowledge and attitudes toward palliative care is important in care delivery. There is minimal information in Sri Lanka to document the knowledge and attitude of palliative care among nurses. Therefore, the present study was conducted to assess the knowledge and attitude of palliative care among nurses in Sri Lanka. METHOD: A cross-sectional, descriptive study was conducted on 200 selected nurses at Colombo North Teaching Hospital, Sri Lanka fulfilling the inclusion criteria. Socio-demographic information of the study participants was obtained through a self-administered questionnaire. The awareness and attitude levels toward the PC were assessed using the Palliative Care Knowledge Test (PCKT) and Frommelt Attitude Toward Care of the Dying, respectively. RESULTS: More than half of the participants (55%) had an inadequate knowledge level regarding the palliative care (<50% for the PCKT score). Regarding the attitude on the palliative care, the majority stated nursing care to a dying person is a worthwhile experience (92%; n = 184). Many of them disagreed with avoiding the care of dying patients (strongly disagree: 37%; n = 74, disagree: 52.5%; n = 105). Overall, 85.5% of study participants had a positive attitude towards the palliative care. According to binary logistic regression, gender (P = .04; OR = 3.57; CI = 1.03-12.41) and working setup (P < .001) were significantly associated with having a positive attitude. The knowledge level was higher among nurses working in surgical wards (OR = 7.84). Those with >10 years of experience were statistically significant to have a positive attitude (P = .02; OR = 1.35; CI = 1.13-5.50). CONCLUSION: The nurses had inadequate knowledge of the PC even though they had a positive attitude toward it. Therefore, it is essential to uplift the awareness level among health workers. This warrants the need for palliative care education in the nursing curriculum and continuous professional development.
A Biological System with Bristle Fiber of Coconut to Reduce COD Level of Synthetic Rubber Waste
(University of Kelaniya, 2012) Prasanna, M.A.U.U.; Ganepola, K.; Mendis, S.
It is a great problem to reduce COD (Chemical Oxygen Demand) levels of water soluble synthetic rubber waste which comes from rubber factories. Solid waste can be removed by using alum and lime. After removing solid waste subjecting to clarifier, the effluent is treated by secondary digestion using aerobic and anaerobic bacteria. Bristle fiber bacterial system is used for secondary digestion and efficiency of this system was very high. After the chemical treating, COD level was between 2000 mg/L and 4000 mg/L. The retention time of the new system was 30 hours and it contained anaerobic system, rotating batch contactor (RBC) system, and finalizing system. Bristle fiber of coconut was used as retention medium in every step and specially developed bacterial culture was used. Under the lab scale project, the following data were reported. Average value of input COD was 2784 mg/L. System A (anaerobic tank, tank capacity-50 L, flow rate-24 L/hour, retention time - 2 hours, output COD - 2202 mg/L, COD reduction percentage - 20.89%, pH - 6.8), System B (RBC with Bristle fiber, tank capacity - 350 L, flow rate - 24 L/hour, retention time - 14 hours, output COD- 330 mg/L, COD reduction percentage - 67.26%, pH - 7 and System C (contact with bristle fiber, tank capacity - 350 L, flow rate - 24 L/hour, retention time - 14 hours, output COD- 110 mg/L, COD reduction percentage- 7.89%, pH - 7). The final COD, BOD, pH and total suspended solids (TSS) values of treated water were 110 mg/L, 23mg/L, pH 7 and 20mg/L respectively while total COD reduction percentage was 96% and total retention time was 30 hours. The treated volume of water per day was 576 L. In the large scale project, the following data were reported. Average value of input COD was 2790.8 mg/L. System X (anaerobic tank, tank capacity - 7000 L, flow rate – 625 L/hour, retention time - 11.4 hours, output COD - 1755 mg/L, COD reduction percentage - 36.16%, pH - 6.8), System Y (RBC system with Bristle fiber, tank capacity – 10000 L, flow rate - 625 L/hour, retention time - 16 hours, output COD - 84.7 mg/L, COD reduction percentage 60 %, pH - 6.8) and System Z (contact with bristle fiber, tank capacity - 1500 L, flow rate - 625 L/hour, retention time - 2.6 hours, output COD - 62.45 mg/L, COD reduction percentage - 0.82%, pH - 6.8). Final COD value of treated water was 62.45 mg/L. Total COD reduction percentage was 96.8% and total retention time was 30 hours. The treated volume of water per day was 15000 L. 96% of COD can be reduced through this system within 30 hours.
