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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 North Colombo diverticular disease snap shot audit (VISTA study): a collaborative research initiative(The College of Surgeons of Sri Lanka, 2023) Chandrasinghe, P.; Ediriweera, E.P.D.S.; Niriella, M.; Ranwaka, C.; Fernando, A.; Gunawardena, H.; Kumarage, S.INTRODUCTION Diverticulosis and diverticular disease (DD) is a common occurrence in clinical practice in the local setting with a lack of documented literature. A snapshot audit was conducted at North Colombo Teaching Hospital (NCTH) to ascertain the disease burden in clinical practice as a pilot study to assess feasibility and response rate for a nation wide snapshot audit. METHODOLOGY All surgical and gastroenterology units at NCTH were requested to enter the data between 1st January 2022 to 30th of June 2022 on all patients presenting with DD or those detected with diverticulosis during screening colonoscopy. Prospective data collection was done using RedCap© data capturing platform. RESULTS Out of the 8 units invited (general surgery – 5, GI surgery – 1, gastroenterology – 2), 5 units participated (general surgery – 2, GI surgery – 1, gastroenterology – 2); response rate is 62%. A total of 46 patient records (median age- 68 years; range 29- 86; female 51%) were received within 6 months. Of the total 54.3% had symptomatic uncomplicated diverticular disease (SUDD) while 33% were detected with diverticulosis at screening. Only 13% (n=6) required inward care (bleeding – 3, diverticulitis – 2, perforation – 1) and detected using colonoscopy in 4 and CT scan in 2. In the DD group, 20% (6/31) had complicated DD while 80% had Symptomatic Uncomplicated Diverticular Disease (SUDD). CONCLUSION In this pilot study, a majority of the patients with DD presented with SUDD while around 20% came with complicated DD. The response rate from collaborators was satisfactory. The secure online database usage is feasible and will be used for a national level study in the future to assess the disease burden in the healthcare setting in Sri Lanka.Item Prevalence of asthma and its symptoms in Sri Lankan adults.(BioMed Central, London, 2022) Gunasekera, K.D.; Amarasiri, W.A.D.L.; Undugodage, U.C.M.; Silva, H.K.M.S.; Sadikeen, A.; Gunasinghe, W.; Fernando, A.; Perera, B.P.R.; Wickremasinghe, A.R.BACKGROUND: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and its symptoms in adult Sri Lankans. METHODS: A cross-sectional study using a translated version of the European Community Respiratory Health Survey screening questionnaire on subjects ≥ 18 years from 7 provinces in Sri Lanka was conducted. The asthma was defined as "wheezing in the past 12 months (current wheeze)", self-reported asthma attack in the past 12 months or on current asthma medication use. RESULTS: Among 1872 subjects (45.1% males, 48.8% between 18-44 years of age), the prevalence of current wheeze was 23.9% (95%CI: 22.0%-25.9%), self-reported asthma was 11.8% (95%CI: 10.3%-13.2%) and current asthma medication use was 11.1% (95% CI: 9.6%-12.5%). The prevalences were higher in adults > 44 years, 31.4% positively responded to any of the above questions (95%CI: 29.3%-33.4%) and 60.9% of current wheezers did not report having asthma whilst 38.2% used asthma medication. Among current wheezers, 80.1% had at least one other symptom, cough being the commonest. Those with no current wheeze, self-reported asthma and on current asthma medication use, 30%, 35.9% and 36.6%, respectively, reported at least one other symptom. Smokers comprises 22% current wheezers, 20.6% of self-reported asthmatics and 18.7% of current asthma medication users. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is higher than the other South Asian countries and higher in the older age group. A significant percentage of symptomatic individuals did not report having asthma or being on medication.Item Associations between ADHD symptoms and maternal and birth outcomes: An exploratory analysis in a multi-country cohort of expectant mothers(SAGE Publications, 2022) Murray, A.L.; Taut, D; Baban, A.; Hemady, C.L.; Walker, S.; Osafo, J.; Sikander, S.; Tomlinson, M.; Toit, S.D.; Marlow, M.; Ward, C.L.; Fernando, A.; Madrid, B.; Van, T.V.; Tuyen, H.D.; Dunne, M.; Hughes, C.; Fearon, P.; Valdebenito, S.; Eisner, M.OBJECTIVE: ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap. METHOD: We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to address this gap. RESULTS: ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b = -0.16, p = .031), friends (b = -0.16, p = .024), and significant others (b = -0.09, p = .001); higher stress (b = 0.34, p < .001) and depressive symptoms (b = 0.31, p < .001), and increased likelihood of an unwanted pregnancy (b = 0.30, p = .009). Significant associations with tobacco use (b = 0.36, p = .023) and premature birth (b = 0.35, p = .007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy. CONCLUSION: Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.Item Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: a latent class analysis(BioMed