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 The establishment of a population-specific reference value for the ruler drop test for the clinical assessment of reaction time(Elsevier, 2023) Rajapaksha, S.; Kitulwatte, I.; Senarathne, U.; Edirisinghe, A.; Perera, P.BACKGROUND: Reaction time (RT) is the interval between a stimulus and an appropriate voluntary response in an individual. Alcohol is known to result in delayed RT. In Sri Lanka, an alleged drunken driver is legally subjected to a medico-legal examination to confirm or exclude impairment. The guideline for examining a drunk person in Sri Lanka includes the ruler drop test (RDT) as a test of RT. RDT is a simple test of visual reaction time in which the subject attempts to stop a falling ruler, and the height fallen is used to determine the time taken to react to the event. However, a formal study has yet to be carried out to establish population-specific reference values to interpret RDT results. METHODS: A cross-sectional descriptive study was conducted using 903 adults ≥18 years. A nonparametric approach was applied for deriving the reference values based on an inter-percentile interval. RESULTS: The study population consisted of 56.6% females, and the mean age of the participants was 41.6 years. Most (95%) of the study population could catch the ruler at or less than 40.0 cm of average height. The average height on RDT increased from younger to older age groups. However, subgrouping based on other variables, including sex, age, and alcohol consumption, did not show any statistically significant difference. CONCLUSIONS: The population-specific cut-off limit to identify alcohol intoxication by RDT in a Sri Lankan adult is 'average height' >40 cm.Item Effects of indoor air pollution on the development of children under five years of age in Sri Lanka(MDPI, 2022) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.Air pollution is a multifaceted environmental toxin affecting the Central Nervous System (CNS) through diverse pathways. The CNS of young children is particularly susceptible to the detrimental effects of toxins, as brain development continues postnatally with the formation of interneuronal connections, glial cell proliferation and myelination of axons. Indoor air pollution (IAP) from solid fuel combustion is more harmful than outdoor air pollution. Numerous air pollutants hazardous to health are released during the burning of unprocessed biomass. The primary source of fuel in Sri Lanka for cooking is biomass, mainly wood. In this study, we evaluated the influence of IAP resulting from biomass combustion on the neurodevelopment of children. In a cohort of children under five years living in a semi-urban area of Sri Lanka, neurodevelopment was assessed using Denver II developmental screening test. Air quality levels were measured (Carbon Monoxide (CO) and Particulate Matter 2.5 (PM2.5)) in a subsample. There were significantly high levels of CO and PM2.5 in the ambient air of households using biomass as the primary fuel for cooking. Children living in these households had a significantly higher number of children with ‘suspect’ developmental assessment scores in the language, social behavior and play and gross motor development domains.Item Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study(Public Library of Science, 2021) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, A.R.ABSTRACT: Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. "High" exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the "high" exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the "low" exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.Item Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka.(BioMed Central, 2019) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.BACKGROUND:Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. METHODS: A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. RESULTS: Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. CONCLUSION: The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.Item Moving from oral poliovirus vaccine to inactivated poliovirus vaccine in Sri Lanka: The rationale and challenges(Sri Lanka College of Paediatricians, 2017) Perera, P.Item Accuracy of measuring axillary temperature using mercury in glass thermometers in children under five years: a cross sectional observational study(Scientific Research Publishing Inc, 2014) Perera, P.; Fernando, M.; Mettananda, S.; Samaranayake, R.BACKGROUND: Measuring axillary temperature with mercury in glass thermometers is continued in clinical practice though there are many limitations. This is mainly due to convenience and cost. This study was conducted to ascertain the accuracy of measuring axillary temperature with mercury thermometers in preschool children. METHODS: Axillary temperature was measured in 250 preschool children using standardized mercury thermometers. Time taken to record the final temperature and its correlates were assessed. RESULTS: Time taken to record the final temperature extended up to six minutes. This duration varied according to age, body mass index and body