25th Anniversary International Scientific Conference-2016

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Plenaries, Symposia and free papers presented at the 25th Anniversary International Scientific Conference, held on 6-8th April 2016, Faculty of Medicine, University of Kelaniya to celebrate the Silver Jubilee Anniversary of Faculty of Medicine

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Follow up of metabolic syndrome in the Ragama Health Study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, S.T.
Although previous population based studies have looked at the prevalence of Metabolic Syndrome (MS) in different groups, studies on the incidence of MS are few and lacking from the South Asian region. This is mainly because long-term cohort studies are difficult to sustain. The Ragama Health Study (RHS) follow up in 2014 looked at the incidence of MS in an urban adult Sri Lankan population that was originally recruited in 2007. Traditional and novel risk factors associated with the development of incident MS were identified. We also looked at the outcome of those identified with MS and its components in 2007.
Functional Gastrointestinal Diseases (FGIDs) in children: An emerging global health problem
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Rajindrajith, S.
Functional gastrointestinal diseases are a group of disorders characterized by chronic recurrent symptoms such as abdominal pain, altered defecation, nausea and vomiting and other subtle alteration of gastrointestinal function. These diseases are highly prevalent across the world both in developed and developing countries. The biopsychosocial risk factors like psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FGDs. FGDs poses a significant healthcare burden on already overstretched health budgets of many countries in terms of outpatient care, in patient care, expenditure for investigations and prescriptions. The complications are common and range from minor psychological disturbances, to lower health related quality of life. Functional constipation in children also has a significant impact on families. Many clinical trials have poor methodological qualities in paediatric practice and drugs proved to be useful in adults are not shown to be effective in relieving symptoms of children. A significant proportion of inadequately treated children grow up to become adults with similar symptoms. All these factors show that constipation is a potentially growing public health problem across the world with a significant medical, social and economic impact. However it is possible to prevent FC by using simple but strategic measures.
Awareness on alternative medical systems among diabetes mellitus patients in Uva and North Central provinces; Mullaithivu, Mannar and Killinochchi districts in the Northern Province
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Nuwansiri, L.S.B.; Abeysooriya, S.R.; Thilakarathne, M.G.T.C.; Pathirana, G.K.M.; Peiris, L.D.C.; Mirfaha, M.A.F.
BACKGROUND: Diabetes Mellitus is a metabolic disorder due to deficiency of insulin. According to Ayurveda concepts this is part of urinary disorders characterized by profuse urination with several abnormal qualities due to Dhosic imbalances. According to the Siddha concept Alaldhosha increase first, then Walidhosha increase, afterwards Wali and Aryamdhoshas is increased. Concurrently disturbance of seven Dhathus function occur and eliminate body energy through urine. The concept of Unani that mentioned Zinbatusshukkari (Diabetes Mellitus) develops due to weakness of the kidney as a result of strong exposures power, weakness of the retentive power and causative factors. Prevention is the best method to control this disease. Awareness among people should be increased to prevent this disease. All medical systems should combine efforts. Other than allopathic system Ayurveda, Siddha, and Unani are other alternative medical systems that can provide awareness. OBJECTIVE: To find out awareness of people about other alternative medical systems that can control Diabetes Mellitus and to find out method of continuing treatment at diabetes clinics in these medical systems. METHODS: An interviewer administered questionnaire was used to collect data visiting Sidda, Unani, Ayurveda District Hospitals, Central Dispensaries and free Ayurveda Dispensaries in Uva province, North central province, Killinochhi, Mannar,and Mullaithivu districts. RESULTS: There were few hospitals that provide Diabetic clinics (Uva-20%, North central -11%, Killinochchi, Mannar and Mullaithivu districts -25%). Of 40 patients identified from clinics only 50% of patients were aware of Ayurveda, Siddha, Unani treatments for Diabetes. CONCLUSIONS: Availability of alternative medical facilities for management of Diabetes Mellitus is limited in these districts. The awareness of people about these systems is not satisfactory.
Factors influencing urinary tract infections caused by extended spectrum β-lactamase producing organisms among a cohort of hospitalized patients in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Luke, W.A.N.V.; Premaratna, B.A.H.R.; Fernando, S.C.; Silva, F.H.D.S.; Sebastiampillai, B.S.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.
