Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Physical disability and psychosocial impact associated with lymphoedema in patients attending filariasis clinics in the Colombo district.(Sri Lanka College of Microbiologists, 2005) Wijesinghe, R.; Ekanayake, S.; Wickremasinghe, A.R.INTRODUCTION: Lymphatic filariasis is a leading cause of long-term disability and can lead to significant social and economic impact in affected individuals. OBJECTIVE: To describe the physical disability and psychosocial impact associated with lymphoedema in patients attending two filariasis clinics in the Colombo district. METHODOLOGY: 413 patients with lymphoedema attending the filariasis clinics in Werahera & Dehiwala were enrolled in the study after obtaining informed written consent. Data was collected using a pre-tested, interviewer-administered questionnaire and analysed using SPSS (Statistical Package for the Social Sciences). RESULTS: The patients' mean- age was 51.27 years. 72.4% were female. The right lower limb, left lower limb, right upper limb and left upper limb were affected in 50.8%, 59.1%, 4.8% and 4.1% respectively. The mean duration of lymphoedema varied from 5.27 to 11.64 years. 11.9% of patients had other family members with swollen limbs. 37.7% of patients with lower limb oedema reported difficulty in walking (p=0.023). The swollen limb affected the work of 87 patients and 26 persons reported loss of job. 8.7% felt that they were stigmatized by society. 25,2 % and 5.8% reported having problems interacting with the community and the family, respectively. 36.8% of patients felt the swollen limb was a major problem. 5.7% and 6.3% of married persons reported sexual and marital problems respectively, due to lymphoedema. Of those who had marital problems, 77.3% reported sexual problems aswell(p<0.001). CONCLUSIONS: Lymphoedema gives rise to physical, psychological and social consequences in affected individuals. Morbidity control, in addition to control of physical disability, should also target the psychosocial consequences. ACKNOWLEGEMENT: Funding by the University of Sri Jayawardenepura Research Grant ASP/6/RE /2004/05 is acknowledged.Item Geohelminthic infection in an estate child population in Sri Lanka: association with hygienic practices and eosinophil counts(Sri Lanka College of Microbiologists, 2006) Banneheke, B.M.H.A.; Gunawardane, D.M.D.E.A.; Pinidiyapathirage, M.J.; Ekanayake, S.; Withana, R.J.; Tilakaratne, W.D.T.OBJECTIVES: To describe hygienic practices, prevalence of geohelminthic infections and its association with eosinophil counts among children. Methods: A descriptive cross sectional study was conducted in a tea plantation in Ratnapura District involving 316 school children. An interviewer-administered questionnaire was used to collect data from the child or parent. Stool and blood samples were obtained from all the consenting children. Stool examinations were conducted using saline smear, agar-plate culture technique, and Kato-Katz quantitative technique. Eosinophil count was obtained using blood smears. RESULTS: Mean age of the children (n=317) in the sample was 8.5 years (SD 1.7). Of the selected sample 219(85%) had access to pipe borne water, 228(72%) washed hands before meals, 164(52%) did not use a toilet, 180(57%) had a domesticated dog or a cat and 168(53%) used antihelminthic drugs regularly. A history of asthma, wheezing/allergies was reported by 101(32%) subjects. Of the 317 stool samples examined, Ascaris infection was prevalent in 60(19%), hookworm infection in 25(8%) (15 of them had>4000 eggs per gram - severe infection), Trichuris infection in 7(2.2%) and Strongyloides infection in 3(0.9 %) children. Of the 298 blood samples examined 12 (4%) had an eosinophil count of > 16 %( severe eosinophilia). A statistically significant association was observed with hookworm infection and increased eosinophil counts (p=0.006). CONCLUSION: Prevalence of geohelminthic infections was low among this population, Ascaris showing the highest prevalence (n~60, 19%). An association between the presence of helminthic infection and an increased eosinophil count was observed only with hookworm infection in which (n= 