ARS - 2009

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    The association between respiratory symptoms and gastro-oesophageal reflux events
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Amarasiri, W.A.D.L.; de Silva, H.J.; Ranasinha, C.
    Introduction: The oesophagus and the airways have a common origin. Abnormal gastroooesophageal reflux (GOR) may predispose to genesis of respiratory symptoms. This association has not been reported previously in Sri Lanka. Aims: To describe the association between reflux events and respiratory symptoms in a cohort of adult asthmatics in Sri Lanka. Methods: 30 stable, mild asthmatics (American Thoracic Society criteria) underwent dual-sensor oesophageal pH monitoring. Respiratory symptoms (cough, wheeze, difficulty in breathing, chest tightness) experienced during monitoring were recorded. Respiratory symptoms were correlated with reflux events by reviewing diary events and oesophageal pH tracings. A reflux episode was defined as a drop in pH to values <4 lasting> 4 seconds. A respiratory symptom was considered as associated with a reflux episode if it occurred 2 minutes prior to or after a reflux episode. Results: 50% of the asthmatics complained of one or more respiratory symptoms during the 24- hour recording period. Of 102 respiratory symptoms recorded, 73 were cough, 23 were wheezing and 5 were episodes of chest tightness. None experienced difficulty in breathing. 93% of coughs, 81 % of wheezes and all episodes of chest tightness were reflux-associated. In most cases reflux episodes preceded respiratory symptoms. There was no statistically significant difference in any oesophageal monitoring parameter between asthmatics with and without respiratory symptoms. Conclusion: Asthmatics experience respira~ory symptoms during reflux events. The deve:lopment of respiratory symptoms during an episode of acid reflux or within 2 minutes thereafter suggests that it is probably GOR that triggers asthma.
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    Students’ perceptions and attitudes to drama in English language learning at the Faculty of Medicine, Ragama
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Athukorala, V.U.; Edirisinghe, E.A.N.J.; Salgado, S.
    INTRODUCTION The greatest challenge that majority of medical students face is the medium switch from their mother tongue to English. The purpose of this research is to explore perceptions and attitudes of the first year students towards drama as an English language learning tool. The dramas were used to assist them overcome their fear of language switch by establishing self-confidence while creating an interest in the use of English language. METHODOLOGY The participants in the research were randomly selected MBBS and SLT (Speech and Language Therapy) students. They were from diversified backgrounds with varying levels of English knowledge at entry level. The research was carried out in the form of questionnaires and interviews that took place before and after classroom practical sessions and also after stage performances at the end of the Intensive Courses of English in the year 2009. RESULTS Over 96% of students perceived situational dialogues/skits/playlets/dramas as a highly useful method since it made learning an interesting task and helped improve fluency, vocabulary and confidence. They claimed that it was an opportunity to develop their personality, to relieve stress and was also a platform to demonstrate their creativity and talents. Further, over 90% of students appreciated peer learning while the weaker students especially claimed that peer learning and group work reduced their anxiety and inhibitions towards the use of English language. CONCLUSION The research highlighted the use of drama activities in English language learning as a highly positive measure. The most important factor therefore is to explore the ways and means to help the students to sustain their newly created self confidence and interest throughout their stay in the university.
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    Audit on quality of care given to the patients who attended the professorial surgical clinic
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Ariyaratne, M.H.J.; Perera, W.A.T.M.N.; Wanigasekera, H.L.A.C.R.
    INTRODUCTION The large number of patents attending the professorial surgical clinic overwhelms the facilities available. An audit was designed to evaluate the quality of care given to the patients. The parameters assessed were, treatment given, drugs given, dose appropriateness and whether unnecessary treatment was administered. METHODOLOGY Every 3rd patient (N=112) who attended the clinic of University Surgical Unit, NCTH, Ragama was included in the study, from June 2009 to August 2009. Each patient was assessed by a single examiner (a senior registrar), and a pre tested profoma was completed. RESULTS Majority was females 68(60.7%). 78(69.65%) were due to variety of diseases including breast pathology. 34(30.35%) were due to thyroid pathology. 76(67.85%) have received a diagnosis card. 108(96.42%) have got the correct treatment. 4(3.57%) have received unnecessary drugs, in 12(10.71%)the dosage of the drugs were not appropriate. 8(7.14%) patients could be discharged from the clinic. CONCLUSION Overall care given in the professorial surgical unit was satisfactory. A few people were receiving unnecessary drugs, improper dosage. Some have not received a diagnosis card and there were few unnecessary follow-ups. We should make the doctors aware of those issues to improve the quality of care given to the patients.
