Conference Papers
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/6561
This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
Browse
43 results
Search Results
Item Lapses of professionalism occurring among Sri Lankan medical students: How should they be remediated?(Sri Lanka Medical Association., 2019) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.INTRODUCTION & OBJECTIVES: Early recognition and correction of lapses of professionalism occurring during 'the undergraduate period is vital. This study aimed to explore the lapses of professionalism occurring among local medical students and identify appropriate remedial measures. METHODS: The study was conducted in two phases. In Phase I, in-depth interviews and focus group discussions were conducted with medical teachers, clinicians, deans, students, nurses and patients (n= 129) to explore lapses they had witnessed. Conversations were audio-recorded, transcribed and analysed inductively. Description by multiple groups was considered an indicator of prevalence of a behaviour. In Phase II, a consensus conference with medical teachers, clinicians, deans and students (n=3 I), was conducted to achieve consensus on remediation strategies for identified lapses occurring as a first-time offence or a repeated behaviour pattern. Degree of consensus was based on modal distribution of responses. RESULTS: In Phase I, over 100 types of misconduct were described. The most common behaviours included, 'not doing allocated ward work', 'not contributing to group work' and 'several students examining a patient at the same time'. In Phase II, it was possible to achieve an acceptable level of agreement (50% or higher consensus) regarding remediation strategies for over 70% of the items, including almost all lapses identified as most common. Strategies ranged from 'ignore' to 'expulsion' and included measures such as discussion with peers, remedial work and counselling. CONCLUSION: Sri Lankan medical students exhibit a wide range of professionalism lapses of varying severity. The value of correcting such behaviour in a standardized manner is recognised.Item Introduction of Recombinase Polymerase Amplification assay based mobile suitcase laboratory as a point of need tool to diagnose cutaneous leishmaniasis in Sri Lanka(Sri Lanka Medical Association, 2018) Gunaratna, G.P.S.; Ranasinghe, P. H. K. I. S.; Manamperi, A.; Pathirana, N.; Pathirana, H.; Wickremasinghe, R.; de Silva, N.R.; Sooriyarachchi, M.; Ahmed, A.E.W.INTRODUCTION AND OBJECTIVES: Cutaneous leishmaniasis (CL) caused by the vector-borne protozoan parasite is now endemic in Sri Lanka. Microscopy of Giemsa stained slit skin smears (SSS), lesion aspirates or scrapings for the presence of amastigotes, is widely used for laboratory confirmation of CL, although the reported sensitivity is low. Facilities for more sensitive culture and molecular techniques are available only in reference laboratories. A newly developed, Recombinase Polymerase Amplification (RPA) assay based Mobile Suitcase Laboratory (MSL) is a promising, molecular point of care test with high sensitivity and specificity for diagnosis of both post-kala• azar dermal leishmaniasis and visceral leishmaniasis. Objective was to assess RPA based MSL as a point of need tool to diagnose CL in Sri Lanka.METHODS: Twenty seven army personnel at Mullaitivu Army camp clinically suspected of having CL were recruited for this pilot study. Two slit skin smears and two punch biopsy specimens were obtained from each of them. Slit skin smears were stained with Giemsa in the field and examined for the presence of amastigotes and RPA was carried out at the point of collection. PCR was performed at the Parasitology Department, Sri Jayewardenepura University. RESULTS: Fifteen patients were confirmed by PCR as having CL and 14 of them were also positive by RPA based MSL conducted in the field (93.33% sensitivity). Only 3/15 were positive with microscopy of SSS (20% sensitivity). CONCLUSION: This pilot study shows RPA based MSL as a promising tool to diagnose CL at point of need.Item Detection of a case of Brugian Filariasis from Anuradhapura, a non-endemic district of Sri Lanka(Sri Lanka Medical Association, 2018) Mallawarachchi, C.H.; Gunaratne, I.E.; Ekanayaka, G.M.G.A.C.; Mallawarachchi, S.M.N.S.M.; Chandrasena, T.G.A.N.; Mendis, D.; de Silva, N.R.INTRODUCTION AND OBJECTIVES: In 2016, the WHO declared that lymphatic filariasis was no longer a public health problem in Sri Lanka. However low-grade persistence of bancroftian filariasis continues in all three endemic provinces, while brugian filariasis has re-emerged. The periodicity pattern of the re-emerged Brugia spp. suggests zoonotic origin. A canine survey done in the district of Anuradhapura found a moderately high prevalence (28.2%) of B. malayi infections in the Thirappane MOH area. Objective of the study was to investigate the threat of zoonotic B.malayi infections to humans in the Thirappane MOH area. METHODS: A cross sectional survey was done among all consenting residents of three randomly selected areas representing the