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 Diagnostic overlap between adolescent affective instability in borderline personality and juvenile bipolar disorder in Sri Lanka(Sri Lanka College of Psychiatrists, 2019) Chandradasa, M.; Fernando, W.K.T.R.; Kuruppuarachchi, K.A.L.A.Borderline personality disorder (BPD) and bipolar disorder (BD) could present a diagnostic challenge in the adolescent due to the presence of overlapping symptoms such as impulsivity, affective instability, and sexual arousal. Of these symptoms, affective instability is a central feature of BPD, and there is a rapid shift from the neutral affect to an intense affect, and this is associated with a dysfunctional modulation of emotions. We describe three Sri Lankan adolescents presenting with affective instability, treated with psychopharmacological agents as for BD. While BPD is characterized by transient mood shifts induced by interpersonal stressors, in BD, there are sustained mood changes. A longitudinal assessment of the symptomatic profile and collateral information clarified the diagnosis as being BPD. An examination of the nature of affective instability is vital for a proper diagnosis and provision of evidence-based treatment.Item Recurrence of pseudocyesis in rural Sri Lanka(SAARC Psychiatric Federation, 2015) Perera, S.R.; Pathiraja, P.D.M.; Ranaraja, A.G.S.K.; Abeyasinghe, D.R.R.No abstract availableItem Charles Bonnet syndrome(SAARC Psychiatric Federation, 2015) Dissanayake, D.M.R.M.; Hewarathne, A.; Wijesinghe, C.A.; Amarasinghe, B.; Williams, S.S.A 41 year old married labourer presented with complex visual hallucinations for six months. He had reduced visual acuity, a subluxated lens, and two retained sutures from a previous surgery of the right eye and complete blindness of the left eye. His mental, physical and neurological examinations were unremarkable. Surgical correction of his visual impairment resulted in resolution of symptoms.Item Unusual presentations of reflex epilepsy in psychiatric practice: A case series(SAARC Psychiatric Federation, 2015) Kuruppuarachchi, K.A.L.A.; Kapugama, K.G.C.L.; Wijesinghe, C.A.No abstract availableItem Making psychotherapy culturally relevant to South Asia: Burden of mental illnesses in South Asia(SAARC Psychiatric Federation, 2015) Rodrigo, A.No abstract availableItem Proximal and distal rectal cancers differ in curative resectability and local recurrence(Baishideng Publishing Group, 2011) Wijenayake, W.; Perera, M.; Balawardena, J.; Deen, R.; Wijesuriya, S.R.; Kumarage, S.K.; Deen, K.I.AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19- 88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum - those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without preoperative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour- free margins, resection with a tumourfree circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.Item Training undergraduates in general practices: student perceptions(the Health, 2014) Ramanayake, R. P. J. C; de Silva, A.H.W.; Perera, D. P.; Sumanasekera, R. D. N.; Athukorala, L. A. C. L.; Fernando, K.A.T.Item Student perceptions of an online post graduate course in family medicine in Sri Lanka(Health Informatics Society of Sri Lanka, 2010) de Silva, R.E.E.; Fernando, J.; Sumanasekera, R.D.N.; Liyanagama, S.D.; de Silva, D.P.BACKGROUND: The online Diploma course in Family Medicine (DFM) of the Post Graduate Institute of Medicine (PGIM) of the University of Colombo is one of the pioneering online post graduate medical courses in Sri Lanka.OBJECTIVES : To describe student perceptions on the online DFM course.METHODS : The study population comprised of all the students (19) of the first batch of the course. Pre- tested self administered questionnaires were administered to all students. A Likert scale was used to assess the domains of teaching, learning, levels of understanding, and technical problems. The scale ranged from 1= ["poor / not useful/did not understand"] to 5= ["excellent/ very useful/ understood very well"]. A focus group discussion was carried out to strengthen the student perceptions, based on the themes which emerged.RESULTS : Response rate was 98.4%. Levels of understanding the lessons were perceived to be high with an average of 4.8. Students were of the opinion that discussions and assignments helped them to engage in active learning. Online discussions were found to be the most useful form of learning. 88% commented that they are able to link clinical work to their online course work.CONCLUSIONS : This online course has been useful in improving student knowledge and the levels of understanding of individual lessons are satisfactory. The most useful form of learning appeared to be online discussionsItem Domain-Specific learning among medical students(Basic Medical Scientists Association, 2012) Perera, D.; Ramanayake, R.P.J.C.; de Silva, A.H.W.; Sumanasekara, R.D.N.; Jayasinghe, L.R.; Gunasekara, R.; Chandrasiri, P.Background: The aim of this study was to investigate undergraduate medical student’s domain-specific learning. Method: The research tool was a structured essay question formulated to assess factual and affective knowledge and application and synthesis of knowledge .The question was administered to 151 students. Results: Mean score on the recall question was significantly higher than the other two domains. Total scores of female students were significantly higher than male students (P<0.05). Gender-wise difference in scores was not significant in any specific domain area. There was no significant relationship between factual knowledge and total scores. However, there was a significant linear relationship between total scores and the two areas of affective knowledge (r=0.78) and application and synthesis of knowledge (r=0.6). Findings indicate that affective knowledge and application of knowledge are closely related to overall acquisition of knowledge (P<0.0005). Conclusion: Teaching and assessment in higher-order knowledge domains and affective knowledge needs to be developed. Questions dealing with affective knowledge and testing higher-order cognitive abilities are more discriminatory than questions testing at the recall level.Item Referral letters from general practitioners to hospitals in Sri Lanka; lack information and clarity(mediWORLD International, 2013) Ramanayake, R. P. J. C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R. D. N.; Jayasinghe, L.R.; Fernando, K. A. T.; Athukorala, L. A. C. L.BACKGROUND: Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. In many instances the referral letter is the sole means of communication between general practitioners (GPs) and specialists/hospital doctors. This study was planned to assess the quality of referral letters sent by general practitioners to out patient departments (OPD) of hospitals. METHODOLOGY: This descriptive cross sectional study was conducted in four hospitals of different levels of care provision in Sri Lanka. Referral letters received by the OPDs during a period of 2 weeks were analyzed. A check list to extract data was developed based on the items of information expected in a referral letter and legibility. Each item was assigned a score. This scoring system was validated using a panel of experts by means of Delphi method. Maximum score possible for a letter was 30. RESULTS: A total of 461 letters were analyzed. Items of information most often present were; to whom referred (96.7%), symptoms (91.5%), reason for referral (90.2%) and date (88.9%). The least often present items were; family history (0.2%), history of allergy (1.1%) and social history (1.7%). Most of the words were not legible in 42.3% of the letters. Median score of the sample was 16 (mean=15.69) Mean score of structured form letters was 18.61 (n=33) and in conventional letters it was 15.53 (n=428). The observed difference was statistically significant (z=-3.544, p<0.01). DISCUSSION: Most of the letters did not have the required information and legibility was also poor. Expected benefits of a referral letter to the patient, recipient and the referring doctor will not be achieved due to these short comings. Form letters were comparatively better. Measures should be taken to improve the content and clarity of referral letters.