15)60% reported a severe degree of infection.Item Serum ferritin in newly diagnosed breast cancer and apparently healthy individuals(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Akalanka, H.M.K.; Ekanayake, S.; Samarasinghe, K.BACKGROUND: Iron is an essential element for the cell proliferation and is primarily stored in human body in the form of ferritin. Iron metabolism is influenced by oestrogen and interactions between iron and oestrogen is thought to synergistically promote breast cancer (BC). OBJECTIVES: To assess serum ferittin concentrations of BC patients and healthy females. METHODS: Newly diagnosed BC patients (n=150) and apparently healthy females (n=75) who consented to be on the study were enrolled. Serum ferritin concentration was assessed using enzyme immunoassay method using mini vidas immune analyser. RESULTS: Median serum ferritin concentrations (IQR) of pre (n=58) and postmenopausal (n=92) BC patients were 32.32 (37.84) ng/ml and 64.33 (27.18) ng/ml respectively. Postmenopausal BC patients had significantly high (p<0.05) serum ferritin concentrations compared to premenopausal BC patients. Apparently healthy pre (n=35) and postmenopausal (n=40) women had median values of 26.06(28.09) ng/ml and 45.00(51.24) ng/ml respectively the difference of which was statistically significant (p<0.05). A significant difference in serum ferritin concentration was not observed among premenopausal BC women and apparently healthy women (p>0.05). However, postmenopausal BC women had significant high levels of serum ferritin compared to postmenopausal healthy women (0<0.05). The postmenopausal ferritin concentrations among BC and normal women studied via ROC curve showed 70% (p=0.000, CI 0.62-0.79) of area under the curve with ferritin cutoff value of 58 ng/mL with 60% sensitivity and 75% specificity. Among postmenopausal BC and healthy women, 56.5% and 29% had ferritin levels above this cutoff value respectively and postmenopausal women having ferritin levels above the cutoff had 3times (OR=3.1, 95%CI 1.6-5.9) risk of having breast cancer. CONCLUSIONS: Elevated serum ferritin concentration in postmenopausal women is associated with breast cancer risk but not in premenopausal women.Item Cancer antigen 15-3 and the grade of the breast carcinoma in newly diagnosed patients(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Akalanka, H.M.K.; Ekanayake, S.; Samarasinghe, K.BACKGROUND: Cancer antigen 15-3 (CA15-3) is a breast tumor marker of clinical utility. However, the utility of measuring CA15-3 in patients with breast cancer (BC) remains controversial. OBJECTIVES: To assess CA15-3 concentrations of newly diagnosed BC patients and to compare those with concentrations of apparently healthy females and within the different the grades of the carcinoma. METHODS: CA15-3 concentration of newly diagnosed BC patients (n=155) and apparently healthy age matched females (n=35) was assessed using enzyme immunoassay sandwich method with a final fluorescent detection using mini vidas immuno analyser. Nottingham grade of the carcinoma of each BC patient was recorded from the histopathology records. RESULTS: The median levels of CA15-3 of the BC patients and apparently healthy women in the study sample was 14.45 (IQR: 10.17) U/mL and 14.19 (IQR: 7.09) U/mL respectively. CA15-3 concentrations were not significantly different among BC and healthy women (p>0.05). Only 11% of women with BC had elevated CA15-3 concentrations above the reference range (30 U/mL). The BC patients were classified as Nottingham grade I (13.4%), II (47.8%) and III (38%). CA15-3. Concentrations (median and IQR) within each grade were 15.24 (6.62), 13.06 (11.56) and 17.52 (13.69) respectively. CA15-3 concentrations were not significantly different according to the grade (p>0.05). CONCLUSIONS: CA 15-3 concentrations of newly diagnosed breast cancer patients were not significantly different when compared with apparently healthy women and according to the Nottingham grading.Item Treatment seeking behavior and treatment practices of lymphatic filariasis patients with Lymphoedema in the Colombo district, Sri Lanka(SAGE Publishing, 2008) Wijesinghe, R.S.; Wickremasinghe, A.R.; Ekanayake, S.; Perera, M.S.A.This