BACKGROUND: Urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing organisms are a management challenge and a health care burden. OBJECTIVES: To describe factors that influence ESBL UTI among hospitalized patients. METHODS: Fifty two consecutive patients who were admitted with culture positive ESBL UTI to the Professorial Medical Units, Colombo North Teaching Hospital, Ragama over a period of 6 month since January 2015 were recruited. Data was collected by an interviewer administered questionnaire and patients medical records after obtaining informed written consent. RESULTS: Among all 52 ESBL UTI patients, 46 (88.5%) had diabetes mellitus, 32 (61.5%) hypertension, 10 (19.2%) chronic liver disease, 18 (34.6%) a history of constipation. Four (7.7%) patients each were detected to have either hydronephrosis, hydroureter or prostatomegaly in USS assessment. Thirty two (61.5%) had received antibiotic treatment within the last 3 months: 18 (34.6%) has had penicillins and 16 (30.8%), 3rd generation cephalosporins, Twenty four (46.2%) had hospitalization in the last 3 months and 16 (30.8%) had a history of urinary catheterization. CONCLUSIONS: Diabetes, recent antibiotic treatment, hospitalization and catheterization were observed to influence ESBL UTIs. However the fact that 53.8% patients who developed ESBL UTI did not have a history of recent hospitalization, suggests high existence of community acquired ESBL.
Emotional and behavioral status and associated factors among inmates aged 11-16 years of Children’s Homes in the Gampaha Probationary Division
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Manori, D.M.S.; Jayawardana, P.L.
BACKGROUND: Emotional and behavioral disorders are common among inmates of Children’s Homes due to lack of love, affection and care available compared to their counterparts living with parents. OBJECTIVE: To describe the emotional and behavioral status and the associated factors among inmates aged 11-16 years of Children’s Homes in the Gampaha Probationary Division. METHODS: This was a descriptive cross sectional study. All eligible inmates of 14 Children’s Homes in Gampaha Probationary Division were recruited. Study instruments comprised, self-rated Strengths and Difficulties Questionnaire, interviewer administered questionnaire on socio demographic and other relevant factors and a checklist. Associations were tested using chi square test. A probability of <0.05 was considered significant. The results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Response rate was 100% (n=279). The prevalence of abnormal emotional and behavioral status (E&BS) was 26.2% (95% CI: 21.1-31.7). Conduct problems were the highest (28.7%; 95% CI: 23.4-34.4) and prosocial problems were the lowest (3.6%; 95% CI: 1.7-6.5). Female sex (OR= 3.1; 95% CI: 1.7-5.9, p<0.001), living in Children’s Homes for more than six years (OR= 2.1; 95% CI: 1.1–4.0, p= 0.01), having less than 10 friends (OR= 1.8; 95% CI: 1.03-3.1, p = 0.04) and keeping problems to themselves (OR= 8.2; 95% CI: 3.5-19.7, p<0.001) were significantly associated with having abnormal E&BS. CONCLUSIONS: Observed prevalence of E&BS was higher than figures from general population which was 18.9%. Except “sex”, all other associated factors are modifiable. Recommend early screening and establishment of counseling services.
Bad cholesterol, vascular risk and dementia
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Armitage, J.
The prevalence of dementia and cognitive impairment is increasing globally as lifespan lengthens and presents major health care challenges as well as creating significant social burdens. Although Alzheimer disease is the most common type of dementia, autopsy and neuroimaging studies show that the majority of dementia cases also have cerebral vascular pathology (such as infarcts, white matter lesions and cerebral microbleeds). In keeping with this, many studies and systematic reviews have shown that higher levels of vascular risk factors and cardiovascular disease predict future risk of dementia and cognitive decline. The extent to which modifying vascular risk factors such as blood cholesterol and blood pressure might prevent dementia has become an important question. Using data from 3 large randomised trials of cholesterol modification we have estimated the impact of different types of incident vascular events on cognitive aging to help understand the potential power of randomised studies to detect such effects. These data provide quantitative estimates of the impact of LDL-lowering on cognitive aging and will be presented.
An efficient inventory management system for the blood banks in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kumari, D.M.S.; Wijayanayake, A.
