Browsing by Author "Perera, D."

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Bioassay-guided isolation and antioxidant properties of phytochemicals present in methanolic extract of Halosarcia indica from salt marsh ecosystems in Sri Lanka
(Faculty of Science, University of Kelaniya Sri Lanka, 2024) Siriwardhana, U. L. I. G.; Perera, D.; Attanayake, R. N.; Paranagama, P. A.
Halosarcia indica, belonging to the family Amaranthaceae, is a halophyte that exhibits unique adaptations to saline environments. Halophytes contain various bioactive chemicals, including plant polyphenols, which have garnered interest due to their antioxidant properties. Isolation of pure compounds responsible for the antioxidant activity is also very important in nutraceuticals, cosmetics, and pharmaceutical industries. The aim of the present study was to isolate and identify bioactive compounds from H. indica samples collected from Sri Lanka. Fresh plant materials were collected from salt marshes in Mannar district, Sri Lanka. Phytochemicals from finely powdered freeze-dried areal parts of H. indica were extracted using cold extraction and sequentially partitioned with methanol, dichloromethane (DCM), and hexane. The antioxidant activity of these fractions was evaluated using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, the 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assay, and the Ferric Reducing Antioxidant Power (FRAP) assay, with butylated hydroxytoluene (BHT) serving as the positive control. The total phenolic content (TPC) was assessed using the Folin-Ciocalteu method, while the determination of total flavonoid content (TFC) was conducted through the aluminum chloride assay. Additionally, the total tannin content (TTC) was examined using the vanillin/HCl method. Finally, methanolic and DCM extractions were subjected to column chromatography, thin layer chromatography, and preparative thin layer chromatography techniques to isolate compounds responsible for antioxidant activity. The methanolic fraction exhibited the highest radical scavenging activity, with IC50 values of 69.78 ± 3.48 µg mL-1 in the DPPH assay and 81.38 ± 1.89 µg mL-1 in the ABTS assay, while the positive control BHT showed IC50 values of 20.91 ± 0.48 µg mL-1 and 22.93 ± 0.65 µg mL-1, respectively. In the FRAP assay, the methanolic fraction presented higher mean absorbance values of 0.598 ± 1.81 compared to that of the BHT 0.821 ± 1.82. Methanolic extracts of the H. indica had higher TPC (184.77 ± 3.21 mg GAE/g), TFC (190.69 ± 5.84 mg CE/g), and TTC (201.33 ± 4.21 mg GAE/g) values compared with DCM and hexane extracts. Methanolic extracts showed higher antioxidant activity followed by DCM and hexane extracts. Therefore, two pure compounds with antioxidant activities were isolated in methanolic (IC50 - 78.69 ± 1.24 µg mL-1) and DCM extracts (IC50 - 192.84 ± 1.65 µg mL-1) respectively. The study identified two antioxidant compounds from H. indica extracts, with methanolic extracts showing the highest activity. Further analysis will be done using spectroscopic methods. These two compounds will be identified using spectroscopic techniques, including 1H NMR, 13C NMR, HPLC, and mass spectrometry.
Case report: Opportunities for Medication Review and Reconciliation by a Clinical Pharmacist to Prevent Drug-Related Hospital Re-Admissions: Evidence from a Case Series in Sri Lanka
(Pharmaceutical Journal of Sri Lanka, 2018) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; Perera, D.; Pathiraja, V.M.; Mamunuwa, N.; Mohamed, F.; Coombes, I.; Lynch, C.; de Silva, H.A.; Dawson, A.H.
ABSTRACT: Medication review by a clinical pharmacist improves quality use of medicines in patients by identifying, reducing and preventing drug related problems and hospital re-admissions. This service is new to Sri Lanka. We present two cases from a non-randomized controlled trial conducted in a tertiary care hospital in Sri Lanka. The first case is from the control group where no clinical pharmacist was engaged and the next case is from the intervention group. The first case was a drug related hospital re-admission because of missing medicines in the discharge prescription and the second case was a re-admission which was prevented by the intervention of a ward pharmacist by performing a clinical medication review of the prescription.