temperature, but a significant variation was noted only with age. CONCLUSIONS: Measuring axillary temperature with mercury thermometers is subjected to error. They need to be replaced with suitable alternatives.Item Pattern of physical growth during first six months of life among a cohort of babies living in Gampaha district, Sri Lanka(2013) Perera, P.; Fernando, M.; Mettananda, S.; Samaranayake, R.Introduction: Current WHO recommendation is to continue exclusive breast feeding (EBF) up to six months. Main concern regarding this recommendation is, whether EBF supports rapidly growing infant with adequate nutrition. Methods: A cohort of randomly selected new-borns was followed up at two, four and six months, to study feeding pattern and physical growth. Feeding practices and socio-demographic data were collected using an interviewer administered questionnaire. Weight & length were measured using standard techniques. Results: EBF rates were very high in this cohort of children. One main reason to stop EBF was growth faltering. Only some children showed a catch up growth by stopping EBF. At two, four and six months, weight faltering rates among EBF babies were, 11.1%, 20.1% and 13.2% respectively. Length faltering had a similar pattern, but with a higher rate at all ages. Conclusions: EBF up to six months did not cause growth faltering in the majority. In the majority, no identifiable cause for growth faltering was found. Possible genetic influence on growth faltering was not considered when stopping EBFItem A Sri Lankan infant with vaccine associated acute flaccid paralysis(Sri Lanka Medical Association, 2012) Perera, P.; Mettananda, S.No Abstract AvailableItem Constipation and functional faecal retention in a group of school children in a district in Sri Lanka(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.; Mettananda, S.; Perera, P.; Jasmin, S.; Karunarathna, U. A.; Adihetti, D.; Goonewardena, R.OBJECTIVE: To assess the prevalence of constipation and functional faecal retention among a group of school children in Gampaha district of Sri Lanka. METHOD: This is a cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in a semi-urban school in Gampaha District of Sri Lanka. Constipation was defined using Rome III criteria and Paris Consensus on Childhood Constipation Terminology (PACCT). Functional faecal retention was diagnosed using Rome II criteria. RESULTS: A total of 441 questionnaires were distributed and 429 (97.3%) responded (53.1% males, mean age 12.4 years, SD 1.5 years). According to Rome III criteria and PACCT, 46 (10.7%) had constipation. Prevalence of constipation was higher in males (14.5%) compared to females (6.5%) [OR 2.45, 95% CI 1.19-5.1, p=0.012]. Twenty three (5.4%) had functional faecal retention. CONCLUSIONS: Chronic constipation is a significant problem, affecting approximately 10% of children in a semi-urban school in Gampaha district. It is commoner among males. Both Rome III criteria and PACCT are effective in diagnosing childhood constipation in epidemiological studiesItem A Pilot study on assessment of racial affinity of Sri Lankan population using discriminant function statistics and a few established morphological racial traits(Elsevier Science Ireland Ltd, 2009) Perera, P.; Pathmeswaran, A.Determination of racial affinity was not considered in investigations of unidentified bones in Sri Lanka until recently. Post-Tsunami exhumation of mass graves to identify Japanese and Europeans tourists highlighted the lack of anthropological data to separate them from Sri Lankans. OBJECTIVE: The objective of this study is to determine the racial affinity of the Sri Lankan population using few well documented anatomical traits and Giles and Elliot's discriminant function analysis. METHODOLOGY: Following measurements were obtained from 38 skulls. Basion-Prosthion length, Maximum length, Maximum breadth, Basion-Bregma height, Basion-Nasion height, Bizygomatic breadth, Prosthion-Nasion height and Nasal breadth. RESULTS: Giles and Elliot (1963)'s discriminant functions developed to determine ancestry were used. In addition, few well-established morphological racial traits were also observed. Separate discriminant functions developed by Giles and Elliot to differentiate American white skulls from black skulls and white skulls from native Indian skulls were used. Five skulls had the measurements of blacks and another five had the measurements of Native Americans. The rest had measurements of American whites. 24 skulls had 'medium' (intermediate triangle) nasal openings. Nasal root contour was low to moderate in height (tented) in 22 skulls. Nasal spine was small in 31 skulls and nasal sill was blurred in 27 skulls. CONCLUSION: Discriminant functions developed by Giles and Elliot identified the majority of skulls in this study as belong to Caucasians but only few skulls had obvious Caucasian morphological traits. However, there were few skulls showing clear Negroid and Mongoloid morphological features. Finally this study showed that the formulae developed by Giles and Elliot can be used to differentiate Sri Lankan skulls from those of American Indians and Blacks.