Dengue Encephalitis with Concurrent Infections by Multiple Dengue Virus Serotypes
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Jayarathne, J.A.J.C.; Wijesinghe, W.A.T.A.; Mendis, S.; Waidyasekara, J.; Gunathilaka, P.A.D.H.N.; Gunasekara, D.
Dengue is a serious public health problem caused by an arbovirus. Abnormal-neurological presentations associated with dengue infection is rare. Herewith, we report a case of a patient with dengue encephalitis who was concurrently infected with multiple serotypes. A 36-year-old, male resident from Poogoda presented to North Colombo Teaching Hospital with a history of generalized tonic-clonic seizures (GTCS) and unconsciousness. On admission, he displayed only a persisting headache. He had no significant illnesses in the past. Detailed history revealed that he has had a fever and left the hospital against the medical advice on the same day. On clinical examination, he was afebrile and blood pressure was 110/80 mmHg. He was well oriented with a Glasgow Coma Scale (GCS) of 15/15 and there was no focal neurological deficit. The funduscopic examination was normal. His initial full blood count revealed a rise in white blood cells with a predominant elevation of neutrophils of 12.44 x 103/uL. His platelet count was reported to be 306 x103/uL and, he was treated for a bacterial infection. On the following day, the patient started developing a fever and GTCS. Aggressive behavior, confusion, and delirium were also demonstrated. Neck stiffness was not observed. Non-contrast computed tomography (NCCT) scan, contrast-enhanced computed tomography (CECT) scan, chest X-ray scan and magnetic resonance image (MRI) of the brain were normal. Electroencephalography (EEG) revealed encephalopathy with non-epileptic discharge. Lumbar puncture was performed on the third day of admission and analysis of cerebrospinal fluid (CSF) was unremarkable. IgM antibody for the dengue virus (DENV) was detected in CSF. All the other viral and parasitological studies were normal. The patient was treated with anti-epileptic, anti-psychotic, antibacterial and antiviral drugs. High fever spikes and seizures were continued. GCS started to deteriorate from 9/15 to 3/15. Urine out-put started to decline. Ultra-sound scanning revealed mild ascites. Blood picture analysis showed evidence of having a severe bacterial infection. On day 9, both CSF and serum specimens were referred to Molecular Diagnostic Laboratory, Faculty of Medicine, Ragama for dengue viral investigations. The presence of NS-1 antigen, IgM/IgG antibodies, and the occurrence of concurrent infections with serotype 2 and 3 in the serum sample confirmed that the patient was infected with DENV. The presence of IgM/IgG antibodies were observed in the CSF sample. On day 10, the patient was transferred to the medical intensive care unit and monitored thoroughly. As the condition was deteriorated, he was ventilated and incubated for 11 days in the intensive care unit. He started to recover gradually after the 31st day. On day 36, the patient was discharged without any residual neurological symptoms. The patient is currently being followed up at the neurological clinic. Dengue encephalitis is a rare and deleterious manifestation of dengue infection. It is believed that concurrent infections with multiple serotypes and serotype replacement may cause disease severity. Therefore, reporting uncommon cases will provide insights for the physicians in early diagnosis and effective management
Female offenders with Psychiatric disorders
(Sri Lanka College of Psychiatrists, 2015) Chandradasa, M.; Champika, L.; Mendis, S.; Fernando, F.