Central,London, 2022) Hemady, C.L.; Speyer, L.G.; Murray, A.L.; Brown, R.H.; Meinck, F.; Fry, D.; Do, H.; Sikander, S.; Madrid, B.; Fernando, A.; Walker, S.; Dunne, M.; Foley, S.; Hughes, C.; Osafo, J.; Baban, A.; Taut, D.; Ward, C.L.; Thang, V.V.; Fearon, P.; Tomlinson, M.; Valdebenito, S.; Eisner, M.Background: This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). Methods: A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. Results: Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes.Conclusion: Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.Item Postdischarge outcomes of COVID-19 patients from South Asia: a prospective study(Royal Society of Tropical Medicine and Hygiene, 2022) Abeysuriya, V.; Seneviratne, S.L.; de Silva, A.P.; Mowjood, R.; Mowjood, S.; de Silva, T.; de Mel, P.; de Mel, C.; Wijesinha, R.S.; Fernando, A.; de Mel, S.; Chandrasena, L.Background: Coronavirus disease 2019 (COVID-19) may cause clinical manifestations that last for weeks or months after hospital discharge. The manifestations are heterogeneous and vary in their frequency. Their multisystem nature requires a holistic approach to management. There are sparse data from the South Asian region on the outcomes of hospital-discharged COVID-19 patients. We assessed the posthospital discharge outcomes of a cohort of Sri Lankan COVID-19 patients and explored the factors that influenced these outcomes. Methods: Data were prospectively collected from patients who were discharged following an admission to the Nawaloka Hospital, Sri Lanka with COVID-19 from March to June 2021. At discharge, their demographic, clinical and laboratory findings were recorded. The patients were categorised as having mild, moderate and severe COVID-19, based on the Sri Lanka Ministry of Health COVID-19 guidelines. Following discharge, information on health status, complications and outcomes was collected through clinic visits and preplanned telephone interviews. A validated (in Sri Lanka) version of the Short Form 36 health survey questionnaire (SF-36) was used to assess multi-item dimensions health status of the patients at 1, 2 and 3 mo postdischarge. Results: We collected data on 203 patients (male, n=111 [54.7%]). The level of vaccination was significantly associated with disease severity (p<0.001). Early recovery was seen in the mild group compared with the moderate and severe groups. At 3 mo, on average 98% of mild and 90% of moderate/severe patients had recovered. Based on the SF-36, physical functioning dimensions, role limitation due to physical and emotional health, energy/ fatigue, emotional well-being, social functioning, pain and general health were significantly different in the moderate/severe vs mild COVID-19 groups at 1, 2 and 3 mo postdischarge (p<0.05). Twenty-three patients developed complications, of which the most common were myocardial infarction with heart failure (n=6/23; 26.1%), cerebrovascular accident (n=6/23; 26.1%) and respiratory tract infections (n=3/23; 13.01%) and there were six deaths. Conclusions: In our cohort, receiving two doses of the COVID-19 vaccine was associated with reduced disease severity. Those with mild disease recovered faster than those with moderate/severe disease. At 3 mo posthospital discharge, >90% had recovered.Item Combination of cycle threshold time, absolute lymphocyte count and neutrophil:lymphocyte ratio is predictive of hypoxia in patients with SARS-CoV-2 infection(Royal Society of Tropical Medicine and Hygiene, 2022) Abeysuriya, V.; Seneviratne, S.L.; de Silva, A.P.; Mowjood, R.; Mowjood, S.; de Silva, T.; de Mel, P.; de Mel, C.; Chandrasena, L.; Wijesinha, R.S.; Fernando, A.; de Mel, S.Background: There is currently no clinically validated biomarker to predict respiratory compromise in sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cycle threshold time (Ct), absolute lymphocyte count (AL) and neutrophil:lymphocyte ratio (NLR) have been previously evaluated for this purpose. We hypothesized that the combination of these parameters at presentation may be predictive of hypoxia (oxygen saturation <92%). Methods: Data were collected on 118 patients with SARS-CoV-2 infection between May 2020 and April 2021. Demographics, clinical parameters and laboratory and radiological investigation results were recorded. Respiratory compromise (RC) was defined based on symptoms and signs, hypoxia and chest X-ray abnormalities. Results: RC occurred in 61 (51.7%) of patients. The Ct, AL and NLR at median day 3 of illness were significantly different between patients with and without RC (Ct, RC vs not: 19.46±2.64 vs 22.62±3.37, p=0.0001; AL, RC vs not: 531.49±289.09 vs 764.69±481.79, p=0.0001; NLR, RC vs not: 3.42±0.75 vs 2.59±0.55, p=0.0001). Receiver operating characteristics analysis showed that a Ct <19.9, AL <630.8×103/μL and NLR >3.12 at median day 3 of symptoms was predictive of hypoxia on day 7 of illness (area under the curve 0.805, sensitivity 96.7%, specificity 69.1%). The predictive value for the parameters combined was significantly superior to their individual predictive power. Conclusions: Ct, AL and NLR used in combination