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    Lymphatic filariasis in selected endemic communities in Gampaha district, Sri Lanka
    (University of Kelaniya, 2009) Wijegunawardana, N.D.A.D.; Gunawardene, Y.I.N.S.; Manamperi, A.; Abeyewickreme, W.
    Background: Epidemiological surveys are important tools for monitoring progress of lymphatic filariasis (Lf) eradication programs. Objective: The objective of this study was to identify the current status of Lf in Gampaha district, following the completion of 5 year mass-treatment program (MDA), by using traditional night blood screening test. Study design: Study sites were selected within the Lf endemic area while following guidelines of Anti Filariasis Campaign and study population consist of all individual living within the 500 m radius randomly selected land area. Methodology: Night blood screening was carried out between May to August 2009 in 9 sites in 3 closely situated Medical Officer of Health (MOH) areas of Gampaha district. All participants were screened for Microfilariae (mf) after examination by a medical officer for clinical manifestations of Lf and the awareness and practices of participating individuals of >15 years with regard to MDA programme surveyed using an interviewer administrated structured questionnaire. Results: Of the 1073 participants (286 children, 787 adult) screened, 6 were positive in 2 sites for mf, giving mf positive rates of 0.5% and 3.4% respectively in Hekiththa and Peliyagoda sites. While giving mean mf density (mf/60 μl blood) of 2 and 7 respectively. Questionnaire analysis revealed that, of the 1073 participants, 78% were aware of MDA and from that 65% had received the drugs and from that nearly 50% had taken the drugs. Out of those 50%, only 34% had taken it continuously all five years. According to the clinical investigation of 1073 participants, 7%, 3% and nearly 1% had symptoms of headlice, Lyphoedema and Hydrocoela respectively. Discussion: mf rate of Lf in this study population is greater than the currently reported in the country (0.18%). Therefore, an intensive MDA programme is recommended to contain the spread of infection.
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    Using regular student feedback to improve the MBBS course
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Liyanage, P.L.C.K.; Fernando, G.M.O.; de Silva, N.R.
    Introduction: A new MBBS curriculum was introduced in the Medical Faculty in 2004. In order to monitor the quality, feedback is obtained from students at regular intervals, both on completion of learning modules and at the end of longer learning phases and conveyed back to teachers through the Medical Education Centre. In this study, feedback from two consecutive batches, regarding their learning experiences in the 3rd and 4th years of study was analyzed in order to ascertain changes in student satisfaction. Methods: Questionnaires were administered to the 1st and 2nd batches of students to follow the new curriculum, at the end of their 4th year of study. Feedback was obtained on 10 learning modules; the clerkships conducted by the Faculty; and the Community Health and Behavioural Sciences, Mental Health & Ethics strands. Students were asked to indicate their satisfaction with the different learning activities in these course components and the proportion of responses indicating satisfaction were compared between batches. Findings: Completed questionnaires were returned by 158/168 students and 140/164 students in the 1st and 2nd batches respectively. The proportion of responses expressing satisfaction with specific learning activities ranged from a low of 24.3% for a 4th year module to a high of 96% for the Family Medicine Clerkship, both for the 1st batch. Comparison of the level of satisfaction with two 4th year modules where the 1st batch had expressed the lowest levels of satisfaction showed that student satisfaction with both modules increased significantly from one year to the next: from 221/909 responses (24.3%) to 451/853 (52.9%) for one module (chi-squared=152.1, P<0.001); and from 595/857 (69.4%) to 631/845 (75.7%) for the other module (chi-squared=5.81, P=0.016). Conclusions: Regular student feedback is useful in identifying course components that need improvement, and can be an effective means of initiating appropriate changes that improve the overall quality of the course.
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    Demographic details, mode of presentation, contributory factors and outcome of trauma patients who visited North Colombo Teaching Hospital, Ragama from 1st April 2009 to 1st July 2009
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Ariyaratne, M.H.J.; Wanigasekera, H.L.A.C.R.; Rupasinghe, G.N.; Dilesha, W.A.L.