BACKGROUND: Over the past decades, the requirement for platelets seems to be increasing continuously around the world, while the number of potential donors is decreasing. However, due to its very short life span of just five days, a large volume of platelets expires while they are on the shelves, resulting in unnecessary shortages. Moreover, it is very costly and borrowing platelets from other blood banks with short notice is not feasible. These unexpected shortages may place the life of patients at risk. OBJECTIVES: The aim of this study was to develop an efficient blood inventory management model to reduce platelet shortage while minimizing wastage. METHODS: Currently, the blood banks are managing platelet inventory according to their own methods. As a solution we propose a model to manage the daily supply of platelets by forecasting the daily demand. Considering the past daily demand, the Weighted Moving Average method was used to forecast the future demand. Ten different models were developed and tested to find the optimal solution that minimizes shortages of platelets. These models were tested using 60 days data obtained from two different levels of blood banks; a General and Base Hospital. RESULTS: The study was able to come up with two different inventory management models for the different types of blood banks. The model that best fits the General Hospital blood bank will be able reduce the shortages by 89.37% and, the model that best fits the Base Hospital one will be able reduce the shortages by 100%. CONCLUSIONS: It may be concluded that the same models can be adopted by other blood banks with similar characteristics to manage their blood inventories efficiently.
Impact of hypertension on mortality: Findings from the Ragama Health Study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kasturiratne, A.
The relationship of hypertension on mortality is well known. In Sri Lanka this relationship has not been quantified in a comprehensive analysis. The objective of the presentation will be to describe the relationship of incident and prevalent hypertension on the 7-year cardio-vascular and all-cause mortality in the Ragama Health Study (RHS) cohort. RHS is a prospective cohort study that recruited nearly 3000 adults between 35-64 years of age resident in the Ragama Medical Officer of Health area in 2007. The participants were sampled using an age-stratified random sampling technique to represent the three 10-year age groups. Baseline assessment of the cohort included socio-demographic, lifestyle, anthropometric and clinical assessments. The cohort was followed up in 2010 and 2014 to determine incidence of important clinical outcomes. 7-year mortality of the cohort was determined through comprehensive community surveys conducted in 2012 and 2014/15. The RHS cohort comprises 2986 individuals who participated in the baseline survey. By the end of 2014, 107 participants had died. The all-cause mortality was significantly associated with a higher systolic hypertension at baseline after controlling for age and sex. One Hg mm increase in systolic blood pressure was associated with 1.02 times increase in all-cause mortality. This presentation will discuss the anthropometric, lifestyle, bio-chemical and clinical characteristics associated with the prevalence and the incidence of hypertension, and cardio-vascular and all-cause mortality over the seven year follow up period.
Non-alcoholic fatty liver disease (NAFLD): have we recognized the burden?
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Dassanayake, A.S.
Non alcoholic Fatty Liver Disease (NAFLD) is the most common chronic liver disease worldwide. There is no established medical treatment for non-alcoholic staetohepatitis (NASH), the more severe progressive form of the illness. Progression of NASH to cirrhosis and hepatocellular carcinoma is well recognized. NASH is the most common cause for unexplained elevation of liver function tests in Sri Lanka. NASH is one of the most common causes for cirrhosis in Sri Lanka. This tendency is also recognized in patients with hepatocellular carcinoma in Sri Lanka. In a study involving 3000 adults from an urban Sri Lankan population north of Colombo 33% had ultrasonographic evidence of NAFLD. There was a significant association between patatin-like phospholipase domain containing 3 (PNPLA3) gene rs738409 polymorphism, and susceptibility to NAFLD in the same population. In a similar study in a physically active population from the rural estate sector from the central Sri Lanka the prevalence of NAFLD was 15%. In a follow up study involving the urban population 7 years later the prevalence of NAFLD had increased significantly to more than 60% suggesting an annual incidence of 6.6% thus illustrating the magnitude of this problem in Sri Lanka.
The uses of dermatoglyphics in kidney diseases: a systematic review
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Wijerathne, B.T.B.; Meier, R.J.; Salgado, S.S.; Agampodi, S.B.
