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 Effect of virgin coconut oil supplementation on cognition of individuals with mild-to-moderate alzheimer's disease in Sri Lanka (VCO-AD study): A randomized placebo-controlled trial(IOS Press, 2023) Fernando, M.G.; Silva, R.; Fernando, W.M.A.D.B.; de Silva, H.A.; Wickremasinghe, A.R.; Dissanayake, A.S.; Sohrabi, H.R.; Martins, R.N.; Williams, S.S.BACKGROUND: Virgin coconut oil (VCO) is a potential therapeutic approach to improve cognition in Alzheimer’s disease (AD) due to its properties as a ketogenic agent and antioxidative characteristics. OBJECTIVE: This study aimed to investigate the effect of VCO on cognition in people with AD and to determine the impact of apolipoprotein E (APOE) ɛ4 genotype on cognitive outcomes. METHODS: Participants of this double-blind placebo-controlled trial (SLCTR/2015/018, 15.09.2015) were 120 Sri Lankan individuals with mild-to-moderate AD (MMSE = 15-25), aged > 65 years, and they were randomly allocated to treatment or control groups. The treatment group was given 30 mL/day of VCO orally and the control group, received similar amount of canola oil, for 24 weeks. The Mini-Mental Sate Examination (MMSE) and Clock drawing test were performed to assess cognition at baseline and at the end of the intervention. Blood samples were collected and analyzed for lipid profile and glycated hemoglobin (HbA1 C) levels.∥ RESULTS: There were no significant difference in cognitive scores, lipid profile, and HbA1 C levels between VCO and control groups post-intervention. The MMSE scores, however, improved among APOE ɛ4 carriers who had VCO, compared to non-carriers (2.37, p = 0.021). APOE ɛ4 status did not influence the cognitive scores in the control group. The attrition rate was 30%.∥ CONCLUSION: Overall, VCO did not improve cognition in individuals with mild-to-moderate AD following a 24-week intervention, compared to canola oil. However, it improved the MMSE scores in APOE ɛ4 carriers. Besides, VCO did not compromise lipid profile and HbA1 C levels and is thus safe to consume.Item Pharmacoeconomics amidst a financial crisis(Sri Lanka College of Psychiatrists, 2023) Williams, S.S.; Medagedara, A.U.; de Silva, H.A.Cost effective strategies must be implemented amidst an economic crisis in Sri Lanka to mitigate ever increasing medicinal costs. Exploration of measures such as evidence based generic prescribing, cost effectiveness analysis, value-based pricing, identification of low cost, high value medication and being sensitive to the ability of the patient to purchase medicine is a necessity. Clinicians must be sensitised to this issue to contribute actively to the process. Policies in line with pharmacoeconomic realities must be pursued.Item Unconfirmed death as a predictor of psychological morbidity in family members of disappeared persons(Cambridge University Press, 2019) Isuru, A.; Hewage, S.N.; Bandumithra, P.; Williams, S.S.BACKGROUND: The 2004 tsunami, the civil conflict until 2009 and the youth insurrection in the late 1980s in Sri Lanka resulted in many persons being classified as 'missing' as they disappeared and were unaccounted for. Our aim was to compare the prevalence of major depressive disorder (MDD) and prolonged grief disorder (PGD) in families of disappeared individuals, who eventually received the mortal remains and those who did not. METHOD: An ethically approved cross sectional study was conducted in a purposively selected sample after informed consent. Information on the circumstances of the family member going missing was gathered. Culturally adapted versions of the General Health Questionnaire and the Beck Depression Scale were administered. Those who screened positive were assessed by a psychiatrist on Diagnostic and Statistical Manual of Mental Disorders-5 criteria to arrive at a diagnosis. RESULTS: Of 391 cases of disappearances studied, MDD (17.5% v. 6%) and PGD (22% v. 7%) were significantly higher in those who did not eventually receive the mortal remains of the disappeared person. Among those who did not receive the mortal remains, being unsure whether the disappeared person was dead or alive was highly predictive of MDD and PGD. Mothers and wives, older family members and those with a family history of mental illness were more vulnerable. CONCLUSIONS: Family members of missing individuals unsure whether their loved one was alive or dead have higher psychological morbidity in the form of MDD and PGD.Item Delayed psychological morbidity associated with snakebite envenoming(Public Library of Science, 2011) Williams, S.S.; Wijesinghe, C.A.; Jayamanne, S.F.; Buckley, N.A.; Dawson, A.H.