Changes in lung volumes and respiratory muscle strength in different phases of the rowing stroke in Sri Lankan rowers: a preliminary study
(Research Symposium on Pure and Applied Sciences, 2018 Faculty of Science, University of Kelaniya, Sri Lanka, 2018) Perera, D.; Ariyasinghe, A. S.; Kariyawasam, A.
Breathing is a muscular process brought on by a group of muscles that are capable of demanding as much as 16% of available oxygen during maximal exercise. The rowing stroke consisting of four major phases; catch, drive, finish and recovery are engaged with the breathing cycle. A cross sectional descriptive study was conducted to assess respiratory functions and ergometer performance in 20 male national level rowers in the Sri Lanka Army in the age range 20-35 years in the competition season. Lung volumes and capacities were measured using a portable spirometer (Spiro analyzer ST-75). Respiratory muscle strength (RMS) was measured using a portable hand held mouth pressure meter (Micro MPM, Micro Medical Ltd., Kent, United Kingdom; Precision Medical MPM, UK). Both Lung volumes and RMS were assessed in standing, upright seated, catch and finish positions on the rowing ergometre machine in the morning before training session. Data was analyzed in SPSS software using descriptive statistics and relationship of variables were assessed with Pearson correlation. Probability values < 0.05 were considered significant. Ethical clearance was obtained from Ethics Review Committee, Faculty of Medicine, University of Peradeniya. The lung volumes of peak inspiratory flows (PIF) (2.40 ± 0.61), vital capacity (VC) (8.37 ± 1.66), forced expiratory volume per second (FEV1) (5.80 ± 1.18) and forced vital capacity (FVC)/FEV1 (1.63 ± 2.54) are higher in standing position while peak expiratory flows (PEF) (13.64 ± 1.48) and FVC (6.57 ± 3.17) are higher in finish and catch position on the ergometre machine respectively. Inspiratory muscle strength (IMS) (111.60 ± 29.79) and expiratory muscle strength (EMS) (155.30 ± 33.94) are higher in standing position. EMS and IMS significantly correlated with FVC/FEV1 in finish (r=-0.64; p<0.01) and upright seated (r=-0.56; p<0.01) position in ergometre machine respectively. This study shows that there is a significant association between lung volumes and RMS in phases of rowing stroke rather than in standing position.
A Comparative analysis of the outcome of malaria case surveillance strategies in Sri Lanka in the prevention of re-establishment phase
(BioMed Central, 2021) Gunasekera, W.M.K.T.A.W.; Premaratne, R.; Fernando, D.; Munaz, M.; Piyasena, M.G.Y.; Perera, D.; Wickremasinghe, R.; Ranaweera, K.D.N.P.; Mendis, K.
BACKGROUND: Sri Lanka sustained its malaria-free status by implementing, among other interventions, three core case detection strategies namely Passive Case Detection (PCD), Reactive Case Detection (RACD) and Proactive Case Detection (PACD). The outcomes of these strategies were analysed in terms of their effectiveness in detecting malaria infections for the period from 2017 to 2019. METHODS: Comparisons were made between the surveillance methods and between years, based on data obtained from the national malaria database and individual case reports of malaria patients. The number of blood smears examined microscopically was used as the measure of the volume of tests conducted. The yield from each case detection method was calculated as the proportion of blood smears which were positive for malaria. Within RACD and PACD, the yield of sub categories of travel cohorts and spatial cohorts was ascertained for 2019. RESULTS: A total of 158 malaria cases were reported in 2017-2019. During this period between 666,325 and 725,149 blood smears were examined annually. PCD detected 95.6 %, with a yield of 16.1 cases per 100,000 blood smears examined. RACD and PACD produced a yield of 11.2 and 0.3, respectively. The yield of screening the sub category of travel cohorts was very high for RACD and PACD being 806.5 and 44.9 malaria cases per 100,000 smears, respectively. Despite over half of the blood smears examined being obtained by screening spatial cohorts within RACD and PACD, the yield of both was zero over all three years. CONCLUSIONS: The PCD arm of case surveillance is the most effective and, therefore, has to continue and be further strengthened as the mainstay of malaria surveillance. Focus on travel cohorts within RACD and PACD should be even greater. Screening of spatial cohorts, on a routine basis and solely because people are resident in previously malarious areas, may be wasteful, except in situations where the risk of local transmission is very high, or is imminent. These findings may apply more broadly to most countries in the post-elimination phase. KEYWORDS: Active case detection; Malaria case surveillance; Malaria in Sri Lanka; Passive case detection; Prevention of re-establishment of malaria; Proactive case detection; Reactive case detection; Spatial cohorts; Travel cohorts; Yield.