BACKGROUND: Kidney disease causes significant global burden with high mortality and morbidity. Dermatoglyphic has been used as a non- invasive diagnostic tool to detect or predict different medical conditions that has foetal origin. However, a scarce number of studies have evaluated a dermatoglyphic relationship in different kidney diseases. OBJECTIVE: The aim of this review was to systematically identify, review and appraise literature and evaluate the association of different dermatoglyphic variables with different types of kidney diseases. METHODS: This review is reported according to PRISMA checklist. The PubMed, POPLINE, Cochrane Library, Trip Database, OpenGrey and Google Scholar databases were searched to earliest date to 17 April 2014. Of the 36 relevant publications, 15 (5 case reports, 7 cases series and 3 comparative studies) were included in the review. RESULTS: Possible association of dermatoglyphic with Wilms tumor (WT) had been evaluated in 2 comparative studies and one case series and found low occurrence of whorls and total ridge count (TRC). Another study evaluated adult polycystic kidney disease (APCD) which revealed lower TRC in cases. All other studies described dermatoglyphics in various kidney diseases without any significant associations. CONCLUSIONS: It is evident that whorl pattern and TRC have been used to investigate the uncertainty related to origin of several kidney diseases, such as, WT and APCD type III. However, limited sample size and/or inconsistency between cases and control groups confines interpretation of any significant findings. Future dermatoglyphics studies with proper protocols and adequate sample sizes may provide stronger evidence to resolve uncertainty related to the etiology of kidney diseases.
Antibiotic sensitivity patterns of Extended-Spectrum β-Lactamase urinary tract infections in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sebastiampillai, B.S.; Premaratna, B.A.H.R.; Luke, W.A.N.V.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.; Miththinda, J.K.N.D.
BACKGROUND: Extended-spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections (UTI) are increasing in incidence and poses a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. The prevalence of ESBL producing organisms particularly in the Asian region remains unknown. OBJECTIVES: To identify common ESBL producing organisms and to evaluate the antibiotic sensitivity patterns of ESBL UTIs in Sri Lanka. METHODS: Patients admitted with ESBL-UTI to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama over a period of 6 months from January 2015 were recruited. Their Urine culture and ABST reports were analysed after obtaining informed written consent. RESULTS: Of the 52 patients who consented to be on the study, 30 (57.7%) were males. Mean age was 64.11 (SD=12.59) years. E. coli was the commonest organisms (84.6%; n=44), causing the ESBL-UTI followed by Klebsiella (15.4%; n=8). Fifty (96.2%) patients were sensitive to meropenem, 38 (73.1%) to imipenem, 30 (57.7%) to amikacin and 24 (46.2%) to nitrofurantoin. Meropenem resistance was found in 2 (3.8%) cases which were due to infection with E. coli.These two patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: While E. coli and Klebsiella are the commonest ESBL producing organisms causing UTI, carbapenems remain as the first line therapy. However 3.8% prevalence of meropenem resistance among the study population should draw attention of clinicians and needs implementation of measures to prevent emergence of carbapenum resistant ESBL organisms.
Menstrual disorders among grade twelve adolescent school girls in Seethawaka Educational Division
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Pathirana, V.P.S.D.; Jayaratne, K.; Pathirana, R.P.R.L.; Dhammika, U.
BACKGROUND: Menstrual problems are common among adolescent girls. Uncorrected menstrual problems may have serious pathological consequences and can adversely affect the daily routine. Seeking care on menstrual morbidities by adolescents is low worldwide. OBJECTIVES: To determine the prevalence of menstrual disorders, their association with daily activities, sources of information and health seeking behaviour among grade twelve girls. METHODS: A descriptive cross-sectional study was conducted using a self-administered questionnaire. All grade twelve female students (n=348) attending government schools in Seethawaka Educational Division were studied in 2013. RESULTS: Mean age at menarche was 12.37 (SD=1.37) years. Four (1.2%) cases of precocious puberty and 1 (0.3%) case of delayed puberty were observed. Menstrual disorders reported among study participants were; dysmenorrheal 234(67.2%), irregular cycles 52(14.9%), premenstrual syndrome (PMS) 51(14.7%), menorrhagia 88/337(26.1%), hypomenorrhoea 29/337(8.6%), polymenorrohea 10/187(5.3%) and oligomenorrhoea 5/187(2.7%). Dysmenorrhoea and PMS were significantly associated with disturbance to daily activities (p<0.001). Main source of information was mother (n=282, 83.9%) where as friends and sisters were second and third respectively. Almost an equal preference was observed for both male and female health workers when seeking information. A larger proportion of girls with menstrual problems (46.7%; n=157) perceived those as normal phenomena. More than three quarters did not seek proper treatment (87.7%, n=243). Only 32(11.5%) sought allopathic treatment for menstrual cycle problems. CONCLUSIONS: Menstrual disorders were common among this study population. Knowledge and utilization of available reproductive health services were very low. Further research to explore need of context-specific health education measures and adolescent friendly healthcare services is recommended.
