Browsing by Author "Williams, S."

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Acceptability of a web-based character strengths module for early adolescent school children
(Postgraduate Institute of Medicine University of Colombo, 2023) Chandradasa, M.; Williams, S.; Sumanasiri, S.; Selliah, S.; Gunarathne, P.; Paric, A.; Ravindran, N.; Kuruppuarachchi, K.A.L.A; Ravindran, A.
BACKGROUND: Frequent socio-political conflicts in the past decades have adversely affected the well-being of youth in Sri Lanka. There is a need to support youth development, mitigate past trauma, and promote social harmony. School-based interventions to improve character development, emotional regulation, and tolerance have good evidence and may benefit adolescents in Sri Lanka. Our objective was to develop a novel character strength program in Sinhala to promote Leadership, Empathy, Altruism, Personal Growth, and Social Responsibility (LEAPS). This program consists of ten web-based modules and is facilitated by teachers. This initial evaluation focuses on the first module and its acceptability among students and teachers. METHOD: Program modules were developed by a child and adolescent psychiatrist with the support of mental health and educational experts. The first module was piloted among grade 8 students (12-14 years) and teachers of two schools in the Gampaha District. It was designed to be interactive and contains various cultural activities and questions. On completion, participants gave feedback online via Likert scales. Ethical approval for the study was obtained from the Faculty of Medicine, University of Kelaniya. RESULTS: A total of 115 students and 66 teachers participated. Overall, more than 95% of students and teachers found the module appropriate and suitable. The students had more favourable ratings for the module compared to the teachers on aspects of understanding the content (p<0.001), ability to complete by self (p<0.001), suitability to age (p<0.001), shorter time for completion (p<0.001) and suitability of the design (p<0.001). Both groups suggested that the pictures and activities be increased. CONCLUSIONS: Teaching character strengths using a web-based intervention was well accepted by adolescent students and teachers in Sri Lanka.
Background radiation levels near a mineral sand mining factory in Sri Lanka: Correlation of radiation measurements with micronuclei frequency
(Nuclear Technology Pub, 2020) Warnakulasuriya, T.; Williams, S.; Weerakkody, T.; Dabarera, M.; Rodrigo, K.; Waduge, V.A.; Ediriweera, D.; Siriwardena, N.; Wickremasinghe, R.
ABSTRACT:Lanka Mineral Sands Ltd (LMS) is a company operating in Pulmoddai, Sri Lanka, mining for rare earth minerals along with monazite which contains thorium that emits ionizing gamma and alpha radiation on decay. The objective of the study was to determine the background radiation levels and selected radionuclides and then to correlate these levels with the frequency of micronuclei (MN) among persons residing in the vicinity of LMS. A cross-sectional study was conducted among persons of both sexes between 35 and 45 years of age residing in the vicinity of LMS. Background radiation measurements were obtained by a survey metre, and gamma spectrometry was done on soil samples. Five millilitres of venous blood was drawn for cytokinesis-blocked MN assay. Background radiation levels measured by the survey metre; 232Th, 226Ra and 210Pb mass activities in soil were highest in the samples collected from the LMS. The background radiation measurements positively correlated with MN frequency although the magnitude of the correlation was small (r = 0.176, p = 0.04). This implies that chronic long-term exposure to low-dose radiation may result in genotoxicity. Prospective large-scale studies are recommended to evaluate the long-term effect of exposure to low-dose radiation at Pulmoddai.
