Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Detection of human strongyloidiasis among patients with a high risk of complications attending selected tertiary care hospitals in Colombo, Sri Lanka using molecular and serological diagnostic tools(BioMed Central, 2024-10) Weerasekera, C.J.; Gunathilaka, N.; Menike, C.; Anpahalan, P.; Perera, N.; De Silva, N.R.; Wickremasinghe, R.BACKGROUND Strongyloidiasis a neglected tropical disease is known to cause severe disease among immunosuppressed and has not been studied extensively in Sri Lanka. Parasitological diagnostic approaches based on faecal microscopy and culture often fail to detect low-intensity infections. This study investigates the presence of strongyloidiasis among selected immunocompromised individuals using parasitological, molecular and serological techniques.METHODS Adult patients with immunocompromising conditions admitted to three tertiary care hospitals in Sri Lanka were recruited. A faecal sample and 2 ml of venous blood were collected. The faecal samples were subjected to direct faecal smear and cultures (agar plate, charcoal and Harada-Mori) and polymerase chain reaction (PCR) using species specific primers designed for Strongyloides stercoralis. The presence of Strongyloides IgG antibodies was tested in the collected serum samples using DRG Strongyloides IgG enzyme-linked immunosorbent assay (ELISA) kits. The PCR products of the positive samples were sequenced using Sanger sequencing method.RESULTS A total of 260 patients were recruited to this study, out of which 160 provided faecal samples and 122 provided blood samples. Out of the 160 faecal samples, none were positive for strongyloidiasis by direct smear, charcoal and Harada-Mori cultures. Only one sample (0.6%) was positive by agar plate culture. Out of the 123 samples subjected to PCR, 14 (11.4%), including the culture positive patient, were positive for S. stercoralis. Sequencing results of the PCR products indicated 100% similarity to S. stercoralis. Out of the 122 serum samples subjected to ELISA, 20 (16.4%), including the culture positive patient, were positive for Strongyloides IgG antibodies. However, sociodemographic, exposure factors, clinical features were not significantly associated with the presence of strongyloidiasis infection.CONCLUSIONS Strongyloidiasis is present among the immunocompromised population in Sri Lanka, even in the absence of a significant relationship with associated factors. It is advisable to screen such patients with highly sensitive tests such as PCR for early diagnosis and treatment.Item Incidental diagnosis of strongyloidiasis in a patient with hepatic metastasis(Sri Lankan Society for Microbiology, 2023) Weerasekera, C.J.; Menike, C.W.; Anpahalan, J.P.; Senevirathne, S.A.A.; Perera, N.; de Silva, N.R.; Wickremasinghe, D.R.Strongyloides stercoralis is a soil-transmitted helminth infecting humans that can cause hyperinfection and disseminated disease in the immunocompromised host. This case report describes a 56-year-old patient, diagnosed with hepatic metastasis, who was screened for strongyloidiasis by faecal culture. The agar plate culture became positive on the third day of incubation, demonstrating characteristic tracks and yielding rhabditiform larvae. The charcoal and Harada-Mori cultures were negative. The patient was treated with albendazole for 7 days but declined further follow up.Item Medical students' perception and attitudes on operating theatre learning experience in Sri Lanka(Elsevier, 2023) Wijesinghe, K.; Lunuwila, S.; Gamage, H.; Gooneratne, T.; Munasinghe, B.N.L.; Harikrishanth, S.; Nandasena, M.; Perera, N.; Jayarajah, U.OBJECTIVE: The operating room is a unique learning experience that has visual, aural, kinesthetic learning stimuli and provides benefits to the medical students such as development of sound clinical knowledge and skills, and gaining personal insight into ones' career choice. However, this can be a challenging place due to the unfamiliar learning environment. We aimed to study the Sri Lankan Medical students' perception and attitudes on operating theatre learning experience. DESIGN AND SETTING: A descriptive cross-sectional survey was carried out among medical students undergoing surgical clinical training on the perspectives of the teaching and learning experience in the operating theatre in Sri Lanka. PARTICIPANTS: Our study group consisted of 390 medical students from four different medical faculties in Sri Lanka representing all levels of surgical clinical rotations. RESULTS: A majority of the students had actively participated in the operating theater. Despite this, the students' clarity of the learning outcomes and expectations in a theatre varied greatly. Majority of the students felt that the surgeons were willingly to teach but also noted that there was no standardization in teaching. This study clearly shows a significant correlation between positive emotions and surgical teams welcoming attitude towards the medical students. Long standing hours were considered a negative emotion by a majority of students. We also observed that theatre environment can be physically and mentally exhausting. CONCLUSIONS: Thus, empathy, feeling welcome and giving breaks to refresh can go a long way in making the learning experience better. Regular feedback to trainers on students' perception of the theatre experience is important to value the students' opinion and improve the quality of the surgical theatre. We strongly recommend initiation of