Serum ferritin in newly diagnosed breast cancer and apparently healthy individuals
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Akalanka, H.M.K.; Ekanayake, S.; Samarasinghe, K.
BACKGROUND: Iron is an essential element for the cell proliferation and is primarily stored in human body in the form of ferritin. Iron metabolism is influenced by oestrogen and interactions between iron and oestrogen is thought to synergistically promote breast cancer (BC). OBJECTIVES: To assess serum ferittin concentrations of BC patients and healthy females. METHODS: Newly diagnosed BC patients (n=150) and apparently healthy females (n=75) who consented to be on the study were enrolled. Serum ferritin concentration was assessed using enzyme immunoassay method using mini vidas immune analyser. RESULTS: Median serum ferritin concentrations (IQR) of pre (n=58) and postmenopausal (n=92) BC patients were 32.32 (37.84) ng/ml and 64.33 (27.18) ng/ml respectively. Postmenopausal BC patients had significantly high (p<0.05) serum ferritin concentrations compared to premenopausal BC patients. Apparently healthy pre (n=35) and postmenopausal (n=40) women had median values of 26.06(28.09) ng/ml and 45.00(51.24) ng/ml respectively the difference of which was statistically significant (p<0.05). A significant difference in serum ferritin concentration was not observed among premenopausal BC women and apparently healthy women (p>0.05). However, postmenopausal BC women had significant high levels of serum ferritin compared to postmenopausal healthy women (0<0.05). The postmenopausal ferritin concentrations among BC and normal women studied via ROC curve showed 70% (p=0.000, CI 0.62-0.79) of area under the curve with ferritin cutoff value of 58 ng/mL with 60% sensitivity and 75% specificity. Among postmenopausal BC and healthy women, 56.5% and 29% had ferritin levels above this cutoff value respectively and postmenopausal women having ferritin levels above the cutoff had 3times (OR=3.1, 95%CI 1.6-5.9) risk of having breast cancer. CONCLUSIONS: Elevated serum ferritin concentration in postmenopausal women is associated with breast cancer risk but not in premenopausal women.
Computer literacy among new medical entrants to the Faculty of Medicine, University of Kelaniya
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Hettige, S.; Gunarathne, M.G.S.S.; Ediriweera, E.P.D.S.
BACKGROUND: Computer literacy is essential for students. OBJECTIVES: To assess the level of computer literacy among new entrants to the Faculty of Medicine, University of Kelaniya. METHODS: Moodle based self-administered questionnaire was given new entrants (159 in 2015 and 147 in 2016). RESULTS: The results are described according to the 2015 (n=159) and 2016 (n=147) batches respectively. Proportions who had used computers were 99% (n=157) and 98% (n=144). Those who had formal training in computer literacy were 68% (n=108) and 65% (n=96) and 46% (n=73) and 45% (n=66) were in possession of paper qualifications related to the training undergone. Proportions who used computers daily were 19% (n=31) and 31% (n=46) and 9% (n=14) and 13% (n=19) used it ≤once/month. Students’ perceptions on their ability to use computers were as follows: 1) Competent - 14%(n=23) and 17% (n=25), 2) Average - 75%(n=119) and 78%(n=114) and 3) Poor - 11%(n=17) and 5%(n=8). Relevance of computer literacy for medical students was as follows: 1) Essential - 48%(n=77) and 56%(n=82), 2) Very important - 42%(n=66) and 36%(n=53) and 3) Reasonably important - 9%(n=15) and 8%(n=12). Only two (1%) students from 2015 batch stated that computer literacy is of very little important to function as a doctor. CONCLUSIONS: Majority had used computers before entering the Medical Faculty and almost two thirds has had formal training and less than one half had paper qualifications on computer literacy. Majority believed computer literacy is important for them as medical students as well as doctors.
Awareness on excessive noise exposure, hearing protection and perceived symptoms of noise exposure among grade 12 students of a selected government school in the Colombo District
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Dantanarayana, N.D.