The burden of diabetes mellitus in an urban population of Sri Lanka
(Sri Lanka Medical Association, 2011) Pinidiyapathirage, M.J.; Kasturiratne, A.; Williams, S.; Wijekoon, N.; Pathmeswaran, A.; Ranawaka, U.K.; Warnakulasuriya, T.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To describe the burden of diabetes in middle and old aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, in which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and 51ood pressure measured by trained personnel. Blood samples were taken after a 14 hour fast for measurement of glucose, HbAlc and lipids. The prevalence of diabetes (fasting plasma glucose [FPG] >7mmol/L) and impaired fasting glycaemia [IFG] (FPG=5.6-6.9mmol/L) and major predictors of diabetes in Sri Lanka were estimated from the population based data. RESULTS: In the whole sample two thirds of the participants were diagnosed as either people with diabetes (20%) or IFG (45%). Among the diabetics only 23.8% were optimally controlled. Through the present screening, 235 diabetics (7.9%) and 1257 (42.1%) participants with impaired fasting glucose levels were newly identified. Old age (OR=5.1, 55-64 years vs. 35-44 years), male sex (OR=3.1), family history (OR- 2.7), central obesity (OR-1.8), and reduced physical activity (OR=1.3) were significantly associated with increased risk of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in the general population. Short and long term control strategies are required not only for optimal-therapy among those affected but also for nationwide primary prevention of pre-diabetes.
Cardiovascular risk profile of the estate population of Sri Lanka
(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Chackrewarthy, S.; Perera, P.S.; Wijayasinghe, Y.S.; Williams, S.; Williams, S.S.; Kato, N.; Wickremasinghe, A.R.
OBJECTIVES: To estimate the prevalence of biochemical and anthropometric risk markers of cardiovascular diseases in the estate population of Sri Lanka. METHODS: Using a cross sectional design, consenting adults aged 35-64 years resident in 3 selected estates in the Nuwara-Eliya District were recruited with the support of estate medical assistants and welfare officers. AH participants were subjected to an interview, blood pressure and anthropometric measurements and collection of fasting blood samples. RESULTS: Of the 401 participants recruited, 53% were females and 99% were cither Indian or Sri Lankan Tamils. The mean age of the participants was 50.3 years (SD 8.5). 47 (12%) participants had a BMI >25, 8 (2%) a BMI >30. 29 males (15%) and 29 females (14%) had a waist circumference [WC] >90cm and >80 cm, respectively. 151 (38%) participants had systolic blood pressure (SBP) > 140mmHg , 127 (32%) had diastolic blood pressure (DBF) > 90mmHg and 170 (42%) had either SBF > 140 or DBF > 90. 41(10%) participants had fasting blood glucose (FBG) >126mg/dL. In 197 (49%) participants, some form of dyslipidaemia was present. Males had a significantly higher mean BMI, FBG and triglyceride (TG) level and a significantly lower high density lipoprotein (HDL) level as compared to females. CONCLUSIONS: Obesity, as defined by BMI or WC, was low in this population as compared to other reported studies from different population groups in the country. But prevalence of hypertension and dyslipidaemia (especially high TG and low HDL levels in males) was high.
A Case report of dengue and chikungunya co-infection in Sri Lanka
(The Parasitology and Tropical Medicine Association of Thailand, 2008) Abeyewickreme, W.; Hapuarachchi, H.A.C.; Bandara, K.B.A.T.; Hapugoda, M.D.; Williams, S.
Dengue fever and chikungunya are arboviral diseases transmitted by Aedes mosquitoes. Though dengue has been an important communicable disease in Sri Lanka for many years, chikungunya has not been reported in Sri Lanka since late 1960s. However, in November 2006, an outbreak suggestive of chikungunya erupted in the country. We report here the first laboratory confirmed case of dengue and chikungunya co-infection in Sri Lanka. The objective is to confirm the co-infection of dengue and chikungunya in a clinical case reported in November 2006. Clinical history of high fever, severe headache, nausea, loss of appetite, severe arthralgia and mild oedema of knees, small joints of hands and feet for 3 days suggested the possibility of dengue and chikungunya in a 70 year old male. There was no skin rash or bleeding manifestations. Laboratory investigations performed included total white blood corpuscle count/differential count (WBC/DC), platelet count (PLT), serum, haemoglobin (Hb%) and packed cell volume levels (PCV). Reverse Transcription- Polyrnerase Chain Reaction (RT-PCR) technology was used to confirm the presence of either dengue or chikungunya. Viral RNA was extracted from serum samples collected during the first five days of infection using QiAmp Viral RNA Kits and amplified products were visualized by 2% agarose gel electrophoresis and ethidium bromide staining. WBC/DC analysis showed a leucopaenia (WBC count 3.04 x 103 per μl) with relative lymphocytosis (51.0%). The total PLT was 115 x 103 per μl. Hb% was 14.3 g/dl with a PCV of 43.8%. The presence of both infections was confirmed by RT-PCR which amplified 225 bp and 354 bp products for dengue and chikungunya respectively. This was the first laboratory confirmed case of dengue and chikungunya co-infection, which was also the first confirmed report of chikungunya since 1969 in Sri Lanka. As clinical and biochemical manifestations of this patient suggested the probability of a mixed infection of dengue and chikungunya, the confirmation was achieved by a RT-PCR assay. This report highlights the importance of using molecular assays to confirm mixed viral infections during their early stages, especially infections such as dengue which can result in fatal complications.