Comparison of different RNA extraction protocols: An optimized RNA extraction protocol for tea leaves [Camellia sinensis (L.) O. Kuntze]
(4th International Research Symposium on Pure and Applied Sciences, Faculty of Science, University of Kelaniya, Sri Lanka, 2019) Keerthika, V.; Ranatunga, M. A. B.; Perera, D.; Herath, H.
Extracting high-quality RNA is critical for downstream applications such as quantitative real time PCR (qRT PCR), RNA sequence based transcriptomics and a prerequisite for ensuring representation of all expressed genes in a cDNA library. Tea is a popular non- alcoholic beverage crop and tissues contain abundant polysaccharides, phenolic compounds and other metabolites, which hinder isolation of high-quality RNA. Tender two leaves and a bud harvested is the economically important tissues of tea. A large number of extraction protocols have been exploited or modified for tea, viz commercial kits, CTAB-based methods and SDS-based methods. However; difficulties were encountered in terms of purity and quantity of isolated RNA, while some of the methods were time-consuming. Hence, the present study was aimed to optimize protocol/s for extracting good quality RNA suitable for downstream applications from two leaves and a bud tissue of tea. Two different RNA extractions protocols based on CTAB and hot borate with modifications along with three commercial RNA extraction kits were used to extract RNA from two tea cultivars. Out of which, a CTAB-based protocol optimized for pomegranate plant tissues with minor modifications resulted in the highest RNA yield, varying from 524 ± 4 to 776 ±16 μg/ml for cultivars TRI 2023 and TRI 2025 and high integrity as confirmed by Gel electrophoresis (distinct and visible 28S rRNA and 18S rRNA bands). The extracted RNA was further used for cDNA synthesis, expression of 18s house keeping gene through Realtime-polymerase chain reaction (qRT-PCR). Results showed that the yield and quality of total RNA extracted were suitable for qRT-PCR, depicting the quality of RNA for the downstream applications. Commercially available extraction kits despite of giving sufficient amount of RNA, had lesser yield and quality when compared to the CTAB based method. The protocol optimized for pomegranate was modified with omitting washing the RNA pellet with LiCl and replacing the extraction buffer (CTAB, PVP, NaCl, EDTA, Tris HCl, Spermidine, β-mercaptoethanol) with extraction buffer used for grapevines. This protocol enables successful isolation of RNA from two leaves and a bud tissues of tea within two days without the use of toxic and expensive chemicals such as phenol, guanidium isothiocyanate and guanidium hydrochloride. The protocol is efficient, simple, and reproducible and is therefore recommended for RNA extraction from plants with high polyphenol contents
Cost accounting in a surgical unit in a teaching hospital--a pilot study
(Sri Lanka Medical Association, 2003) Malalasekera, A.P.; Ariyaratne, M.H.J.; Fernando, R.; Perera, D.; Deen, K.I.
INTRODUCTION: Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. PATIENTS AND METHODS: 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). RESULTS: The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). CONCLUSION: Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units
Dengue vector surveillance in a dengue hot-spot in Sri Lanka
(Faculty of Tropical Medicine, Mahidol University, 2007) Sumanadasa, S.D.M.; Hapugoda, M.D.; Perera, D.; Bandara, S.; Mansoor, M.A.; Peris, I.; Abeyewickreme, W.