    Introduction Trauma is one of the main causes of hospital morbidity and mortality. Material and methods Descriptive study which included 110 consecutive patients who presented to the Professorial Surgical Unit ,NCTH, Ragama as the first contact hospital following trauma during the period of 3 months from 1st of April 2009 to 1st of July 2009 Data was collected by interviewer administered questionnaire from the day of admission to day of discharge. Results • Demographic details The mean age of trauma victim was 34 (17-68) years and 71% (n=78) were males. 11.5% (n=23) victims were daily paid manual workers. Among all victims of trauma 77% (n=70) were to be educated up to O/L or more. 42% (n=46) were single. • Mode of presentation of all admissions The analysis revealed 56% (n=61) of trauma were due to road traffic accidents and 13.5% (n=14) due to occupational hazards. 39.1% (n= 43) had head injury and 12% (n=11) had hand injury. • Contributory factors At the time of admission13.5% (n=13) were under the influence of alcohol, 66.5% (n=73) had sleep deprivation(less than 6 hours of sleep), 65.4% (n=68) of trauma were high velocity injuries, 57.6% (n=60) had not used protective devices. • Other factors influencing the outcome 57.7% (n=60) had not had first aid and 15.7% (n=15) had delay for more than 2 hours in reaching the hospital. • Outcome 65.4% (n=68) of trauma victims were discharged before 7 days after admission and 1.9% (n=2) died and 1.9 % (n=2) ended up with amputation. Discussion and conclusion Our study shows the importance of wearing protective devices, controllable speed, avoidance of sleep deprivation and abstinence from intoxicating liquor as primary prevention and practicing first aid measures, early access to medical facility as secondary preventive measures in order to achieve SAFE TOMORROW.
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    Development and validation of a tool to assess neuro-developmental outcome of 5-9 year old children in Sri Lanka
    (2009) Abeysuriya, V.; Wickremasinghe, A.R.; Perera, K.P.J.; Kasturiratne, A.; Poddalgoda, I.
    Objective: To determine the validity and reliability of a tool which has been developed based on Griffiths Mental Development scale (GMDS) to assess the neuro-developmental outcome of 5-9 year old children in Sri Lanka. Design: Descriptive cross sectional study Setting: Randomly selected five primary schools of the Medical Officer of Health (MOH) area in Ragama, Pediatrics Out patient clinic at Colombo North Teaching Hospital in Ragama and the Department of Pediatrics at the Faculty of Medicine, University of Kelaniya. Method: The study population consisted of two groups. Group A had 60 children. This sample consisted of 20 children who have been clinically diagnosed as having poor neuro-development and 40 children with normal neuro development. They were assessed using the developed neurodevelopment assessment tool at Colombo North Teaching Hospital, Ragama to determine the cutoff value for poor and normal neuro- developmental outcome. The ROC curve analysis was used to determine the statistical significant of the cutoff GQ value which identify the poor and normal neuro developmental outcome of children by the tool. Group B had 100 primary school children (n=100) who were selected from Ragama MOH area. It consisted of 50 children with the high educational performance and 50 with the poor performance based on teacher’s assessment based on student performance reports. The group B has been used to re-asses the validity of the developed tool with the identified cut off GQ value. History of birth and development, family history, teachers’ records, school performance, clinical examination and aptitude test were used to determine neuro-developmental outcome of children by the pediatrician. Result: A cut-off value of GQ 100 (P<0.05) was identified to differentiate children with poor and normal neuro-developmental outcome (sensitivity 100% and specificity 100%). Reliability of identified cutoff value was tested by administrating the tool to the selected primary school children. Out of 50 poor educational performance children who were identified by the teachers’ only 36 were below GQ 100. There were 31 children who were clinically diagnosed as having poor neruo-development by the pediatrician and all of them had GQ of below 100 (Sensitivity 100%). Conclusion: The developed neuro-developmental outcome assessment tool is a valid and reliable instrument to screen neuro developmental outcome of Sri Lankan children aged between 5-9 years.
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    Factors associated with osteoporosis among a sub-urban Sri Lankan population
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Karunanayake, A.L.; Pinidiyapathirage, J.; Salgado, L.S.S.
    Introduction : Risk factors for osteoporosis can vary from country to country. Objective: To determine the association between osteoporosis and age, physical activity, body mass index (BMI), smoking, alcohol consumption, consumption of milk, level of education and income in a sample of sub-urban Sri Lankan adults. Methodology: A descriptive cross sectional study involving 22 grama niladari divisions of the Ragama MOH area was conducted from March to October 2007. A randomly selected sample of 700 adults, in the age group of 35-64 years, were invited to participate in the study. A structured interviewer administered questionnaire was used to collect demorgraphic data and details of risk factors. Bone mineral density (BMD) was measured with a peripheral Dexa scan. A BMD of < -2.5 was considered as having osteoporosis. Result: Of the 700 subjects studied, 60% (n=421) were females. Using logistic regression analysis, age >50 years (OR 3.5 95% CI 1.9-6.2), female sex (OR 12.2 95% CI 4.8-30.9), low level of education (OR 1.8 95% CI 1.1-2.8), low BMI (OR 3.5 95% CI 1.7-7.3) and smoking (OR 5.8 95% CI 1.9-17.2) had a significant association with osteoporosis. Conclusion: Age, sex, level of education, nutritional status and regular smoking showed a significant association with osteoporosis.