Clinical and laboratory evaluation of childhood anaemia
(Sri Lanka College of Paediatricians, 2020) Mettananda, S.; Williams, S.
No Abstract available.
Comparison of suicide rates in Sri Lanka during and after the civil war
(SAGE Publishing, 2013) Rodrigo, A.; Owada, K.; Wainer, J.; Baker, R.; Williams, S.
No Abstract Available
Coping strategies used by traumatic spinal cord injury patients in Sri Lanka: a focus group study
(Informa Healthcare, 2016) Arya, S.; Xue, S.; Embuldeniya, A.; Narammalage, H.; da Silva, T.; Williams, S.; Avindran, A.
PURPOSE: Psychosocial consequences of traumatic spinal cord injury (SCI) have been well documented in Western populations, but there is no published literature on such incidence in the Sri Lankan population. The purpose of this study was to explore the psychosocial impact of SCI in a SriLankan population and to examine this population's coping mechanisms. METHODS: Participants were recruited purposively at the Ragama Rheumatology and Rehabilitation Hospital, the sole rehabilitation facility for SCI patients in Sri Lanka. Focus groups were conducted with 23 consenting individuals. Interview transcripts were analysed using descriptive thematic analysis. RESULTS: Four domains of life impact, three types of active coping strategies and four types of external supports were identified. Decreased ambulation and burden on family life were significant concerns for male and female participants alike. Religious practices were reported most frequently as active coping strategies, followed by positive reframing and goal-setting. Reported external supports included guided physiotherapy, informational workshops, social support and peer networks. CONCLUSION: Rehabilitation efforts for Sri Lankan SCI patients should be sensitive to psychosocial concerns in addition to physical concerns in order to help patients re-integrate into their family lives and community. Furthermore, religious practices should be respected as possible aids to rehabilitation. Implications for Rehabilitation Rehabilitative efforts should be conscientious of patients' psychosocial well-being in addition to their physical well-being. Hospital-based rehabilitative efforts for traumatic spinal cord injury patients should promote functional independence and community re-integration. Spiritual and/or religious practices should be respected as ways by which traumatic spinal cord injury patients may confront personal challenges that arise following injury.
Cross-cultural validation of the Sinhalese version of the Liebowitz Social Anxiety Scale (LSAS-SR): study of the items and internal consistency
(Book of Abstracts, Annual Research Symposium 2014, 2014) Williams, S.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.; Wickremasinghe, R.; Ravindran, A.
Background: Despite being the third most prevalent psychiatric disorder, social phobia remains to be under -diagnosed due to multiple reasons. Although many screening instruments are available in English language, up to date no instrument has been translated in to Sinhalese or its cultural relevance studied. Liebowitz Social Anxiety Scale(LSAS-SR) is one of the most widely used scales to screen for social phobia and it evaluates fear and avoidance symptoms associated with the above disorder.
Deferoxamine, deferasirox, and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a randomised clinical trial
(Elsevier Ltd, 2024-10) Premawardhena, A.; Wanasinghe, S.; Perera, C.; Wijethilaka, M.N.; Rajakaruna, R.H.M.G.; Samarasinghe, R.A.N.K.K.; Williams, S.; Mettananda, S.