BACKGROUND: In South Asia, dengue has been declared as one of the most, fast-spreading vector-borne diseases. Therefore, mosquito surveillance is important for early detection of outbreaks along with implementation of prompt control activities. OBJECTIVES: To identify entomological risk factors with regard to transmission of dengue in a dengue hot-spot. Seventy five human dwellings in Vehara in the Kurunegala District of the Western Province were selected based on high disease incidence during 2000-2004, high Aedes as well as human population density and increased building activities. Entomological surveillance was done during May-August, 2007. RESULTS: The house Index ranged from 2.67% to 5.33% for Aedes aegypti while it for Aedes albopictus was 1.33% to 6.60%. The container index ranged from 23.67% to 29.33% for Ae. aegypti and from 1.33% to 18% for Ae. aibopictus. Man biting rates of 0.43-5.78 bites/man/hour were estimated for Ae, aegypti, while it ranged between 0.49 and 1.33 for Ae. aibopictus. The most common breeding place for Aedes species was plastic baskets (16%, n=12). DISCUSSIONS: Vector surveillance showed that the predominant vector species present in the study area was Ae. ageypti. Aedes mosquito larval densities and adult biting rates were sufficient to promote outbreaks of dengue in this study area. Community must be educated regarding effective measures to protect them from dengue. Their cooperation should be elicited in the early detection and elimination of vector species by source reduction, environmental management and personal protection measures.
Development of low-cost automated robot arm; its limitations and the validity of results through modified potentiometric experiments
(Institute of Chemistry Ceylon Adamantane House, Rajagiriya, Sri Lanka., 2020) Perera, K. A. N. K.; Rodrigo, S.; Liyanage, I.; Umayanga, I.; Perera, B.; Nawarathne, D.; Perera, D.; Jiffry, N.; Sirimuthu, N.; Ekanayake, E. M. M. S.
Robotics is used widely in design, construction and operation, further also in control, sensory, feedback and information processing. Robotics arm performs a crucial task in all the above. Automation in a chemical laboratory will be a major breakthrough in terms of productivity, quality and the reproducibility of the results, improved safety, reduce the time and cost of the whole running process. To catalyze this revolutionized system performances, as a combination of engineering and chemistry, we developed an automated robot arm and validated its results while overlooking the limitations via modified potentiometric experiments. The idea behind this concept is to use this robotics hand in places where it can be used to replicate the action of a human hand and thereby substituting its purpose in places where a human hand cannot be used. During this experiment robot arm involved in measuring cell voltage by using a standard calibrated potentiometer in a thermostat water bath at different temperatures; where it produced steady results compared to the manual procedure under same conditions while saving a considerable working time. The potentiometric reading equipment IEEE 488 fitted with an Interface Scanner 740 and a GPIB (General Purpose Interface Bus) program was used to obtain a continuous record of the potentials while test solutions were moving on a belt. For the validation, reading taken by using the automated arm and manual readings for the same sample were statistically analyzed (n=181) using t-test, linear regression and Spearman correlation coefficients which clearly indicate no significant difference between them. In summary, this work described an inexpensive and simple method for the automated potentiometric titration. The only limitation encountered during this process was the servo motors used, have only a maximum rotation of 180⁰ for 1m radius semicircle within 75s. Therefore, the area of movement is restricted to a certain region of space, but the arm can move an object from one-point coordinate to another in the x, y and z axes which could be adapted to many applications other than in a chemical lab.
Domain-Specific learning among medical students
(Basic Medical Scientists Association, 2012) Perera, D.; Ramanayake, R.P.J.C.; de Silva, A.H.W.; Sumanasekara, R.D.N.; Jayasinghe, L.R.; Gunasekara, R.; Chandrasiri, P.
Background: The aim of this study was to investigate undergraduate medical student’s domain-specific learning. Method: The research tool was a structured essay question formulated to assess factual and affective knowledge and application and synthesis of knowledge .The question was administered to 151 students. Results: Mean score on the recall question was significantly higher than the other two domains. Total scores of female students were significantly higher than male students (P<0.05). Gender-wise difference in scores was not significant in any specific domain area. There was no significant relationship between factual knowledge and total scores. However, there was a significant linear relationship between total scores and the two areas of affective knowledge (r=0.78) and application and synthesis of knowledge (r=0.6). Findings indicate that affective knowledge and application of knowledge are closely related to overall acquisition of knowledge (P<0.0005). Conclusion: Teaching and assessment in higher-order knowledge domains and affective knowledge needs to be developed. Questions dealing with affective knowledge and testing higher-order cognitive abilities are more discriminatory than questions testing at the recall level.
Duplication errors due to brand name confusion; It is not always the name-Short case series
(John Wiley & Sons, 2023) Mamunuwa, N.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Perera, D.; Shanika, T.; Mohamed, F.; Lynch, C.; de Silva, A.; Dawson, A.
Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.
Evaluation of phytochemical profile and in -vitro antioxidant activity Suaeda maritima
(Faculty of Science, University of Kelaniya Sri Lanka, 2023) Pathirana, K. P. S. S.; Herath, H. M. N. P.; Perera, D.; Attanayake, R. N.; Paranagama, P. A.
Suaeda maritima, a halophytic plant species from the family Amaranthaceae, possesses unique adaptations that enable it to thrive in high-salt environments. Halophytes contain various bioactive chemicals, including plant polyphenols, which have garnered interest due to their antioxidant properties. This study aims to investigate how the polyphenolic content and antioxidant activity of extracts change across the polar, mid-polar, and non-polar fractions of crude extracts from S. maritima. These extracts are obtained from both the aerial parts and the roots of the plant, which were harvested from Seguwantivu area of Puttalam, Sri Lanka. Each dried and powdered plant part was sequentially extracted into hexane, dichloromethane (DCM), and methanol at ambient temperature using cold maceration. The Antioxidant activity of each concentrated extract was determined by 2,2-diphenyl-1-1-picrylhydrazyl(DPPH) assay, and 2,2'-azino-bis(3- ethylbenzothiazoline-6-sulfonic acid (ABTS) assay , phenolic content by (TPC) by FolinCiocalteau method, flavonoid content (TFC) by aluminum chloride assay and condense tannin content (CTC) by vanillin/HCl method. Six sequential extracts of S. maritima (from aerial parts and roots) showed antioxidant activity. The results indicated that S. maritima shoot extracts have significant levels of polyphenolic compounds (p=0.05), with methanolic extracts exhibiting the highest TPC (31.55±1.54 mg GAE/g dw), TFC (18.41±0.91 mg CE/g dw) and CTC (3.66±0.19 mg CE/g dw). In contrast, root extracts showed lower polyphenolic content (23.69±5.63 mg CE/g dw, methanol extract) but still possessed appreciable antioxidant activity (IC50, 0.40±0.07×10-1 mg/mL DPPH and IC50, 0.69±0.02×10-1 mg/mL ABTS). The ABTS assays revealed the radical scavenging ability of the extracts, with the methanolic aerial parts extract exhibiting the most potent antioxidant activity (IC50, 0.17±0.01×10-1 mg/mL) exhibiting it has more water-soluble antioxidants. Overall, Solvent extracts of the S. maritima possess antioxidant properties at varying levels. The fraction of polar compounds in the areal parts of S. maritima contains a relatively high amount of phenolic compounds and potent antioxidant properties. Moreover, identifying antioxidant properties from halophytes could contribute significantly to developing of natural antioxidants for combating oxidative stress-related diseases.
General practice is ‘different’: qualitative study of acculturation experiences of East Staffordshire general practice specialty trainees
(Royal College of General Practitioners, 2020) Perera, D.; Mohanna, K.
BACKGROUND Undergraduate medical education and postgraduate foundation training are largely secondary care based. General practice trainees also spend nearly half of their training in hospital rotations. Little is known about factors that support effective transition into general practice specialty training or belongingness experiences throughout training. AIM To explore the reported experiences of general practice trainee transition into general practice, training in hospital settings, and views of the future. METHOD Semi-structured interviews with 18 purposively selected trainees plus observation and stakeholder discussions by a visiting Sri Lankan general practice trainee attending the vocational training scheme in a participant observer role. RESULTS Mastering core skills of general practice, undergraduate and early experience in general practice during specialty training, and general practice trainer guidance and role modelling facilitated transition. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, and secondary care affiliative behaviours were adaptive strategies. Allocation to more general practice relevant duties was thought to create value within the hospital team. General practice trainees are thriving with the support of general practice trainers and colleagues, vocational training scheme, and good work/life balance. International graduates require additional support in specific areas. CONCLUSION Adequate support towards transition into general practice and fostering belongingness in hospital settings is important due to the wider impact on training, patient care, and primary/secondary care integration. We propose a theoretical explanation based on Wenger’s social learning model, which may have useful practical implications.