Introduction: More studies have been conducted recently to address the growing concern of hearing loss among adolescents due to non-occupational noise exposure. Objective: To describe adolescents’ current awareness on excessive noise exposure, risky listening situations and perceived auditory symptoms in the Sri Lankan context. Methods: This was a school based descriptive cross sectional study. In a purposively selected school, study participants were selected using simple random sampling. Proportional probability sampling was used to select participants from each subject stream. Results were analyzed using descriptive statistics. Results: All participants considered excessive noise exposure as a cause of hearing loss. 71.4% comprehended that hearing loss due to excessive noise cannot be cured. Only 9.9% recognized that the usage of ear protectors was the most effective mode of hearing protection. Among different noisy situations, most frequently exposed situations included traffic noise exposure, usage of mobile phones and MP3 players. The most common exposure duration was less than one hour with 6-10 loudness range. Ear fullness and muffled speech were the most prominent auditory symptoms after being exposed to noise. Conclusion: Although all study participants were aware that hearing loss can occur due to excessive noise, their awareness on the usage of most effective hearing protection methods was considerably low. A hearing conservation programs for adolescents should be developed to address non-occupational noise effects on hearing and hearing protection. Schools seem to be the best place to begin the process of teaching hearing protection.
Mini incision thyroidectomy: alternative approach to cosmetic thyroidectomy
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Munasinghe, B.N.L.; Fernando, R.; Kumarasinghe, K.A.P.R.; Sandaruwan, C.; Pinto, M.D.P.; Amaraweera, P.C.; Dissanayake, D.M.C.D.
BACKGROUND: Technique of thyroidectomy has evolved from conventional open technique to minimally access techniques over the past few years. Regardless of the technique, outcome depends on meticulous surgical technique used. Mini incision is defined as surgical incision less than 3 cm or less in length. Once the small incision is made, retraction is used and thyroidectomy done in the conventional manner. Main advantage is the superior cosmetic outcome compared to conventional method. Size of the gland is a main factor before deciding on a mini incision thyroidectomy (MIT) and careful patient selection must be done as large glands cannot be retrieved with the mini incision. METHODS: A longitudinal descriptive study was carried out on all patients undergoing MIT between 2008 to 2015 in Professorial Surgical Unit, University of Kelaniya, Sri Lanka. Patients with small sized glands and nodules less than 2cm were included. Skin incision was marked by measuring 3 cm with a sterile measuring tape and Methyline blue dye. The thyroid gland was delivered in to the incision and both pedicles were ligated. Capsular dissection with nerve encountering technique was adhered to. Recurrent laryngeal nerves, external branch of the superior laryngeal nerves and parathyroid glands were demonstrated and preserved. Drains were not used and routine closure was done after absolute haemostasis. RESULTS: Twenty nine MITs were performed (Male -3 , Female – 26, median age 34.26 years, range 22 – 42 years, total thyroidectomy -18, hemi-thyroidectomy -11). The commonest indication for total thyroidectomy was small MNG. None had recurrent laryngeal nerve injuries or significant haematoma formation. Transient hypocalcaemia was seen in 3%. The cosmetic outcome was satisfactory. The longest follow up is 7 years. CONCLUSIONS: MIT is a safe alternative to conventional approach in carefully selected patients and also it gives a superior cosmetic outcome.
The knowledge and preparedness on maternal and child health during disasters among Public Health Midwives serving in Medical Office of Health areas covered by National Institute of Health Sciences
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Madarasinghe, H.P.; Hemachandra, D.K.N.N.
BACKGROUND: In a disaster situation, pregnant women and children are at a higher risk and the presence of an experienced health worker, with good knowledge and preparedness on how to handle their special needs is essential. OBJECTIVES: To assess the knowledge and preparedness and associated factors related to maternal and child health during disasters among Public Health Midwives (PHMs) serving in Medical Officer of Health (MOH) areas covered by National Institute of Health Sciences(NIHS). METHODS: Between July to September 2015, PHM in NIHS area (74) were selected and they were surveyed on information about their field, history of occurrence of disasters, knowledge on maternal and child care in disasters, level of disaster preparedness and training received on disaster management. Data was statistically analyzed using SPSS software. The association between knowledge and preparedness were analyzed against socio-economic and demographic characteristics of the participants. RESULTS: Proportion of PHMs with good knowledge was 47.3% and adequate preparedness for disasters was 33.8%. There was no significant association between the age, educational qualifications, field experience, MOH area and past experience in disasters with the knowledge and preparedness. CONCLUSIONS: Knowledge on natal, newborn and infant care was lacking in the PHM in NIHS area and they were not prepared to handle disasters in their field with a proper response plan. Recommend inclusion of disaster management into their basic curriculum and conduct of regular in-service training programmes and drills to ensure sustainability of knowledge and skills on disaster preparedness and management.
