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 Effectiveness of a Calgary-Cambridge model-based communication skills training for paediatric trainees in Sri Lanka: A nationwide pre-post intervention study using observed practices(Elsevier, 2025-01) Dayasiri, K.; Krishnapradeep, S.; Caldera, D.; Wijayasinghe, H.; Mudiyanse, R.OBJECTIVE To evaluate the effectiveness of a Calgary-Cambridge model-based communication skills training program for postgraduate paediatric trainees in Sri Lanka.METHODS A pre-post intervention study was conducted among 133 paediatric trainees across Sri Lanka. The training program focused on relationship-building, information gathering, and information giving. Communication skills were assessed using an OSCE with simulated patients and a 12-item checklist. Paired t-tests were used to analyze score differences.RESULTS Significant improvements were observed across all domains. Relationship-building scores increased from 13.5 to 23, information gathering from 12.6 to 20.2, and information giving from 13.3 to 24.8 (p < 0.01 for all). Relationship-building correlated positively with information gathering (r = 0.626) and giving (r = 0.600, p < 0.01). Trainees with prior communication training scored higher post-intervention (mean difference = 10.5, p = 0.019). No gender differences were observed. CONCLUSION The Calgary-Cambridge model-based training program effectively enhanced communication skills among Sri Lankan paediatric trainees. PRACTICE IMPLICATIONS Incorporating structured communication skills training into postgraduate curricula is essential, particularly in culturally diverse medical settings.Item The impact of mummies on modern psychiatry(Elsevier, 2025-01) Khaled Elbarbary, K.; Shoib , S.; Chandradasa , M.; Saeed, F.No abstract availableItem Congenital titinopathy: comprehensive characterization of the most severe end of the disease spectrum(Wiley-Liss, 2025-01) Coppens, S.; Deconinck, N.; Sullivan, P.; Smolnikov, A.; Clayton, J. S.; Griffin, K. R.; Jones, K. J.; Vilain, C. N.; Kadhim, H.; Bryen, S. J.; Faiz, F.; Waddell, L. B.; Evesson, F. J.; Bakshi, M.; Pinner, J. R.; Charlton, A.; Brammah, S.; Graf, N. S.; Krivanek, M.; Tay, C. G.; Foulds, N.C.; Illingworth, M.A.; Thomas, N.H.; Ellard , S.; Mazanti , I.; Park , S.M.; French, C.E.; Brewster , J.; Belteki , G.; Hoodbhoy, S.; Allinson , K.; Krishnakumar , D.; Baynam , G.; Wood , B.M.; Ward, M.; Vijayakumar , K.; Syed, A.; Murugan , A.; Majumdar , A.; Scurr , I.J.; Splitt , M.P.; Moldovan , C.; De Silva, D.C.; Senanayake, K.; Gardeitchik, T.; Arens, Y.; Cooper, S.T.; Laing, N.G.; Raymond , F.L.; Jungbluth , H.; Kamsteeg , E.J.; Manzur , A.; Corley , S.M.; Ravenscroft , G.; Wilkins , M.R.; Cowley, M.J.; Pinese , M.; Consortium, T.R.; Phadke , R.; Davis, M.R.; Muntoni , F.; Oates, E.C.Congenital titinopathy has recently emerged as one of the most common congenital muscle disorders. OBJECTIVE To better understand the presentation and clinical needs of the under-characterized extreme end of the congenital titinopathy severity spectrum.METHODS We comprehensively analyzed the clinical, imaging, pathology, autopsy, and genetic findings in 15 severely affected individuals from 11 families.RESULTS Prenatal features included hypokinesia or akinesia and growth restriction. Six pregnancies were terminated. Nine infants were born at or near term with severe-to-profound weakness and required resuscitation. Seven died following withdrawal of life support. Two surviving children require ongoing respiratory support. Most cohort members had at least 1 disease-causing variant predicted to result in some near-normal-length titin expression. The exceptions, from 2 unrelated families, had homozygous truncating variants predicted to induce complete nonsense mediated decay. However, subsequent analyses suggested that the causative variant in each family had an additional previously unrecognized impact on splicing likely to result in some near-normal-length titin expression. This impact was confirmed by minigene assay for 1 variant.INTERPRETATION This study confirms the clinical variability of congenital titinopathy. Severely affected individuals succumb prenatally/during infancy, whereas others survive into adulthood. It is likely that this variability is because of differences in the amount and/or length of expressed titin. If confirmed, analysis of titin expression could facilitate clinical prediction and increasing expression might be an effective treatment strategy. Our findings also further-support the hypothesis that some near-normal-length titin expression is essential to early prenatal survival. Sometimes expression of normal/near-normal-length titin is due to disease-causing