Impact of a ward based clinical pharmacist intervention on improving the quality use of medicines in patients with chronic non communicable diseases in a tertiary hospital
(Sri Lanka Medical Association, 2014) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Coombes, I.; Perera, D.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: To investigate the impact of a ward based clinical pharmacy service (CPS) on appropriate prescribing of discharge medications. METHODS: This is a non-randomised controlled trial conducted to assess CPS in a medical unit. Eligible patients admitted with non-communicable chronic diseases were considered. The female and the maie wards were the control and intervention during initial phase. Groups were swapped between two wards during next phase. The control patients received usual management. Intervention received CPS in addition to the existing management. Both clinical and demographic data were collected until discharge. Appropriateness of prescribing was assessed at discharge with the Medication Appropriateness Index (MAI). RESULTS: 354 (2140 medications) and 359 (2232 medications) patients' data were evaluated respectively in, control and intervention. Medications received per patient in both groups were similar. Appropriateness of discharged medications in intervention' group was significantly higher compared to control, 66% (235/359) and 34% (120/354) respectively (p< 0.0001). Furthermore, the mean MAI score per patient was significantly lower in intervention compared to th.e control (0.99 vs. 4.1, p< 0.001). Proportion of appropriate prescriptions in relation to all MAI criteria was significantly lower in intervention group compared to the control, all (p< 0.01). Among the drugs prescribed in the intervention [5% (112/2232)] and control groups, [20% (420/2140)] respectively had at least one inappropriate MAI criterion (p< 0.0001). CONCLUSIONS: This study demonstrates that a ward based CPS can reduce inappropriate prescribing of medications at discharge providing an opportunity to improve quality use of medicine.
Impact of a ward-based clinical pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases
(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Coombes, I.; Perera, D.; Pathiraja, V.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: This is the first study done in Sri Lanka to evaluate the benefit of a ward-based pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases. METHOD: This is a part of a controlled trial conducted in a tertiary care hospital to evaluate ward-based clinical pharmacy service. Intervention group (IG) received a ward-based pharmacist's service during hospitalization to optimize the patients' drug therapy. At discharge the pharmacist counseled patients regarding all aspects (name, indication, dose, frequency, side effects, and actions for side effects, timing, monitoring and storage) of long term medications and written instructions were also provided. Control group (CG) received usual care without a ward-based pharmacist. The knowledge and adherence were assessed over the phone on the 6th day after discharge by a different pharmacist. Previously validated knowledge and adherence questionnaires were used. RESULTS: There were 334 and 311 patients in the IG and CG, respectively, The IG had a significantly higher average medication knowledge compared to the CG {IG-75.81+19.14 vs. CG-40.84+19.20; P < 0.001). Proportion of drugs with correct answers, to all 9 dimensions tested, was greater in the IG compared to the CG (P < 0.001). IG had a significantly higher medication adherence score compared to the CG (IG-92.97±15.04 vs. CG-80.42±28,29; P <0.001). A significantly large number of individuals in the IG had high adherence score on Morisky adherence scale compared to the CG (P < 0.001). CONCLUSION: Discharge counseling by a ward-based pharmacist improves medication knowledge and adherence of patients on long term medications.
The Knowledge and attitude of primary school teachers in Sri Lanka towards childhood attention deficit hyperactivity disorder
(Sri Lanka Medical Association, 2011) Rodrigo, M.D.A.; Perera, D.; Eranga, V.P.; Williams, S.S.; Kuruppuarachchi, K.A.L.A.
OBJECTIVE: To assess the knowledge and attitudes towards attention deficit hyperactivity disorder (ADHD) among primary school teachers in the Gampaha District. METHODS: A descriptive cross sectional study was conducted in randomly selected schools of Gampaha district using a stratified sampling method. The knowledge and attitudes on ADHD were assessed by a self-administered questionnaire distributed among all the consenting primary school teachers in the selected schools. RESULTS: Total of 202 completed questionnaires of 210 distributed were returned. The majority showed good understanding about ill effects of ADHD, teachers' role in management and counterproductive effects of punishment. Three-fourths had a positive attitude towards behavioural therapy. However, only a minority had adequate knowledge about the presentation of ADHD and its treatment with medication. More than 80% of teachers believed that the parents were to be blamed for the child's ADHD. The majority of participating teachers also believed that behavioural disturbances caused by ADHD children were deliberate and malicious. Teachers who had training in child psychology recorded a significantly higher knowledge and had a more favourable attitude. CONCLUSIONS: The knowledge of ADHD and its treatment among primary school teachers needs to be improved. Particular focus should be on improving attitudes and disseminating the message that timely interventions can make a difference in the educational and social development of the child.