clear induction sessions with introduction of well-structured teaching learning activities in the operating theatre.Item Meta-analysis of global variations in grade of pT1 urothelial bladder cancer and supplementary evaluation of a Sri Lankan cohort(The College of Surgeons of Sri Lanka, 2022) Malalasekera, A.P.; Ediriweera, D.; Goonewardena, S.; Perera, N.; Abeygunasekara, A.; Jayasekara, R.W.; Wettasinghe,T.K.; Dissanayake,V.H.W.D.; Lokuhetty, M.D.S.Introduction Bladder cancer grading is fraught with ambiguity. We aimed to conduct a meta-analysis of grading of pT1 urothelial cancers and assess histopathology and outcomes in a Sri Lankan pT1 bladder cancer cohort. Patients and Method A meta-analysis of grading of pT1 urothelial cancers was conducted as per PRISMA guidelines. A second metaanalysis of the proportion of pTa/NMIBC at disease presentation was conducted to assess impact of delayed presentation on grading. Analysis was supplemented with data from a cohort of Sri Lankan patients. Results In the meta-analysis, the overall pooled pT1 HG prevalence was 75.3% [95% CI:68.3%-81.7%]. The pT1 HG prevalence was significantly higher (p=4.916878e-11) among the European, Japanese and Taiwanese studies at 90.1% [95% CI: 85.3%-94.0%] compared to the rest of the countries at 56.1% [95% CI:46.5%-65.4%]. The overall pooled pTa/NMIBC prevalence was 44.2% [95% CI:36.4%-52.1%]. The pTa/NMIBC percentage among Europe, China and Taiwan was 66.9%[95% CI:62.4%-71.2%] and it was 37.6% [95% CI:29.0%-46.6%] in Turkey and other Asian countries indicating a significant difference(P=1.08e-08). In the Sri Lankan cohort of 66 enrolled patients, 31(47%) had pT1, of which 61% were low-grade (LG). The 5-year progressionfree survival (PFS) of pT1 was 60.9%. In LG it was 85.7% and 22.2% in high-grade (HG) (P = 0.0006). Conclusion There is a global variation of percentages of pT1 LG versus HG disease in bladder cancer specimens at presentation which could be attributed to delay in treatment with stage migration, ethnic variations in tumour biology, and interobserver variability in assigning a grade of tumour, and needs further study.Item Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol(BMJ Publishing Group Ltd, 2022) Rajapaksha, R.M.N.U.; Khatri, R.B.; Abeysena, C.; Wijesinghe, M.S.D.; Endalamaw, A.; Thomas, T.K.; Perera, N.; Rambukwella, R.; de Silva, G.; Fernando, M.; Alemu, Y.A.Introduction: Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic. Methods: The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar ETHICS AND DISSEMINATION: Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review's findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.Item Quality of care in the management of asthmatic children with regard to compliance with the guidelines in in-ward setting in a district of Sri Lanka: a descriptive study(College of Community Physicians of Sri Lanka, 2020) Abeysena, C.; Perera, N.INTRODUCTION: The quality of paediatric asthma management in the in-ward settings has not been assessed in Sri Lanka. OBJECTIVES: To describe the quality of care in the management of asthmatic children with regard to compliance with the guidelines. METHODS: A descriptive cross-sectional study was carried out in state hospitals with paediatric units in a district of Sri Lanka. A sample of 577 children diagnosed by a consultant paediatrician was selected. Eleven indicators were chosen by modified Delphi technique. Data collection instruments were an interviewer-administered questionnaire and a record sheet. Compliance with guidelines according to 11 indicators was expressed in percentages. RESULTS: The assessment of acute severity was 100%. The use of systemic corticosteroid at first prescription was 88.9% (n=513), whereas it was 69% (n=398) with oral steroid therapy and 54.5% (n=315) with long-term use of steroid inhaler. Assessment of chronic asthma severity was 31.2% (n=180). Caregivers who had received health education on triggering factors of asthma, on what to do during an asthma attack, and how to use the inhaler were 62.0% (n=358), 37.1% (214) and 68.8% (n=217), respectively. All patients have been issued a diagnosis card on discharge and among them, 74.4% (n=429)received a complete discharge summary and 90.6% (n=523) were scheduled for follow up appointments. CONCLUSIONS: Assessment of acute severity of asthma and the provision of diagnosis card on discharge were exceptional. Assessment of the severity of chronic asthma and providing health education for caregivers should be improved. Prescribing long term use of a steroid inhaler is to be revised. KEYWORDS: Children, Clinical, Indicators, Medication, PerformanceItem Knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to paediatric wards in Gampaha District.