cross-sectional, descriptive study describes the treatment-seeking behavior of 413 lymphoedema patients attending 2 filariasis clinics in theColombo district, Sri Lanka. A pretested, interviewer-administered questionnaire obtained information regarding sources and types of treatment taken, time taken for diagnosis, and details regarding diethylcarbamazine citrate (DEC) treatment. There was a mean delay of 2.37 years (SD 1.37) in diagnosing filariasis after the first appearance of limb swelling. General practitioners were the most frequent first-contact health care providers and the most visited source overall, followed by government hospitals and Ayurvedic practitioners. Approximately 95% of patients were on DEC treatmentranging from 10 days to 43 years (mean 2.5 years SD +/- 1.1). Sixty-one percent of patients reported always having taken the recommended DEC course. Nonsteroidal anti-inflammatory drugs, diuretics, and antibiotics were liberally prescribed. Approximately 97% had sought treatment from a medical practitioner for an acute adenolymphangitis attack. Despite the area being endemic for filariasis, there was a delay in treatment and inappropriate use of DEC in patients with chronic filarial lymphoedemaItem Knowledge and perceptions of filariasis in Colombo, Sri Lanka, among patients with chronic filarial lymphoedema(Academic Press, 2007) Wijesinghe, R.S.; Ekanayake, S.; Perera, M.S.; Wickremasinghe, A.R.Item Physical disability and psychosocial impact due to chronic filarial lymphoedema in Sri Lanka(BioMed Central, 2007) Wijesinghe, R.S.; Wickremasinghe, A.R.; Ekanayake, S.; Perera, M.S.BACKGROUND: Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka. METHODS: Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS. RESULTS: Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p = 0.023). The swollen limb affected the work of 87 (52%) of employed patients and 26 persons reported loss of job. Approximately 25% and 6% reported having problems interacting with the community and family, respectively and 8.7% felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8% of patients. Of the married persons, 5.7% and 6.2% reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001). CONCLUSION: Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences.Item Efficacy of a limb-care regime in preventing acute adenolymphangitis in patients with lymphoedema caused by bancroftian filariasis, in Colombo, Sri Lanka(Academic Press, 2007) Wijesinghe, R.S.; Wickremasinghe, A.R.; Ekanayake, S.; Perera, M.S.The efficacy of a programme of community home-based care (CHBC) for lymphoedematous limbs was evaluated among 163 lymphoedema patientsattending two filariasis clinics in Colombo. Each patient was interviewed and examined and his or her lymphoedema was graded during a baseline assessment, before the CHBC programme, and again, during a post-intervention assessment, after the patient had been in the programme for 1 year. The number of patients having entry lesions was 24% lower at the post-intervention assessment than at the baseline (P<0.001), with a reduction in the frequency of each type of entry lesion investigated. In the year the patients were in the CHBC programme, 30% fewer of them experienced at least one attack of adenolymphangitis (ADL; P<0.001), the mean number of ADL attacks/patient was lower (P<0.001), and the mean duration of each ADL attack suffered was slightly shorter (5.70 v. 5.84 days; P>0.05) than in the year before the baseline assessment. The reduction in the incidence of ADL attacks was greatest in the patients with the higher grades of lymphoedema. Approximately 66% of the patients perceived an improvement in their swollen limb post-intervention. Eleven patients had grade-II lymphoedema at baseline but only grade-I lymphoedema after being on the CHBC programme for a year (P=0.012). The programme appeared to increase the frequencies with which patients followed each of the limb-care measures considered and most of the measures for the home management of ADL attacks that were investigated. It is recommended that the CHBC programme be implemented as a national programme in Sri Lanka.