on day 3 of symptoms are predictive of hypoxia on day 7 of SARS-CoV-2 illness.Item Pre-defined competency level based instructional design model for learning Anatomy in an undergraduate medical curriculum(South East Asia Regional Association for Medical Education (SEARAME), 2021) Abeykoon, I.; Fernando, L.; Fernando, A.; Weerasooriya, T.; Chandratilake, M.ABSTRACT: The paper presents a competency based instructional design model to teach gross Anatomy in an undergraduate medical course. The main objectives of the presented instructional design model is to allow space for identification of finer demarcations for expected competencies while allowing the students to possess a broader understanding of the discussed areas under each competency level. Here the traditional semester will be split into three competency levels and within each competency level the entire region expected to be discussed will be presented. However, the first competency level will discuss the given area superficially with details being introduced during second and third competency levels. The center of focus as well as teaching learning modalities will also evolve with increasing competency levels making the presented instructional design model a more dynamic than a static approach. KEYWORDS: Medical education, Anatomy, Competency based education, Higher education, Educational modelItem Readmission of neonates after discharge to the Paediatric Unit of Colombo North Teaching Hospital(Sri Lanka College of Paediatricians, 2020) Hoole, T; Fernando, A.; Mettananda, S.No abstractItem Screening for risk of obstructive sleep apnoea - results of an island wide survey in Sri Lanka(Journal of the Ceylon College of Physicians, 2019) Undugodage, C.; Amarasiri, L.; Kamalanathan, M.; Gunasinghe, W.; Sadikeen, A.; Fernando, A.; Wickremasinghe, R.; Gunasekera, K.INTRODUCTION: Obstructive sleep apnoea (OSA) is the commonest sleep related breathing disorder worldwide, but there is only limited community level data on the risk of OSA from South Asian countries. AIMS AND OBJECTIVES: This study assessed the community prevalence of persons at high-risk for OSA among Sri Lankan adults. METHODS: A randomly selected sample of adults from 7 (out of 9) provinces of Sri Lanka was screened using the Berlin Questionnaire (BQ). BQ has 3 categories related to snoring severity (category 1), excessive day time somnolence (category 2) and history of hypertension or obesity (category 3). Individuals were classified as high or low risk according to the category score. RESULTS: One thousand six hundred and eight adults (46.2% male) were screened, and 270 were classified as high risk for OSA {16.8%; 95% Cl 14.9 %-18.6% (15.1% in males; 18.3% in females, p >0.05)}. Of the high-risk individuals, 239 (88.5%) were category 1 positive, 142 (52.6%) category 2 positive and 202 (74.8%) category 3 positive. 49/577 (8.5%) among persons = or <40 years and 221/ 1031 (21.4%) among those >40 years were at high risk. 10.3% of the adults had a BMI ≥30 (5.7% of males, 14% of females p<0.001). Snoring was reported by 573 (35.6%) individuals; 120 of them (20.9%) had apneas during sleep. CONCLUSION: The prevalence of high risk for OSA in this Sri Lankan community survey is lower than that reported from Western countries and did not show a gender-related difference.Item Profile of suicidal hanging presented to a tertiary care hospital: a descriptive study(Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, 2019) Edirisinghe, P.A.S.; Senarathne, U.D.; Pratheepa Mendis, H.K.N.L.; Wijesinghe, P.R.; Fernando, A.; Kitulwatte, I.D.G.ABSTRACT: When a body is found suspended, the forensic pathologist is expected to give an opinion on the manner of death excluding or confirming possible criminal involvement. Conclusion is easy when findings are classic. However, it is a dilemma when there are atypical findings. OBJECTIVES: To analyze the autopsy findings in deaths due to hanging and to have an insight into the typical and atypical findings in order to appreciate the difficulties in interpretation. METHODS: A retrospective descriptive study on post mortem records of the victims of hanging during a period of three years, brought to a tertiary care hospital. The findings of death investigation including background information, scene, and autopsy examination were analysed. RESULTS: Total of hundred and twelve records of deaths due to suicidal hanging were perused and 97 (86.6%) out of them were males. The majority of victims (37%) were in the age group of 21 to 40 years. The complete suspensions was identified in most cases (79.5%). The commonest ligature material (25%) was the coir rope. Sixty-nine were having a ligature mark rising to an inverted ‘V’. Classic signs were observed in 47% and the presence of classic signs was significantly associated with partial suspension (p<0.001). Internal injuries were observed in 34% and the majority were fractures. Internal injuries had no significant association to the degree of suspension (p=0.11). KEYWORDS: Hanging, Ligature material, Ligature mark, Classic signs, Internal injuries, Fractures