three PHI areas of the Thirappane MOH. Residents were screened between 8.00 pm and 12.00 pm using night blood smears (NBS) and Brugia rapid test (BRT) for presence of anti-Brugia IgG4 antibodies. BRT was done selectively. Ethical and administrative clearance was obtained prior to the survey. RESULTS: A total of 752 individuals were screened by NBS; 176 of them were also screened by BRT. 193, 208 and 351 NBSs were done respectively in Thirappane, Galkulama and Mooriyankadawala PHI areas. One individual, a 25-year-old long-term resident of Mooriyankadawala PHI area was positive for Brugia spp. microfilariae by NBS and by BRT. The microfilariae exhibited nocturnal sub-periodicity. CONCLUSION: Transmission of brugian filariasis appears to occur even outside the traditional endemic belt. The presence of canine reservoirs of infection and water bodies with aquatic vegetation probably favour transmission by Mansonia spp. vector mosquitoes in the study area.Item Effectiveness of mebendazole and health education in control of pinworm infection among children living in low income settlements(Sri Lanka Medical Association, 2017) Kumarendran, B.; Pathmeswaran, A.; de Silva, N.R.INTRODUCTION & OBJECTIVES: We aimed to evaluate the effectiveness of mebendazole (MBZ) mass treatment and health education in reducing reinfection with pinworm among children living in low income settlements (LIS). METHODS: A factorial cluster-randomized, controlled trial was conducted during January to May 2014, to compare the effectiveness of MBZ 100mg for positive cases versus mass treatment, and routine versus special health education. 1257 children aged 3-7 years, from 48 clusters of LIS in the Colombo Municipal Council area, were selected using cluster sampling. Perianal cellophane adhesive swabs (CAS) were examined for pinworm eggs. About 2-3 weeks after collection of the first sample (CAS1), depending on the intervention arm, eligible participants were given MBZ. Second sample (CAS2) was collected a week after administration of the first dose (MBZ1). Second dose (MBZ2) was given two weeks after MBZ1. Third sample (CAS3) was collected a week after MBZ2, and a fourth sample (CAS4) was collected 12 weeks after MBZ2. RESULTS: Sample collection rate was 94%, 80%, 75% and 73%, for CAS1, CAS2, CAS3 and CAS4 respectively. Overall egg positivity reduced from 42.5% to 10% following MBZ1, and to 6.8% following MBZ2, but increased to 29.3% at 12 weeks following MBZ2. In logistic regression, reinfection rate at 12 weeks after MBZ2 (i.e. those who were CAS3 negative but CAS4 positive) was associated with baseline pinworm egg positivity (OR=1.2) and BMI for age Z score (OR=0.96), but not with intervention arm. CONCLUSION: MBZ is effective in reducing pinworm egg positivity, but re-infection is common.Item Prevalence of pinworm infection among children living in low income settlements in Colombo Municipal Council area(Sri Lanka Medical Association, 2017) Kumarendran, B.; Pathmeswaran, A.; de Silva, N.R.INTRODUCTION & OBJECTIVES: Pinworm (Enterobius vermicularis) infection is associated with overcrowding and poor personal hygiene. We aimed to estimate the pinworm egg positivity (EP) rate among children living in low income settlements (LIS) in the Colombo Municipal Council (CMC) area, as there is no empirical evidence of prevalence. METHODS: This descriptive cross-sectional study was conducted during January - March 2014 as part of a clinical trial. Study population included children aged 3-7 years living in LIS in the CMC area for at least one year. Cluster sampling was used to select 1257 children, who were tested for pinworm infection using perianal cellophane adhesive swabs (CAS). Each child’s principal caretaker was educated to take the swabs early morning, immediately after awakening, on two consecutive days. CASs were examined by experienced technicians. EP was defined as EP on at least one of the two CAS. RESULTS: Sample collection rate was 94.3% (n=1185). Overall EP was 42.5 % (95% CI 39.7 - 45.4), but only 20.8% showed EP on both days. In logistic regression analysis, EP was associated with socioeconomic score (OR = 0.98), age of the child [from 3 years to 7 years] (OR= 1.02), BMI for age Z score (OR= 0.97) and increasing number of children aged 3 to 7 years in a household (OR= 1.05). CONCLUSION: A high proportion of 3-7 year old children living in LIS in the CMC area have pinworm infections. Prevention and control of this infection in LIS in the CMC area should be strengthened.Item Attributes of professionalism expected of a medical doctor in Sri Lanka(Sri Lanka Medical Association, 2016) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.INTRODUCTION: Professionalism is an essential competency for a doctor. OBJECTIVES: To identify the attributes of professionalism expected of a doctor in the Sri Lankan setting. METHOD: A two-round Delphi study was conducted online with the participation of 158 representatives of various stakeholders in healthcare. In the first round, participants outlined attributes of professionalism expected of a doctor in the local