BACKGROUND Many patients with β-thalassaemia die prematurely due to iron overload. In this study, we aim to evaluate the efficacy and safety of the triple combination of deferoxamine, deferasirox and deferiprone on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload.METHODS This open-label, randomised, controlled clinical trial was conducted at Colombo North Teaching Hospital, Sri Lanka. Transfusion-dependent β-thalassaemia patients with ferritin >3500 ng/mL were randomised 2:1 into intervention (deferoxamine, deferasirox and deferiprone) and control (deferoxamine and deferasirox) arms. Reduction in serum ferritin after six months was the primary outcome measure. Reduction in liver iron content, improvement in cardiac T2∗, and adverse effects were secondary outcome measures.FINDINGS Twenty-three patients (intervention-15, control-8) were recruited. 92% and 62% in the intervention and control arms showed a reduction in ferritin, respectively. The mean reduction of ferritin was significantly higher in intervention (−1094 ± 907 ng/mL) compared to control (+82 ± 1588 ng/mL) arm (p = 0.042). There was no statistically significant difference in the liver iron content in two arms. In the intervention arm, 67% improved cardiac T2∗ (mean change +6.72 ± 9.63 ms) compared to 20% in the control arm (mean change −3.00 ± 8.24 ms). Five patients discontinued deferiprone due to arthralgia, which resolved completely after stopping the drug.INTERPRETATION Triple combination therapy with deferoxamine, deferasirox and deferiprone is more efficacious in reducing iron burden measured by serum ferritin and showed a positive trend in reducing myocardial iron content in patients with transfusion-dependent β-thalassaemia with very high iron overload. Deferiprone has the disturbing side effect of reversible but severe arthropathy.
Developing research capacity in mental health in South Asia South Asian
(SAARC Psychiatric Federation, 2011) Williams, S.
No Abstract Available
Development of a model for a resource limited setting, to predict the presence of oesophageal varices among newly diagnosed patients with cirrhosis.
(Sri Lanka Medical Association., 2019) Perera, K.; Kodisinghe, S.K.; Ediriweera, D.; Moratuwagama, H.M.D.; Williams, S.; Pathmeswaran, A.; Niriella, M.A.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: In cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV). UGIE is unavailable in most resource-limited settings. Therefore, we assessed prediction of presence OV using hematological parameters (HP) and Child-Turcott-Pugh (CTP) class. METHODS: A prospective study was carried out on consecutive, consenting, newly-diagnosed patients with cirrhosis, in the University Medical Unit, Colombo North Teaching Hospital, Ragama, from April 20 I 4-April 2016. All patients had UGIE to evaluate presence and degree of OV, prior to appropriate therapy. HP (FBC with indices using automated analyzer and peripheral blood smear using Leishmann stain) and CTP class were assessed. Linear logistic regression model was developed to predict OV using HP and CTP class. RESULTS: 54-patients with cirrhosis were included [14(26%), 24(44%) and 16(30%) belonged to CTP class A, B and C respectively]. 37 had varices [CTP-A 4/14(26.6%), CTP-B 19/24(79.2%), CTP-C 14/16(87.5%)] on UGIE. Generalized linear model fitting showed decreasing percentage of small platelets (%SP) (P=0.002), CTP-B (P=0.003) and CTP-C (P=0.003) compared to CTP-A had higher probability of having OV. The model predicts the log odds for having OV = - 0.189 - (0.046*%SP) + 2.9 [if CTP-B] + 3.7 [if CTP-C]. Based on ROC analysis, a model value >-0.19 was selected as the cutoff point to predict OV with 89%-sensitivity, 76%-specificity, 89% positive predictive value and 76%-negative predictive value. CONCLUSION: We constructed a model using %SP on peripheral blood smear and CTP class. This model can be used to predict the presence of OV, in newly diagnosed patients with cirrhosis, with high sensitivity and specificity, avoiding the need for initial UGIE.
Diabetes and Alzheimer's disease: Can tea phytochemicals play a role in prevention?
(IOS Press, 2017) Binosha, F.W.M.A.D.; Somaratne, G.; Williams, S.; Goozee, K.G.; Singh, H.; Martins, R.N.