BACKGROUND: Female offenders are characterised by higher rates of psychiatric morbidity. Studies in developed countries show an increase in the number of female prisoners in recent years. The objectives of this study were first to describe socio-demographic factors and rates of psychiatric morbidity in female offenders, and second, among females with psychiatric illness, to compare those with and without a history of offending. METHODS : A retrospective case control study was carried out among 71 alleged female offenders who had been admitted to the National Institute of Mental Health (NIMH), Sri Lanka over an 18 months period. Females attending an outpatient psychiatry clinic with no prior history of offending were considered as controls. Data were collected from court reports and patient records. RESULTS: Among the alleged offences, 63% were reported as ‘‘behavioural disturbance due to mental illness’’, and 14% as physical assault. The most common diagnoses among female offenders with psychiatric illness were schizophrenia (43%) and bipolar affective disorder (22%). Childhood sexual abuse was reported by 22% of cases compared to 12% of controls (p=0.08). Rates of marriage and employment were significantly lower among the female offenders with psychiatric illness, compared to the controls. CONCLUSION: Patterns of psychiatric illness among female offenders in Sri Lanka may differ from that of the West. Among females with psychiatric illness in Sri Lanka, being single, unemployed and use of alcohol is significantly associated with offending compared to controls. Further research is required to explore these findings.
Fixed low-dose triple combination Antihypertensive Medication vs usual care for blood pressure control in patients with mild to moderate hypertension in Sri Lanka: A Randomized Clinical Trial
(American Medical Association, 2018) Webster, R.; Salam, A.; de Silva, H.A.; Selak, V.; Stepien, S.; Rajapakse, S.; Amarasekara, N.; Amarasena, N.; Billotm, L.; de Silva, A.P.; Fernando, M.; Guggilla, R.; Jan, S.; Jayawardena, J.; Maulik, P.K.; Mendis, S.; Mendis, S.; Munasinghe, J.; Naik, N.; Prabhakaran, D.; Ranasinghe, G.; Thom, S.; Thisserra, N.; Senaratne, V.; Wijekoon, S.; Wijeyasingham, S.; Rodgers, A.; Patel, A.; TRIUMPH Study Group
IMPORTANCE: Poorly controlled hypertension is a leading global public health problem requiring new treatment strategies. OBJECTIVE: To assess whether a low-dose triple combination antihypertensive medication would achieve better blood pressure (BP) control vs usual care. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label trial of a low-dose triple BP therapy vs usual care for adults with hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg; or in patients with diabetes or chronic kidney disease: >130 mm Hg and/or >80 mm Hg) requiring initiation (untreated patients) or escalation (patients receiving monotherapy) of antihypertensive therapy. Patients were enrolled from 11 urban hospital clinics in Sri Lanka from February 2016 to May 2017; follow-up ended in October 2017. INTERVENTIONS: A once-daily fixed-dose triple combination pill (20 mg of telmisartan, 2.5 mg of amlodipine, and 12.5 mg of chlorthalidone) therapy (n = 349) or usual care (n = 351). MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion achieving target systolic/diastolic BP (<140/90 mm Hg or <130/80 mm Hg in patients with diabetes or chronic kidney disease) at 6 months. Secondary outcomes included mean systolic/diastolic BP difference during follow-up and withdrawal of BP medications due to an adverse event. RESULTS: Among 700 randomized patients (mean age, 56 years; 58% women; 29% had diabetes; mean baseline systolic/diastolic BP, 154/90 mm Hg), 675 (96%) completed the trial. The triple combination pill increased the proportion achieving target BP vs usual care at 6 months (70% vs 55%, respectively; risk difference, 12.7% [95% CI, 3.2% to 22.0%]; P < .001). Mean systolic/diastolic BP at 6 months was 125/76 mm Hg for the triple combination pill vs 134/81 mm Hg for usual care (adjusted difference in postrandomization BP over the entire follow-up: systolic BP, -9.8 [95% CI, -7.9 to -11.6] mm Hg; diastolic BP, -5.0 [95% CI, -3.9 to -6.1] mm Hg; P < .001 for both comparisons). Overall, 419 adverse events were reported in 255 patients (38.1% for triple combination pill vs 34.8% for usual care) with the most common being musculoskeletal pain (6.0% and 8.0%, respectively) and dizziness, presyncope, or syncope (5.2% and 2.8%). There were no significant between-group differences in the proportion of patient withdrawal from BP-lowering therapy due to adverse events (6.6% for triple combination pill vs 6.8% for usual care). CONCLUSIONS AND RELEVANCE: Among patients with mild to moderate hypertension, treatment with a pill containing low doses of 3 antihypertensive drugs led to an increased proportion of patients achieving their target BP goal vs usual care. Use of such medication as initial therapy or to replace monotherapy may be an effective way to improve BP control.