context. Through conventional content analysis, a list of attributes was compiled. These were rated by participants in round II. The most important attributes were identified by calculating the Content Validity Index (CVI) of responses. Kappa value was calculated to determine the adequacy of inter-rater agreement. RESULTS: In round I, 56 attributes of professionalism were identified. These items were compiled into a questionnaire with four distractors (i.e. misperceptions of professionalism) to minimize indiscriminate rating of items. In round II, 46 items received a CVI >0.78 (cutoff value to determine essential items). ‘Possessing adequate knowledge and skills’ received the highest CVI (0.99), followed by ‘displaying a sense of responsibility’ (0.98) and ‘being compassionate and caring’ (0.97). ‘Altruism’ and ‘socio-cultural sensitivity’ were not rated as important. Interestingly, one of the 4 distractors (‘stands for professional autonomy’) also received a CVI>0.78. The K-value was 0.77, indicating adequate inter-rater agreement. CONCLUSIONS: This study enabled the development of a prioritized list of professionalism related attributes expected of a doctor in Sri Lanka. The conceptualization of professionalism in the local healthcare context appears to have both commonalities and disparities with the rest of the world.Item Parasitic infections - challenges in treatment(Sri Lanka College of Microbiologists, 2012) de Silva, N.R.Professor of Parasitology, Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama The term 'parasitic infections' includes infection by uni-cellular protozoan organisms as well as multi-cellular helminths. Many of these organisms have complex life-cycles with several morphological forms and sophisticated mechanisms to evade the host's immune response. Challenges in the treatment of parasitic infections may arise due to a variety of different reasons. It may be an infection where it is difficult to make a conclusive diagnosis in the first place. Examples include toxoplasmosis and hydatidosis, infections that are confined to the tissues, and a conclusive laboratory diagnosis is notoriously difficult to establish. Other parasitic infection are difficult to treat simply because of the lack of effective drugs {e.g. cryptosporidiosis) or because the available drugs are difficult to administer and have toxic adverse effects (e.g. visceral ieishmaniasis, human African trypanosomiasis). There are yet other infections that are challenging to treat because the pathogen has a complex life cycle that involves auto-infection. Strongyloidiasis and entero-biasis are examples of such infections where recurrent re-infection resulting from auto-infection may make it necessary to repeat treatment several times over. Finally, the emergence of drug resistance could also mean that the infection may be a challenge to treat. Fatciparum malaria is a prime example of an infection that can be very difficult to treat because the pathogen is resistant to many different drugs. The presentation will focus on two intestinal parasitic infections that can be particularly challenging to treat: Strongyloidiasis and cryptosporidiosis. Both infections are briefly reviewed under the following aspects: life cycle and morphology; epidemiology; clinical manife¬stations; pathogenesis and immunity; diagnosis; treatment and prognosis. was implemented. From October 2010 to July 2011, 30-day mortality fell significantly, 118/668 (17.7%). BHRUT is one of 3 centres to have published data demonstrating a reduction in mortality through a continuous cycle of regular bacteraemia surveillance and implementation of a quality improvement programme.Item Prevalence of enterobiasis among primary school children in Ragama MOH region(Sri Lanka College of Microbiologists, 2012) Gunawardena, N.K.; Chandrasena, T.G.A.N.; Senarathna, B.P.; Silva, G.M.K.S.; de Silva, N.R.INTRODUCTION: Although frequently diagnosed clinically, there is only one previously reported survey of Enterobius vermicularis infection among Sri Lankan children, conducted in the 1980s. OBJECTIVES: To determine the prevalence of enterobiasis among Year One school children in Ragama MOH area and investigate association between infection and risk factors. METHOD: A cross sectional descriptive study was performed among Year One children in seven randomly selected schools. Infection was diagnosed using adhesive cellophane peri-anal swabs obtained on two consecutive days. A pre-tested, self-administered questionnaire completed by the mother, identified risk factors associated with enterobiasis. Initial univariate analysis was followed by multivariate analysis with logistic regression. RESULTS: Of 322 children, 276 (male: female ratio 1.1:1, mean age 6 years) returned the swabs and questionnaires (compliance 85.7%). Prevalence of infection by double and single swab examination was 37.5% and 20.1% respectively. Prevalence was significantly lower among children of more educated mothers (34.2%), fathers with permanent employment (28.9%) and those dewormed in the last 30 days (22%) compared to children