Parental expectations and experiences of their child’s cochlear implantations
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Jayawaruni, U.C.; Chandrasekara, J.M.A.U.
BACKGROUND: Cochlear Implantation (CI) has become a most popular amplification option for children with severe, to profound pre-lingual deafness, in both developed and developing countries. Although several studies have done in other countries in terms of parental perspectives of CI, enough studies have not done to describe relationships of expected and true outcomes of CI in Sri Lankan context. OBJECTIVES: To describe parental pre-implant expectations and post-implant experiences of their child’s CI. METHODS: A descriptive cross-sectional study design was implemented, employing a self-administered questionnaire. A purposive sampling method was utilized for recruiting parents from a special pre-school setting and two cochlear rehabilitation centers. The survey compared parents’ pre-implant expectations with their post-implant experiences in five domains: communication abilities, general function, social skills, academic achievements and happiness and well-being. Results: The participants comprised of 44 child/parent pairs of 38 mothers and 6 fathers. There was no statistically significant difference between parents’ pre-implant expectations and post-implant experiences, except in the communication abilities domain (P<0.05). CONCLUSIONS: The overall findings indicated that the majority of parents’ pre-implant expectations met with their post-implant experiences. Parents were satisfied with their decision to proceed with CI and accordingly the anticipated improvements achieved by their children after CI. The study suggested that parents should be supported to synthesize more realistic expectations to perceive the outcomes optimistically as child’s progression takes time.
Sinhala social communication production in children with typical and atypical development (Gampaha district, Sri Lanka)
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Perera, E.I.
Social communication disorders in children, such as Autism Spectrum Disorder (ASD) are raising much concern globally. The rising figures of the child populations affected by Autism Spectrum Disorder have called for more scientific investigation both at international and national levels. A diagnosis of Autism Spectrum Disorder can be reliably made by the age of 2 years, and behaviour predictive of autism is evident as early as 12 or 18 months. Culturally and linguistically validated tools and functional markers do not exist for children in Sri Lanka. The available profiles are western models. This presentation describes a cross sectional and mixed methods study, exploring the social communication production of 32 typically developing children, living in Sinhala speaking home environments in the Gampaha district, from 09 – 30 months of age and 08 children with developmental disorders from 09 – 48 months of age. Interviewer administered questionnaires and naturalistic observation were employed as methods for data collection. Data analysis used Excel and SPSS and thematic analysis of video observations. Linguistic and socio cultural aspects emerging from the data and the need for validation of norms for Sinhala social communication for early identification of children with at risk for atypical development will be discussed.
Usage analysis of student interactions in an online learning platform conducted at Faculty of Medicine, University of Kelaniya: Pedagogical considerations for implementing e-Learning
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Karunaratne, W.C.D.; Chandratilake, M.N.; Heiyantuduwage, S.
BACKGROUND: Learning Management Systems (LMS) designed to support teaching and learning has changed how education is offered and consumed in higher education. OBJECTIVES: This study was conducted with the aim of identifying what inferences, educators can make through student usage statistics of the Moodle Learning Management System termed as the VLE (Virtual Learning Environment) on developing a pedagogical model for online learning. METHODS: Student and staff course usage statistics were recorded from the VLE of the Faculty of Medicine, University of Kelaniya for all the modules, and related resources and activities conducted from first to the fourth year students during the year 2015 and analyzed. RESULTS: A majority of students (88-90%) access the materials available in the VLE. The mean student access during the module is higher than following the completion of the module while the frequency of student access during faculty hours is similar to the frequency of use after faculty hours. As expected, student access was increased with availability of more learning materials in the modules and with incorporation of student activities and links to web resources. The mean usage frequency of staff were considerably low and limited whereas the support staff usage being more than ten times higher. CONCLUSIONS: The Virtual Learning Environment (VLE) of the faculty can be used as an effective platform to supplement didactic learning and to promote self-learning among students. It also highlights the necessity to form an eLearning development team for the institution consisting of instructional designers, graphic artists, multimedia developers and instructors with whom the content experts can work together to realize there requirements.