Dementia and diabetes mellitus are prevalent disorders in the elderly population. While recognized as two distinct diseases, diabetes has more recently recognized as a significant contributor to risk for developing dementia, and some studies make reference to type 3 diabetes, a condition resulting from insulin resistance in the brain. Alzheimer's disease, the most common form of dementia, and diabetes, interestingly, share underlying pathological processes, commonality in risk factors, and, importantly, pathways for intervention. Tea has been suggested to possess potent antioxidant properties. It is rich in phytochemicals including, flavonoids, tannins, caffeine, polyphenols, boheic acid, theophylline, theobromine, anthocyanins, gallic acid, and finally epigallocatechin-3-gallate, which is considered to be the most potent active ingredient. Flavonoid phytochemicals, known as catechins, within tea offer potential benefits for reducing the risk of diabetes and Alzheimer's disease by targeting common risk factors, including obesity, hyperlipidemia, hypertension, cardiovascular disease, and stroke. Studies also show that catechins may prevent the formation of amyloid-β plaques and enhance cognitive functions, and thus may be useful in treating patients who have Alzheimer's disease or dementia. Furthermore, other phytochemicals found within tea offer important antioxidant properties along with innate properties capable of modulating intracellular neuronal signal transduction pathways and mitochondrial function.
Efficacy and safety of deferoxamine, deferasirox and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a protocol for randomised controlled clinical trial
(BMJ Publishing Group Ltd, 2024) Premawardhena, A.; Perera, C.; Wijethilaka, M.N.; Wanasinghe, S.K.; Rajakaruna, R.H.M.G.; Samarasinghe, R.A.N.K.K.; Williams, S.; Mettananda, S.
INTRODUCTION: Despite the improvement in medical management, many patients with transfusion-dependent β-thalassaemia die prematurely due to transfusion-related iron overload. As per the current guidelines, the optimal chelation of iron cannot be achieved in many patients, even with two iron chelators at their maximum therapeutic doses. Here, we evaluate the efficacy and safety of triple combination treatment with deferoxamine, deferasirox and deferiprone over dual combination of deferoxamine and deferasirox on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload. METHODS AND ANALYSIS: This is a single-centre, open-label, randomised, controlled clinical trial conducted at the Adult and Adolescent Thalassaemia Centre of Colombo North Teaching Hospital, Ragama, Sri Lanka. Patients with haematologically and genetically confirmed transfusion-dependent β-thalassaemia are enrolled and randomized into intervention or control groups. The intervention arm will receive a combination of oral deferasirox, oral deferiprone and subcutaneous deferoxamine for 6 months. The control arm will receive the combination of oral deferasirox and subcutaneous deferoxamine for 6 months. Reduction in iron overload, as measured by a reduction in the serum ferritin after completion of the treatment, will be the primary outcome measure. Reduction in liver and cardiac iron content as measured by T2* MRI and the side effect profile of trial medications are the secondary outcome measures. ETHICS AND DISSEMINATION: Ethical approval for the study has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (Ref. P/06/02/2023). The trial results will be disseminated in scientific publications in reputed journals.
Elder abuse--a wake up call
(Sri Lanka Medical Association, 2009) Paranitharan, P.; Edirisinghe, P.A.S.; Williams, S.
Ethics in Haematology (Editorial)
(The Sri Lanka College of Haematologists, 2019) Williams, S.
No abstract available
Examining depression and quality of life in patients with thalassemia in Sri Lanka
(Wolters Kluwer - Medknow, 2019) Patel, P.; Beamish, P.; da Silva, T.L.; Kaushalya, D.; Premawardhena, A.; Williams, S.; Ravindran, A.V.