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    Anatomical variations of the superficial palmar arch in Sri Lankans – A cadaveric study
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Salgado, S.; Fernando, E.D.P.S.; Anuradha, W.K.; Nishantha, M.P.
    Vasculature of the hand is one of the complex areas having a high degree of anatomical variations. It is very important to have an adequate knowledge of the arterial supply to the hand in this era of modern medical technology, as a significant number of surgical procedures such as radial arterial cannulation, radial forearm flap, and radial artery conduits in coronary artery grafting are carried out. Improvement of microsurgical techniques in reconstructive hand surgery also have made a necessity for better understanding of the vasculature of the hand. The superficial palmar arch provides the major blood supply to the hand along with the deep palmar arch and represents an important anastomosis between the ulnar and radial arteries. Objective: To study the variations of the superficial palmar arch in Sri Lankans compared to the classical description given in standard text books. Methodology: Eighteen hands from formalin preserved cadavers, both males and females of the ages between 30 to 80 years were dissected. Special attention was paid to trace the blood vessels supplying the thumb. Results: The superficial palmar arch is mainly formed by ulnar artery and some contribution from the radial artery. Two types of superficial palmar arches were described, as complete and incomplete. The classic superficial palmar arch was described as the direct continuity between the ulnar artery and the superficial palmar branch of radial artery which is considered as the sub group of complete type. In the incomplete type superficial palmar arch is formed only by the ulnar artery with some communications from the deeper palmar arch . According to the previous literature, complete type ranges from 80% to 90%. In our study 16 hands (89%) were with complete type and 02 (12%) were with incomplete type. However the anastomosis between radial and ulnar arteries were seen in all the specimens of our study. Classical palmar arch having a direct continuity between the ulnar artery and the superficial palmar branch of radial artery was found in 10 (55%) hands, in contrast to the 10% in the literature. Palmar type of median artery was noticed in 2 (12%) hands contributing to form the superficial palmar arch, in contrast to the 20% in literature. Although the sole blood supply to the thumb is by the princeps pollicis according to the standard text books, in our study it was found only in 6 (33%) specimens. The classical picture of the superficial palmar arch, with the princeps pollicis supplying the thumb was not seen in any of the specimens. Conclusion: Variations in the terminations of the radial and ulnar arteries are common. Since there are anastomoses between radial and ulnar arteries it may be safe to sacrifice any of the main arteries when performing surgical and medical interventions of the hand in the absence of vascular diseases.
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    Smoking and semen quality; Comparative study in a Sri Lankan subfertile population
    (Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Dissanayake, D.M.A.B.; Wijesinghe, P.S.
    Rationale: Adverse effects of smoking on reproductive health are well established, but the extent of its effects on semen parameters is inconclusive. Aims: Aims of this study were to find out the prevalence of smoking habit in a subfertile population in Sri Lanka, and to find out the relationship between smoking and semen parameters. Design and setting: Cohort study was carried out at the, Infertility unit, department of Obstetrics and Gynaecology, Faculty of Medicine, Ragama. Patients and Method: Detailed history (including smoking habit) was taken from 1300 men undergoing subfertility evaluation. Males with Azoospermia or severe oligozoospermia, history of STI, mumps related orchitis, varicocele, DM, use of recreational drugs and regular medication for any other disease and occasional smokers were excluded. Four hundred men who fulfilled the inclusion criteria were enrolled in the study (200 smokers and 200 non smokers). Semen analyses of all subjects with the standard 3-5 days of sexual abstinence were performed. Statistical analysis was done using the SPSS 10.0 for windows software. Result: Pathozoospermics were significantly high among smokers compared to non smokers (93 Vs. 73, p<0.05). Similarly, semen volume, total sperm count and morphology were low in smokers; mean (SD) volume 2.30 (1.18) Vs. 2.89 (2.36), total count 124.75 (105.14) Vs. 151.94 (114.10) and morphology 45.57 (13.05) 48.17 (12.86) respectively (p<0.05). Both duration of smoking and intensity (duration x number of cigarettes) had negative correlation with sperm viability; r = -0.199 and -0.151 respectively (p<0.05). Conclusion: Smoking is associated with reduced semen quality affecting the semen volume, total sperm count, morphology and viability in this population.