variants having an additional impact on splicing.Item Effects of Cinnamomum zeylanicum (Ceylon cinnamon) extract on lipid profile, glucose levels and its safety in adults: A randomized, double-blind, controlled trial(Public Library of Science, 2025-01) Muthukuda, D.; De Silva, C. K.; Ajanthan, S.; Wijesinghe, N.; Dahanayaka, A.; Pathmeswaran, A.BACKGROUND Cinnamon has been studied as a possible way to control blood glucose and serum cholesterol levels. However, there are no well-conducted randomized controlled trials that can accurately measure the lipid and glucose-lowering effects of Cinnamomum zeylanicum (C. zeylanicum) extract. This study primarily aimed to evaluate the effect of a standardized C. zeylanicum extract on serum low-density lipoprotein cholesterol (LDL-C) levels and secondarily on other lipid parameters (high-density lipoprotein cholesterol (HDL-C), total cholesterol and triglycerides), glucose levels, anthropometric measures, blood pressure, and safety outcomes in individuals with an LDL level between 100-190mg/dL.MATERIALS AND METHODS This was a randomized, double-blinded, placebo-controlled clinical trial. Participants were allocated to either C. zeylanicum extract or placebo group (1:1 allocation ratio). They were advised to take two capsules per day (1000 mg/day, a dose based on prior clinical studies suggesting potential efficacy and safety). Reduction in LDL-C at 12 weeks (from the baseline value) was compared between the two groups using ANCOVA. A complete-case analysis was adhered to in analyzing the outcome data.RESULTS The mean age (SD) of the 150 participants was 50.4 (10.52) years, and 66% were females. Among the 127 participants assessed at 12 weeks, those in the C. zeylanicum extract arm had a lower LDL-C value than the placebo arm but the difference was not significant (the baseline adjusted mean difference was 6.05mg/dL; 95% CI: -2.43 to 14.52; p = 0.161). However, participants in the C. zeylanicum extract group showed significantly greater reductions in fasting blood sugar (FBS) levels (the baseline adjusted mean difference was 8.59mg/dL; 95% CI: 0.59 to 16.59; p = 0.036). There was a significant interaction effect between the supplement and participants' glycemic status, with individuals with type 2 diabetes mellitus (T2DM) who received C. zeylanicum extract experiencing a notable reduction in FBS levels (standardized coefficient: -63, 95% CI: -102 to -25; p = 0.002).CONCLUSIONS C. zeylanicum extract did not have significantly reduce LDL-C but demonstrated a significant FBS-lowering effect, particularly in individuals with T2DM, with a favorable safety profile.Item Risk factors for low resilience among Grade 10 adolescents in the Gampaha district, Sri Lanka: a case-control study(BMJ Publishing Group, 2025-01) Manori, S.; Jayawardana, P. L.; Godamunne, P.OBJECTIVE Resilience means the ability to deal successfully with difficult situations, and hence low resilience will lead to many negative outcomes. The aim of this study was to explore risk factors for low resilience among Grade 10 adolescents in Gampaha district, Sri Lanka.METHODS Resilience levels and data related to putative risk factors were obtained by using a validated 14-Item Sinhala Resilience Scale and a questionnaire on putative risk factors (both of which were self-administered) from Grade 10 adolescents by conducting a descriptive cross-sectional study. There were 464 (33.6%) cases with low resilience (score=14-73) and 916 (66.4%) controls with high resilience (score=74-98). For the case-control study, the computed sample size for each case and control group was 128, who were selected by applying simple random sampling. Risk factors for low resilience were determined using bivariate and multivariable analyses by applying χ2 test and multivariable logistic regression. Results were expressed as ORs with respective 95% CIs.RESULTS Among the 33 putative risk factors analysed, 13 were found to be significant in bivariate analysis. In multivariable logistic regression analysis, out of 24 independent variables entered initially into the model, only 9 were retained in the final model. These comprised (1) one or both parents dead (AOR=2.5, 95% CI [1.2, 14.5]; p=0.032), (2) mother's low educational level (AOR=1.9, 95% CI [1.6, 3.8]; p=0.021), (3) sleep <8 hours (AOR=1.6, 95% CI [1.1, 3.8]; p=0.002), (4) having less than six close classmates (AOR=1.5, 95% CI [1.1, 4.3]; p=0.021), (5) not attending Sunday school (AOR=1.8, 95% CI [1.1, 10.6]; p=0.001), (6) being short-tempered (AOR=2.2, 95% CI [1.5, 3.6]; p=0.003), (7) having conflicts with friends (AOR=1.4, 95% CI [1.2, 7.5]; p=0.043), (8) not seeking help when confronted/facing with difficulties (AOR=1.6, 95% CI [1.2, 6.9]; p=0.032) and (9) lack of support from home when in need (AOR=1.6, 95% CI [1.2, 5.8]; p=0.001).CONCLUSION AND RECOMMENDATION Altogether nine risk factors were identified. Interventions focusing on risk factors ascertained should be developed and conducted regularly by the schools, targeting all adolescents of Grade 10 to boost their status of resiliencyItem Waiting times in the colorectal cancer treatment pathway in a Sri Lankan cohort: data from a specialised tertiary care setting(The College of Surgeons of Sri Lanka, 2025-01) Priyadarshanie, W. P. C. D.; Smaranayake, U. M. J. E.; Hansanie, S. M. N.; Geekiyanage, U.; Kumarage, S. K.; Chandrasinghe, P. C.INTRODUCTION Colorectal cancer (CRC) is the third most prevalent cancer in Sri Lanka, with rising incidence rates over the past decade. Timely intervention is essential for favourable outcomes, but prolonged waiting times remain a significant healthcare challenge globally. This study examines the time intervals between key steps in the CRC diagnostic and treatment pathway to identify potential areas for reducing delays. METHODS A cohort of 108 patients with suspected CRC symptoms, presenting to the University Surgical Unit at North Colombo Teaching Hospital from 2017 to 2024, was analysed. Data were collected on time intervals between: [1] symptom onset to primary care visit, [2] General Practitioner (GP) referral to specialist consultation, [3] specialist consultation to colonoscopy, [4] colonoscopy to imaging or neoadjuvant chemo-radiotherapy (NCRT), and [5] colonoscopy to surgery. Median times for each interval were calculated. RESULTS Of the 108 patients (36.1% male, median age 63), the median time from symptom onset to GPvisit was 11 weeks. Patients referred by GPs waited a median of 3 weeks for specialist consultation. Two-thirds underwent colonoscopy within 2 weeks of specialist consultation, with 78% completing it within 4 weeks. For patients not requiring NCRT, the median time from colonoscopy to surgery was 3.86 weeks; for those requiring NCRT, it was 12.86 weeks. CONCLUSIONS Waiting times for colonoscopy and curative surgery are within the accepted universal standards for colorectal cancer management, in this cohort. The delay in patient presentation to primary care was notably longer than physician-related delays. Early specialist referral for bowel symptoms may reduce time to diagnosis and treatment, aligning colonoscopy-to-treatment intervals with international standards.Item Awareness on malaria among healthcare providers and public during the prevention of re-establishment phase in Sri Lanka(European Society of Medicine, 2025-01) Hamsananthy, J.; Wickremasinghe, A.R.INTRODUCTION Prevention of re-establishment of malaria is a challenge for Sri Lanka due to the country’s high receptivity and importation risk. As imported malaria cases are being reported, awareness on malaria among both healthcare providers and the public is crucial to anticipate a resurgence and re-establishment of malaria in the country.OBJECTIVES The objective of this study was to assess the awareness on malaria among healthcare providers and the public during the prevention of re-establishment phase immediately after “malaria-free” certification by the World Health Organization (WHO).METHODOLOGY Two national surveys were conducted among 766 healthcare providers and 3454 households in 2016/17. Healthcare providers’ survey was conducted using stratified random sampling and administering a self-administered questionnaire. The household survey was conducted using multistage cluster sampling method. A marking scheme was developed and adjusted binary logistic regression analysis was used to assess the association between awareness and socio-demographic and economic factors, using IBM SPSS version 20 statistical software package.RESULTS The mean score for awareness on malaria among healthcare providers was 54.7% (SD=10.6%) and the heads of households was 28.6 % (SD = 9.03%). Awareness among healthcare providers was significantly associated with the sector of the institution, type of institution, but not with ever seen a malaria case. For the heads of households, awareness was significantly associated with age group, family income/wealth quintile, sector of residency, ever heard about malaria, seen/heard messages about malaria in the past 6 month and had been overseas within the last 3 years.CONCLUSIONS AND RECOMMENDATIONS The awareness on malaria among healthcare providers and public in Sri Lanka is poor during the prevention of re-establishment phase. Awareness programmes should be conducted for both public and healthcare providers to keep malaria on the radar through television, mobile phones and newspapers. Updates