BACKGROUND: With more effective treatments and improved outcomes in thalassemia, there is increasing focus on its psychological sequelae. Most published data on this topic are from high income countries and much less so from low and middle income countries, where thalassemia is more prevalent. AIM: The aim of this study was to systematically evaluate the psychiatric morbidity and quality of life in relation to demographic and illness related variables among Sri Lankan patients with thalassemia. METHODS: This cross sectional investigation was conducted at the University of Kelaniya Teaching Hospital in Sri Lanka. Patients with all forms of thalassemia, over 12 years of age, and in stable medical condition (n = 120) were recruited. Assessment tools included a general demographic questionnaire, the Beck Depression Inventory II, and the World Health Organization Quality of Life Measure–Brief. Statistical analysis was conducted using linear regressions, Chi squares, and analyses of variance. RESULTS: Lack of family support, longer duration of inpatient admission, and female gender were associated with higher depression scores and reduced quality of life. Environmental and social quality of life were positively correlated with levels of peer support in males, while increased support from religion correlated with lower depression scores and higher satisfaction with environmental and psychological quality of life in women. There was no association between the type of thalassemia and either depression or quality of life measures. CONCLUSION: Several factors may influence the psychological state and well being of patients with thalassemia in Sri Lanka. Specific service innovations (some gender specific) may help to address these factors to improve treatment outcome and well being.
Exploring the genetic basis of 3MC syndrome: Findings in 12 further families:
(Wiley-Blackwell, 2016) Urquhart, J.; Roberts, R.; de Silva, D.; Shalev, S.; Chervinsky, E.; Nampoothiri, S.; Sznajer, Y.; Revencu, N.; Gunasekera, R.; Suri, M.; Ellingford, J.; Williams, S.; Bhaskar, S.; Clayton-Smith, J.
The 3MC syndromes are a group of rare autosomal recessive disorders where the main clinical features are cleft lip and palate, hypertelorism, highly arched eyebrows, caudal appendage, postnatal growth deficiency, and genitourinary tract anomalies. Ophthalmological abnormalities, most notably anterior chamber defects may also be seen. We describe the clinical and molecular findings in 13 individuals with suspected 3MC syndrome from 12 previously unreported families. The exclusion of the MASP1 and COLEC11 Loci in two individuals from different consanguineous families and the absence of mutations in four further individuals sequenced for both genes raises the possibility that that there is further genetic heterogeneity of 3MC syndrome. © 2016 Wiley Periodicals, Inc.
Frequency of micronuclei among persons resident in the vicinity of a mineral sand processing factory in Pulmoddai, Sri Lanka
(Oxford University Press, 2017) Warnakulasuriya, T.; Williams, S.; Dabarera, M.; Rodrigo, K.; Weerakkody, T.; Wickremasinghe, R.
Lanka Mineral Sands Ltd (LMS), a government-owned company, has been mining mineral sands including monazite which contains thorium (Th) at Pulmoddai, Sri Lanka since 1957. Th emits alpha particles on decay and gamma rays are emitted by the daughter products. The cytokinesis-blocked micronucleus (MN) assay is popular for large scale radiation exposure studies as it is an easy, fast and reliable method of biodosimetry. The objective of the study was to determine the frequency of micronuclei among persons residing in the vicinity of LMS. A cross-sectional study was conducted from November 2012 to September 2016 among persons 35-45 years of age to evaluate the frequency of micronuclei in peripheral blood lymphocytes. Fifty-three employees of LMS factory, 25 residents within 5 km from LMS, 25 residents 20-25 km from LMS and 29 residents from >50 km away from LMS were included in the study. The highest median frequency of micronuclei per 1000 binucleated (BN) cells was in the group residing within 5 km from LMS with a median (IQ range) of 0.67 (0.17-2.17). The median (IQ range) of MN frequency of employees of LMS, residents 20-25 km from LMS and residents >50 km from LMS were 0.66 (0.16-1.16), 0.33 (0.00-0.67) and 0.33 (0.33-0.67), respectively. There was no significant difference in the MN frequency between employees of LMS and the group residing within 5 km from LMS. Being a resident of Pulmoddai and being exposed to X-rays were significant predictors of MN frequency. Persons residing within 5 km from LMS had a higher risk of MN formation irrespective of being employed at LMS.
Hematology
(Samudra Medical Publications, 2022) Mettananda, S.; Williams, S.
No abstract available