(College of Community Physicians of Sri Lanka., 2019) Perera, N.; Abeysena, C.INTRODUCTION: Asthma is considered to be one of the major public health problems. The accurate knowledge of caregiver on asthma is important for the management. OBJECTIVES: To describe the knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to the paediatric wards in the district of Gampaha. METHODS: A descriptive cross-sectional study was carried out among 577 caregivers of inward asthmatic children. Pre-tested interviewer- and self-administered questionnaires were used to assess the knowledge on asthma. The grand score of knowledge on asthma was calculated out of 34. The 75th percentile value was considered to differentiate ‘good’ knowledge from ‘poor’ knowledge. Multiple logistic regression was applied to determine the factors associated with poor knowledge on asthma. Results were expressed in adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS: The mean score for knowledge on asthma was 20.6 (SD=4.42) ranging from 7 to 30. Among the caregivers, 369 (64%) had poor knowledge on asthma. Low educational level of the caregiver (aOR=2.48; 95% CI=1.59, 3.86) and being under prophylaxis treatment for less than one year (aOR=2.49; 95% CI=1.50, 4.13) were the determinants of poor knowledge on asthma. CONCLUSIONS: Majority of the caregivers’ knowledge on asthma was poor. The caregivers’ low educational level and shorter duration of prophylaxis treatment for the children were associated with poor knowledge on asthma.Item Effectiveness of providing health education to caregivers of hospitalized children with asthma for the prevention of recurrent attacks: a quasi-randomized trial(Informa Healthcare, 2020) Perera, N.; Abeysena, C.OBJECTIVE: To determine the effectiveness of health education intervention for caregivers of children with asthma, focused on preventing recurrent attacks and improving knowledge. METHODS: A quasi-randomized trial of 177 caregivers of asthmatic children was conducted in government hospitals in a district of Sri Lanka. At the time of discharge from the hospital, a health education booklet was prepared and given to the caregivers in the intervention group, along with individual explanation and discussion. The caregivers' knowledge of asthma and preventive practices was assessed. The primary outcome was the proportion of children with recurrent attacks of asthma who needed doctor visits during the three month post discharge period. The intention-to-treat principle was applied for data analysis.RESULTS: In comparison to the control group, the intervention group had a 76% significant reduction in visits to the doctor for recurrent attacks (95% CI:45%-90%) and a 75% significant reduction in hospital admissions required for asthmatic children (95% CI:16%-93%) at the end of three months of intervention. The mean score of knowledge of asthma in the intervention group was 1.73 units higher at three months (p < 0.01) and 1.47 units higher at six months (p < 0.01) than the control group. The mean score of preventive practices for asthma in the intervention group was 1.25 units higher at three months (p = 0.02) and 1.15 units higher at six months (p < 0.01) versus the control group.CONCLUSION: Health education intervention significantly decreased doctor and hospital visits at three months. In addition, caregiver knowledge of asthma and preventive practices also improved. TRIAL REGISTRATION NUMBER: SLCTR/2010/007.Item Predictive value of persistent NS1 antigen positivity beyond 3rd day for dengue haemorrhagic fever in Sri Lankan children.(London : Biomed Central, 2019) Manamperi, M.; Jayamanne, B. D. W.; Somaratne, T.; Perera, N.; Fernando, L.OBJECTIVE:Dengue haemorrhagic fever (DHF) is a major public health concern responsible for significant morbidity in both adult and paediatric populations in Sri Lanka. This study examined if persistent non structural protein 1 (NS1) antigen positivity beyond day 3 was predictive of the occurrence of dengue haemorrhagic fever. The patients were followed up during their in-hospital stay and the severity of the illness was classified according to the WHO classification. The NS1 antigen test was repeated after day 3 of the onset of illness, at least 2 days after the initial test. RESULTS: One hundred and fifty-seven patients were enrolled. Persistent NS1 antigen test positivity after day 3 of the illness was not predictive of subsequent development of DHF. Out of multiple other demographic and illness related factors assessed, only having a secondary dengue infection was associated with a high risk of DHF (relative risk = 3.077, 95% CI 1.361, 6.954). Persistent NS1 positivity on day 3 may not be indicative of disease severity. However results need to be confirmed by a larger study with quantitative NS1 testing.Item Evaluating an AAC training for special education teachers in Sri Lanka,a low- and middle-income country.(Taylor & Francis, 2018) Muttiah, N.; Drager, K. D. R.; McNaughton, D.; Perera, N.A majority of people with disabilities live in low- and middle-income countries where communication services for individuals with complex communication needs are scarce. It is essential that communication partners of individuals who have complex communication needs receive training to support communication. To address this issue, the current study evaluated an augmentative and alternative communication training for special education teachers living in a low- and middle-income country, Sri Lanka. The training was based on four key practices identified when training in low- and middle-income countries: investigate learner needs, provide contextually relevant instructional content, use engaging instructional activities, and assess the impact of instructional activities. This investigation implemented an interrupted time-series design with nine teacher-student dyads. Special education teachers were taught to provide evocative communication opportunities. Following the training, all nine special education teachers significantly increased the number of evocative communication opportunities provided to students with complex communication needs. Additionally, all nine students with complex communication needs significantly increased their number of communication turns.