Hyperhomocysteinaemia in Sri Lankan patients with coronary artery disease
(Sri Lanka Medical Association, 2002) Mendis, S.; Ranatunga, P.; Jayathilake, M.; Wanninayake, S.; Wickremasinghe, R.
OBJECTIVE: To determine the association between hyperhomocysteinaemia and coronary artery disease (CAD) in a sample of Sri Lankans. DESIGN: A case control study. SETTING: Asiri Hospital, Kirula Road, Colombo 5, Sri Lanka. SUBJECTS: 105 patients with coronary artery disease and 112 controls. METHOD: Fasting serum homocysteine levels were measured in 105 patients diagnosed as having CAD and in 112 unmatched controls. All patientsadmitted with clinical, electrocardiographical, biochemical or echocardiographical evidence of CAD were included in the study. Controls were selected from subjects admitted for health screening. RESULTS: 105 patients with CAD and 112 controls (unmatched for age and sex) were studied. A serum homocysteine level in excess of 18.2 mumol/l was considered high. Confounding effects of other conventional risk factors for CAD were controlled using multivariate logical regression analysis. CONCLUSION: Hyperhomocysteinaemia is significantly associated with CAD. Multivariate logistic regression analysis indicated that the association between hyperhomocysteinaemia and CAD was confounded by other risk factors. However, statistical analysis revealed a significant independent association between hyperhomocysteinaemia and CAD (adjusted odds ratio = 2.881).
Impact of COVID-19 outbreak on the number of invasive procedures in Institute of Cardiology, National Hospital of Sri Lanka -A descriptive longitudinal study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Kuruppu, C.; Gunawardena, R.; Dunuwille, A.; Ranasinghe, G.; Fernando, N.; Mendis, S.; Fernando, M.; Wijewardena, A.; Prabath, I.H.D.S.
Introduction: Covid-19 pandemic has significantly affected healthcare services worldwide with a similar impact on invasive procedures, in Institute of Cardiology, National Hospital of Sri Lanka (NHSL). Objectives: To analyse the impact of Covid-19 outbreak on therapeutic cardiology interventions, both elective and emergency, by comparing frequencies of procedures done during the initial affected year and immediate previous year. Methods: A Retrospective longitudinal descriptive study was carried out on frequencies of invasive therapeutic cardiology procedures during the period of 2019 March to 2021 February, at Cardiology Unit, NHSL. Pre-formed data collection sheets were filled using hospital registries. Final analysis was done by Microsoft-Excel 365. Results: Total number of procedures done in affected year was 4690 compared to 6096 in previous year. In April 2020, which was the most affected month, 52 cumulative procedures have been done in comparison to 427 procedures in April 2019. By August 2020 number of procedures has increased to 668 in compared to 486 in August 2019. Total of elective procedures were 3751 and 5061 in affected and non-affected years respectively. Similarly, the number of emergency procedures was 1035 in immediate previous year and 939 during Covid pandemic. Conclusions: Study has highlighted a significant impact on invasive therapeutic cardiology procedures, especially on electives, by the onset of the Covid-19 pandemic, especially during the period of lockdown. However, there has been a compensatory increase in procedures once lockdown was over, partially compensating for the numbers. There has been less impact on emergency procedures, the numbers of which have remained relatively constant.
Influence of baseline inflammatory status on dietary effects of nutrition counseling in women with and without coronary artery disease
(Sri Lanka Medical Association, 2012) Thoradeniya, T.; Senenayake, C.; Wickremasinghe, R.; Mendis, S.; Jayasena, S.; Atukorala, S.