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION: The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied. OBJECTIVES: To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims. METHODS: The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming. RESULTS: Previous snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p<0.001) and Hopkins Symptoms Checklist (38.9 vs. 28.2; p<0.001). 48 (54%) cases met criteria for depressive disorder compared to 13 (15%) controls. 19 (21.6%) cases also met criteria for PTSD. 24 (27%) claimed that the snakebite caused a negative change in their employment; nine (10.2%) had stopped working and 15 (17%) claimed residual physical disability. The themes identified in the qualitative arm included blindness, tooth decay, body aches, headaches, tiredness and weakness. CONCLUSIONS: Snakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economic and social impacts of this problem need further investigationItem A Study of intimate partner violence among females attending a Teaching Hospital out-patient department(Sri Lanka College of Psychiatrists, 2010) Kuruppuarachchi, K.A.L.A.; Wijeratne, L.T.; Weerasinghe, G.D.S.S.K.; Peiris, M.U.P.K.; Williams, S.S.BACKGROUND: Intimate partner violence (IPV) is considered a public health problem with physical and psychological consequences. AIMS: To describe the prevalence of IPV among married females attending the out-patient department of North Colombo Teaching Hospital and their attitude towards abuse. METHODS: A pre-tested self-administered questionnaire on physical, verbal, sexual and emotional abuse was given to the first 50 consenting married females attending the out-patient department on each day for five consecutive days. Confidentiality of responses was assured and adequate privacy was provided for the questionnaires to be completed. RESULTS: Of the 242 participants 98(40.5%) reported some form of abuse by their male partner. Prevalence of abuse reported was physical abuse 19%, verbal abuse 23%, emotional abuse 23% and sexual abuse 7%. A quarter (26.9%) of those inflicted physical violence sought medical treatment for the injuries but only two of them divulged the reason for the injury to medical staff. More than three quarters (79%) of those abused were in the relationship for more than ten years. The majority of the females surveyed believed that violence by the male partner should be tolerated. CONCLUSIONS: IPV is a common problem that is poorly divulged to medical personnel. Attitudes regarding IPV have to be changed in order to reduce abuse significantly.Item Olifactory impairment is more marked in patients with mild dementia with Lewy bodies than those with mild Alzheimer disease(BMJ Publishing Group, 2009) Williams, S.S.; Williams, J.; Combrinck, M.; Christie, S.; Smith, A.D.; McShane, R.BACKGROUND: Dementia patients with anosmia are more likely to have Lewy body pathology at postmortem, but clinicopathological studies have only assessed olfaction in moderate dementia or an average of 5 years before death. It is not known whether, in patients with mild dementia (MMSE score over 20), olfactory function is more impaired in Alzheimer disease (AD) than dementia with Lewy bodies (DLB). METHODS: Patients with mild DLB (n = 21), mild AD (n = 27), mild cognitive impairment (MCI) (n = 21) and controls (n = 47) were assessed using a 16-item olfactory identification test and an olfactory threshold test which used sticks impregnated with differing concentrations of butanol. RESULTS: Patients with mild DLB had impaired olfactory identification ability compared with those with mild AD or MCI, independent of age, cognitive function and sex. The sensitivity of a cutoff score of seven correct responses out of 16 was 0.81 for distinguishing mild DLB from mild AD (AUC 0.682). The specificity, positive predictive value and negative predictive value for the same cut-off score were 0.41, 0.48 and 0.73, respectively. The olfactory threshold was not different in the AD and DLB groups. CONCLUSIONS: Simple bedside tests of olfactory identification merit further examination for their potential to improve the identification of patients with DLB when used alongside existing criteria. They are insufficiently specific for use in screening.Item Trichotillomania(Sri Lanka Medical Association, 2004) Williams, S.S.; Peiris, M.U.P.K.No Abstract AvailableItem Delusional parasitosis(Sri Lanka Medical Association, 2003) Kuruppuarachchi, K.A.L.A.; Williams, S.S.No Abstract AvailableItem Betel use and schizophrenia.(Royal College of Psychiatrists, 2003) Kuruppuarachchi, K.A.L.A.; Williams, S.S.Comment on: McCreadie RG, Scottish Comorbidity Study Group. (Br J Psychiatry. 2002; 181:321-5).No abstract available.Item Psychiatry and media(Royal College of Psychiatrists, 2003) Kuruppuarachchi, K.A.L.A.; Williams, S.S.Comment on: (Psychiatric Bulletin, 2003, 27, 123-125). No Abstract Available