about malaria should be regularly conducted for healthcare providers.Item Establishment and evaluation of real-time PCR based SELEX platform for the identification of protein binding aptamers: A pilot study in Sri Lanka(National Science Foundation of Sri Lanka, 2025-01) Abeykoon, A.I.; Kumarasinghe, K.M.N.; Chandrasekharan, N.V.; Wickramasinghe, P.M.T.B.Aptamers are single-stranded DNA (ssDNA) affinity reagents capable of substituting conventional antibodies in processes of molecular recognition. Their higher affinities, lower costs of production and longer shelf lives of aptamers are making them increasingly popular and replacing conventional antibodies in the fields of diagnostics and therapeutics. Systematic evolution of ligands by exponential enrichment (SELEX) is a well-established and efficient technology for generation of aptamers with high affinity against various targets including whole cells, isolated proteins, and small molecules. This study is the first to report efforts in exploring SELEX for isolating protein-binding aptamers using a quantitative PCR and NGS-based approach in a local context. A low-cost selection platform was developed by coating microwell plates with human serum albumin, the target protein of interest, for quantitative and qualitative solid phase immunoassays. Changes in affinity and diversity were monitored through analysis of amplification plots, melt curves, remelt curves and high-resolution melt curve (HRM). Following eight selection cycles, the enriched DNA was subjected to high-throughput sequencing, and the two most abundant sequences were identified. The sequences were evaluated through in-silico binding assays, which resulted in comparable binding affinities expected for aptamers. Among the monitoring techniques, the amplification curve analysis was a valuable tool in understanding changes in pool affinity. Although the melt curve initially lacked sufficient resolution in the early stages of SELEX, the re-melt curve and HRM analysis accurately reflected pool diversity during this time. Thus, we demonstrate that it is feasible to use locally available technology for the successful development of aptamers. This highlights the potential to produce affinity reagents locally on a commercial scale in the future.Item Anatomy of the thoracic duct: a cadaveric study(The College of Surgeons of Sri Lanka, 2025-01) Abeysuriya, V.; Nuwantha, A.A.S.; Kumarage, S.No abstract availableItem Effective use of an innovative learning method: a perspective from a Sri Lankan setting(South East Asia Regional Association for Medical Education (SEARAME), 2025-01) Dayasiri, K.; Kiridana, V.; Mudiyanse, R.INTRODUCTION Numerous medical schools have incorporated humanities and narrative medicine into their curricula to cultivate compassion and foster essential interpersonal abilities in medical students. These progressive educational approaches prove effective in cultivating empathy, ethical conduct, and professionalism among future healthcare practitioners. METHODS This qualitative study was conducted at the Faculty of Medicine, University of Kelaniya to study the effectiveness of an innovative learning method in enhancing active learning, critical thinking and personal professional development amongst first-year medical students. Newly graduated medical students, following exposure to a Training of the Trainer (TOT) program, served as facilitators for the training program, and insights from facilitators were gathered through audio-recorded focus group discussions. Following this, a thematic analysis was conducted to explore the interplay and correlations among the identified domains. RESULTS The study revealed that facilitators experienced a sense of empowerment after participating in the facilitator training program. They acknowledged that learning about learning itself was a novel experience, which they hadn't encountered during their time as students. Further, the findings indicated that junior medical graduates can successfully undergo training to facilitate a combination of five innovative active learning methods aimed to boost critical thinking and personal professional development among fresh medical students, resulting in high levels of acceptance and satisfaction among the facilitators. CONCLUSION The results of this study support the idea that training facilitators can improve their skills in delivering programs that promote critical thinking and active learning among first-year medical graduates. Feedback from newly graduated medical professionals acting as facilitators indicated that with enthusiasm and motivation, junior healthcare workers could be successfully trained to facilitate in settings with limited resources.