Knowledge of location of organs in the body among patients attending a university family practice in Sri Lanka
(2013) Ramanayake, J.; Perera, D.; de Silva, A.; Sumanasekera, D.; Jayasinghe, L.R.; Gunasekera, R.; Chandrasiri, P.
Introduction: The referral letter is the interface between the primary and secondary/tertiary levels of care. It facilitates the referral process and is beneficial for optimizing patient care. In Sri Lanka a referral letter is not essential to consult a Specialist. In this scenario, the quality as well as the number of referral letters encountered in practice needed to be explored. Objectives: To describe Specialists' views on the quality of referral letters received, perceived advantages of referral letters and to identify other modes of communication between General Practitioners and Specialists. Methods: Conducted in 2013, this study consisted of in-depth interviews using a semi-structured format, with 21 purposively selected Specialists representing a range of specialties. They included clinicians and university academics from both the government and the private sector. Analysis was by generating a thematic framework based on the recurrent themes and issues which was then applied to the textual data. Results: Most patients consulted Specialists without a referral letter and also the few letters received were of poor clarity, lacking important information and scribbled in illegible hand. Main themes identified as advantages of referral letters were: impart important information about the patient, clear description of the initial condition and treatment given, reduced consultation time, prevents delays in diagnosis and reduced healthcare costs by reducing polypharmacy and repetition of investigations. Some of the other modes of communication suggested by Specialists were via telephone, SMS, fax and email. Conclusions: The general belief amongst Specialists is that referral letters are an important part of the patient care system. This has not been adequately utilized by the primary care providers in Sri Lanka, despite the numerous advantages described. Also consideration needs to be given to newer modes of emerging information communication technology
Morphological and molecular identification of different morphotypes of Suaeda maritima from Puttalam district in Sri Lanka
(Faculty of Science, University of Kelaniya Sri Lanka, 2023) Jayasundara, R.; Siridewa, K.; Neththipola, T.; De Silva, W. L.; Perera, D.; Attanayake, R. N.
Suaeda is a genus belonging to the family Amaranthaceae (Chenopodiaceae) and comprises more than 100 species that are distributed all over the world. Members of the genus are mainly used for food, feed, and medicine. Three Suaeda species have been reported in Sri Lankan salt marshes among them, S. maritima is widely distributed. During a field survey in Seguwanthive in July 2022, two clearly distinct morphotypes of tentatively identified S. maritima were found. This tentative identification was done purely based on morphological characteristics. One morphotype had green stems and leaves while the other had reddish-green leaves and brightly red-colored stems. No reproductive parts were found at the time of the survey. Even though, previous reports indicated high phenotypic plasticity among the members of the genus, it was not clear whether both morphotypes belonged to the same species or not. Due to the lack of floral structures throughout the year, accurate species identification was a great challenge for a layperson and for a trained taxonomist. Therefore, the current study was conducted to obtain detailed morpho molecular identification of each morphotype of Suaeda maritima, and to confirm their species identity using molecular data as well. Plant samples were collected from Seguwanthive area mainly focusing on two morphotypes and documented. Leaves were succulent, linear in shape, flattened only on one side, and acute in the apex. Plants were 40-65 cm range in height in both morphotypes with a woody base. Flowers were observed only on green plants by the time of sampling, and they were bisexual and contained 5 stamens and 3 stigmas and located axillary in 2 mm diameter clusters and seeds were black, smooth and glossy, and suborbicular to ovoid in shape. Molecular identification was conducted using DNA barcoding approach. Genomic DNA extraction was optimized. The nuclear ribosomal ITS (Internal transcribed spacer) region was PCR (Polymerase chain reaction) amplified using universal primers BLASTn searchers of the sequences confirmed that both morphotypes were identical and 100% similar to previously published records of S. maritima (KF866384). This project findings give insights into the plant’s phenotypic plasticity under its natural environment and can be used as a future guide.