INTRODUCTION: Inflammatory status influences the biochemical response to diet, suggesting an additional mechanism increasing coronary artery disease (CAD) risk. Aims: To determine the effect of baseline inflammatory status on biochemical response to nutrition counseling to reduce CAD risk. METHODS: A 2x2 factorial experiment having an intervention was conducted among 40-60 year old women with (n=101) and without CAD (n=109). Intervention comprised nutrition counseling. Baseline and post-intervention data on diet, serum high sensitivity CRP (hsCRP), soluble ICAM-1 (sICAM-1), ferritin, folate, plasma total homocysteine (tHcy) concentrations and traditional CAD risk factors were assessed. RESULTS: At baseline tHcy, sICAM-1 and hsCRP concentrations were significantly higher (p<0.05) among women with CAD than in women without CAD. Baseline sICAM-1 [OR=3.19 (95"% CI, 1.65-6.17)] and tHcy concentrations [OR=1.33 (95% CI 1.1-1.61)] were independently associated with CAD after adjusting for other risk factors. Nutrition counseling significantly decreased serum total and LDL cholesterol and increased serum folate (p<0.05) in women without CAD, but not in women with CAD. Among women without CAD, nutrition counseling decreased serum total and LDL cholesterol, and increased serum folate (p<0.05) in the "low" hsCRP group (below median of controls) but not in the "high" hsCRP group (above median). CONCLUSIONS: Nutrition counseling was effective in reducing serum total and LDL cholesterol and increasing serum folate in women without CAD having a "low" baseline inflammatory status. The hindering effect of underlying inflammation, on the biochemical response to dietary modification should be considered in dietary interventions in CAD risk reduction.
The Role of a Cardiac Rehabilitation Programme on Risk Modification in Patients with Established Coronary Heart Disease
(University of Kelaniya, 2007) Pinidiyapathirage, M.J.; Wickremasinghe, A.R.; Mendis, S.
Objective: To evaluate the effectiveness of a cardiac rehabilitation programme (CRP) on risk modification behaviour of patients following a major cardiac event. Methods: A quasi-experimental pre-test post-test design was used to evaluate the CRP. The study was conducted at the National Hospital of Sri Lanka (NHSL) from July 2005 to August 2006. Patients admitted with a myocardial infraction (MI) to the Institute of Cardiology of the NHSL and all patients who underwent a coronary artery by-pass graft (CABG) surgery or a Percutaneous Transluminal Coronary Angioplasty (PTCA) during the study period were invited to participate in the CRP. Control group consisted of patients admitted with a MI to all medical wards at the. NHSL. An intervieweradministered questionnaire with a food frequency questionnaire and a physical activity questionnaire was used to collect data. Weight, height, and waist and hip circumferences were measured adhering to standard protocols and using standardized instruments. Biochemical analysis of blood at follow up was done at the laboratory of the Nawaloka Group of Hospitals and the National Diabetes Centre. Results: 91% of those who participated in the CRP (n=167) and 75% of the control group (n=168) were followed up at six months following the major cardiac event. There were significant changes in the risk profiles at six months in both groups when each group was taken separately. However, the absolute changes were seen only with regard to serum LDL cholesterol level (difference in improvement in the two groups=9.7%, p=0.015), quality of diet (difference in improvement in the two groups=19.3%, p<0.001), physical activity levels (difference in improvement in the two groups =22.2%, p<0.001) and smoking status (difference in improvement in the two'groups=16%, p
Splenic Syndrome in a young man at high altitude with undetected Sickle Cell Trait
(Sage, 2018) Fernando, C.H.K.A.; Mendis, S.; Upasena, A.P.; Costa, Y.J.; Williams, H.S.A.; Moratuwagama, D.
INTRODUCTION: Splenic syndrome is a rare presentation of sickle cell disease. It is important to rule out this possibility when an ethnically vulnerable patient presents with an acute abdominal symptoms in a background of precipitating events. CASE REPORT: A 26-year-old man who developed a severe abdominal pain at high altitude, found to have a tender splenomegaly. However, further inquiry revealed he is from an area where sickle cell disease is prevalent. Screening for sickle cell disease was positive. Radiological investigations confirmed a massive splenic infarction keeping with a diagnosis of splenic syndrome. Patient was managed conservatively. CONCLUSION: Sickle cell trait is considered a benign carrier state. However, rarely they can present with life-threatening conditions. Therefore, a high degree of clinical suspicion is required for early diagnosis of these specific entities to avoid increased morbidity and mortality of these patients.