of less educated mothers (46.5%), fathers with casual (46.9%) or no employment (36.4%) and those not dewormed recently (41.6%)(P<0.05). Infected children belonged to households with significantly more members, siblings and persons sleeping with index child (P<0.05). Multivariate analysis showed that more children in a household and recent deworrning were the only significant determinants of enterobiasis. CONCLUSIONS: Over one-third of primary school children in the Ragama MOH area have enterobiasis. The risk of infection is higher in families with more children and is reduced by regular deworrning.Item Lymphoedema management knowledge and practices among patients attending filariasis clinics in the Gampaha District, Sri Lanka(Sri Lanka College of Microbiologists, 2004) Chandrasena, T.G.A.N.; Premaratna, R.; de Silva, N.R.INTRODUCTION: Little information is available on methods of treatment practiced by Sri Lankan patients with filarial lymphoedema. The burden of acute dermatolymphagioadenitis (ADLA) attacks in these patients is also unclear. OBJECTIVES: To determine knowledge, perceptions and practices regarding lymphoedema management and the burden of ADLA attacks among patients with lymphoedema attending filariasis clinics. METHODS: The survey was carried out in the Gampaha district. Semi structured questionnaires were deployed to assess knowledge, practices and perceptions regarding morbidity alleviation in filarial lymphoedema. The burden of ADLA attacks was estimated using one-year recall data. RESULTS: 66 patients (22 males: 44 females) mean age 51.18 years SD 13.9% were studied. Almost two thirds of the population was aware of the importance of skin and nail hygiene, limb elevation and use of footwear. Washing was practiced"bn a daily and twice daily basis by 40.9% and 48.5% respectively. However limb elevation, exercise and use of footwear were practiced by 21 -42.4% (while seated and lying down), 6% and 34.8% respectively. Regular intake of DEC was considered important by the majority (n=61. 92.4%). Most (65.2%) had received health education from the filariasis clinics. Among patients who sought private care (n~48) the average cost of treatment of an ADLA attack was Rs. 737.91. Only 18.2% had feelings of isolation and reported community reactions ranging from sympathy to fear and ridicule. CONCLUSIONS: Filariasis clinics seem to play an important role in the dissemination of knowledge regarding morbidity control. Referral of lymphoedema patients to morbidity control clinics is recommended.Item Randomized placebo-controlled trial of the efficacy of mebendazole polymorphs in the treatment of hookworm infections(Sri Lanka College of Microbiologists, 2013) Gunawardena, N.K.; Kumarendran, B.; Manamperi, N.H.; Senarathna, B.P.; Silva, M.; Pathmeswaran, A.; de Silva, N.R.INTRODUCTION: Mebendazole has three polymorphic forms, identified as A, B and C. Animal studies and one previous study in humans have suggested that unlike polymorph C, polymorph A is ineffective in the treatment of hookworm and whipworm infections. OBJECTIVES: A randomized double-blind, placebo-controlled trial was carried out to compare the efficacy of single dose 500 mg tablets of pure mebendazole polymorph C with those containing a 1:1 mixture of polymorphs Aand C, for the treatment of hookworm infections. . DESIGN, SETTING AND METHODS: All eligible individuals living in 219 households in 8 estate divisions in Ratnapura District known to have a high prevalence of hookworm, were recruited after obtaining written, informed consent. A single faecal sample was obtained and examined the same day, using the Kato-Katz technique for quantification of intestinal nematode infections. Those who were found infected with hook¬worms were randomized to one of three treatment arms and requested to provide a second faecal sample 10-14 days after treatment. This was examined in the same manner as the first. RESULTS: A total of 892 individuals were recruited; 601 provided faecal samples; 214 were found positive for hookworm infection; 70, 74 and 70 individuals were randomized to treatment arms A (mixture of polymorphs A and C), B (pure polymorph C) and C (placebo) respectively. Follow-up faeca! samples were provided by 53,48 and 49 persons respectively in each treatment arm. The cure rates in the three treatment arms were 28.3%, 18.8% and 16.3% respectively; they were not significantly different from one another. Comparison of faecal egg count reductions (FECR) in the 3 treatment arms (86.1%, 84.5% and -6.6% in arms A, B and C respectively) showed that both mebendazole formulations performed significantly better than placebo, but there was no statistically significant difference between FECR with the two drug formulations. CONCLUSIONS: A single SOOmg dose of mebendazole, either as Polymorph C alone, or as a mixture of Polymorphs A and C, has little efficacy in curing hookworm infections. However, both formulations are significantly better than placebo in reducing the intensity of infection, with no statistically significant difference between the two formulations.