Non-invasive diagnostic approach for diabetes using pulse wave analysis and deep learning
(MDPI, 2024) Gunathilaka, H.; Rajapaksha, R.; Kumarika, T.; Perera, D.; Herath, U.; Jayathilaka, C.; Liyanage, J.; Kalingamudali, S.
The surging prevalence of diabetes globally necessitates advancements in non-invasive diagnostics, particularly for the early detection of cardiovascular anomalies associated with the condition. This study explores the efficacy of Pulse Wave Analysis (PWA) for distinguishing diabetic from non-diabetic individuals through morphological examination of pressure pulse waveforms. The research unfolds in four phases: data accrual, preprocessing, Convolutional Neural Network (CNN) model construction, and performance evaluation. Data were procured using a multipara patient monitor, resulting in 2000 pulse waves equally divided between healthy individuals and those with diabetes. These were used to train, validate, and test three distinct CNN architectures: the conventional CNN, Visual Geometry Group (VGG16), and Residual Networks (ResNet18). The accuracy, precision, recall, and F1 score gauged each model’s proficiency. The CNN demonstrated a training accuracy of 82.09% and a testing accuracy of 80.6%. The VGG16, with its deeper structure, surpassed the baseline with training and testing accuracies of 90.2% and 86.57%, respectively. ResNet18 excelled, achieving a training accuracy of 92.50% and a testing accuracy of 92.00%, indicating its robustness in pattern recognition within pulse wave data. Deploying deep learning for diabetes screening marks progress, suggesting clinical use and future studies on bigger datasets for refinement.
Pilot study for non-invasive diabetes detection through classification of photoplethysmography signals using convolutional neural networks
(University of Kelaniya, 2024) Gunathilaka, H.J.; Rajapaksha, R.; Kumarika, T.; Perera, D.; Herath, U.; Jayathilaka, C.; Liyanage, J.A.; Kalingamudali, S.R.D.
Diabetes is a chronic disorder affecting vascular health, often altering pulse wave characteristics. Traditional pulse wave analysis (PWA) methods face challenges such as variability and complexity of signals. This study aims to overcome these limitations by leveraging deep learning models for more accurate and efficient classification. The methodology used in this study involves four key steps: data collection, data preprocessing, Convolutional Neural Network (CNN) model development, and model evaluation. Primary data were collected using a multipara patient monitor, including finger photoplethysmography (PPG) signals, blood pressure, mean arterial pressure, oxygen saturation, and pulse rate. Single pulse wave cycles from 60 healthy individuals and 60 patients with type 2 diabetes underwent preprocessing. The CNN model was trained using 50 PPG images from each group and achieved a training accuracy of 92%. The prediction capability of the model was evaluated using 20 unseen images, comprising 10 healthy and 10 diabetes PPG images. It attained a 90% overall test accuracy in distinguishing between PPG images of individuals with diabetes and those who are healthy. These findings suggest that CNNbased analysis of PPG signals provides a precise, non-invasive tool for diabetes screening. To further enhance accuracy, future studies should focus on increasing the dataset size and performing hyperparameter tuning to optimize the CNN model.
Road rage in Sri Lanka: prevalence and psychiatric distress
(Sri Lanka Medical Association, 2015) Rodrigo, A.; Perera, D.; Eranga, V.P.; Peris, M.U.P.K.; Pathmeswaran, A.
INTRODUCTION: Road traffic accidents are a major public health concern in Sri Lanka. Aggressive and reckless driving is an important contributor to the high rate of road traffic accidents. OBJECTIVE: We studied prevalence, nature, determinants and associated psychiatric morbidity ofroad rage among motorists in Sri Lanka. Methods Data were gathered from 238 randomly selected motorists in Sri Lanka using a modified questionnaire regarding road rage and the 6-item version of Kessler's psychological distress scale. RESULTS: While 98.7% participants reported being victims of road rage, 85.3% were involved in offending behaviour. However actual physical assault (0.8%) and damage to vehicles (2.5%) were rare. Male gender, young age, increased traffic density and driving a three-wheeler or bus were associated with daily road rage victimisation and perpetration. Psychiatric distress was associated with being a victim of road rage. CONCLUSIONS: High prevalence of road rage in Sri Lanka and significant psychiatric distressassociated with it indicate the necessity of interventions at least for target groups