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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Depressive morbidity among persons with spinal cord injury in Sri Lanka and the diagnostic utility of the Centre for Epidemiologic Studies Depression Scale(Elsevier Ltd, 2022) Rathnayake, L.; Baminiwatta, A.; Chandradasa, M.; Fernando, L.No abstract availableItem Early phase child and adolescent psychiatry response after mass trauma: lessons learned from the Easter Sunday attack in Sri Lanka(London Avenue Publishing Co, 2020) Chandradasa, M.; Rathnayake, L.C.; Rowel, M.; Fernando, L.BACKGROUND: Sri Lanka is a South-Asian nation with a multi-ethnic population. A 26-year-old armed conflict ended in 2009 and the relative stability over the last decade was unexpectedly disrupted by the Easter Sunday Bombings of Catholic Churches and luxury hotels in 2019. More than 250 were killed and most of the deaths were reported from the St. Sebastian's Church in Negombo in the District of Gampaha. This article describes how mental health services of the District of Gampaha, with a population of 2.3 million and only one child and adolescent psychiatrist responded to the psychological trauma in children. ACTIVITIES: The child and adolescent psychiatry response to the mass trauma was a collaboration between health, educational and voluntary organisations. The psychological support was provided at affected villages, schools and hospital settings. Medical and non-medical personnel were able to refer affected children directly to the child and adolescent psychiatrist. Children who had developed psychological consequences of trauma were provided with evidence-based psychotherapies and psychopharmacology where necessary. In addition, health staff members and teachers were trained to provide psychological support and a booklet was prepared in the local language based on trauma-focused cognitive behaviour therapy. Psychoeducation about the psychological response to trauma was provided through electronic, printed and social media. The limited number of trained psychotherapists and experts in child mental health were a major barrier to implement effective management strategies. CONCLUSIONS: Due to the severe shortage of child mental health experts, practical low-cost methodologies were employed to provide an early response to trauma. Traditional ways of mental health service provision were modified to be implemented via non-experts. KEYWORDS: Psychological trauma; Sri Lanka; adolescent; child; mental health services.Item Child abuse and neglect; who gets abused and who abuses them?(Sri Lanka Medical Association, 2005) Fernando, A.D.; Karunasekera, K.A.W.; Fernando, L.; Samarasekera, A.OBJECTIVES: To study the socio-demographic characteristics of victims of child abuse and characteristics of the perpetrators. Study Design: A descriptive study. METHOD: A prospective study of 112 victims of child abuse presenting to the University Paediatric Unit, Ragama from January 2000 to August 2004. The study evaluated characteristics of victims and perpetrators. Ethical approval was obtained. Data Analysis: Epi info version 6. RESULTS: Mean age of the victims was 9.7 years. 79% were females. Ethnicity-91% Singhalese, 5%Muslims and 4%Tamils. 82% resided in Gampaha District. Education of father and mother respectively - 5% and 11%-not attended school, 32% and 34%-primary education, 52% and 50%-ordinary level and 11% and 9%-advanced level. Social class -46%-unskilled, 26%-poorly skilled, 18%-skilled and 10%-lesser professionals. Monthly income (Rs.) -6% <2000, 37% 2000-5000, 33% 5000-10,000 and 24% >10,000. Marital status- 64%-married, 27%-divorced, 6%-unmarried and living together, 3%-single. Amongst married parents, 20% of mothers and 6% of fathers were abroad. Caregiver to the victim- 47%-both parents, 15%-mother, 15%-father, 14%-relatives and 9%-others. Consumption of alcohol by father -59%. Characteristics of perpetrators- 98% were known to the victims and in 24% the perpetrator was the father. Number of perpetrator/s- 86%-one, 5%-two, 5%-three, 4%-more than 3. Perpetrator being drunk at the tine of abuse in 31%. Amongst sexually abused, 26% were acts of incest. Of those 70% by father. CONCLUSIONS: The most vulnerable victims of abuse are shown to be 10-year-old females. Majority came from low social and educational backgrounds, In <5Q%, both parents cared for the child. 98% of perpetrators were trusted persons and in nearly a quarter it was the father.Item A profile of child abuse and neglect in a tertiary care hospital(Sri Lanka Medical Association, 2005) Fernando, A.D.; Karunasekera, K.A.W.; Fernando, L.; Samarasekera, A.OBJECTIVES: To study the pattern of child abuse and neglect. To evaluate the management and the Outcome of such victims STUDY DESIGN: A descriptive study METHOD: The sample consists of 112 victims of child abuse referred to the University Paediatric Unit, Ragama Hospital, from January 2000 to August 2004. The study prospectively evaluated types of abuse, their characteristics, management of victims and outcome. Ethical approval was obtained. RESULTS: 24% had more than one type of abuse. Categories of abuse were: 70% -sexual, 33% -physical, 16% -neglect, 14% -emotional and 6% -child labour. Amongst sexually abused, 62% had penetrative sex, 8% became pregnant, 4% had sexually transmitted diseases, 5% had severe degree perineal/peri-anal tears, and 37% had psychological disturbances at the time of presentation. 39% came for follow up assessment after 6 months. Amongst them, 60% had psychological disturbances, amongst physically abused, 19% had fractures. Amongst all victims, the mean duration of hospital stay was 29 days. Management outcome: 46% sent back to parents, 11% to extended family member/s, 38% to Children's Homes and 5% to others. CONCLUSIONS: 24% had more than one type of abuse. The commonest type was sexual abuse. The majority of them had penetrative sex and 8% became pregnant. Psychological disturbances were found in the majority of victims of sexual abuse on follow up. 57% of victims were able to continue to live with their parents/extended family.Item Screening based on risk factors for gestational diabetes in an Asian population(Informa Healthcare, 2001) Wagaarachchi, P.T.; Fernando, L.; Premachandra, P.; Fernando, D.J.S.The results of glucose tolerance testing (OGTT) in 1004 consecutive women were examined with respect to risk factors for gestational diabetes mellitus (GDM). GDM was diagnosed in 41 of 1004 (4.08%) women. GDM was present in 7.8% of women aged over 35 years (compared to 3.1% if less than 35 years), in 8.1% women with a body mass index (BMI) >/=30 (compared to 3.6% if BMI <30) and in 5.2% of women with a family history of diabetes (compared to 3.9% in the absence of family history of diabetes). Past history of macrosomic babies (over 4 kg) was present in 12.1% of GDMs compared to 8.4% of non-diabetic pregnancies (NDP). A history of unexplained perinatal loss was present in 4.8% of GDMs compared to 2.2% of non-diabetic pregnancies (NDP). Thirteen per cent of grandmultiprous women had GDM compared to 3.9% in women with low parity. The proportion of women who had more than one risk factor was 16.7%. A combination of one or all of these risk factors predicted GDM in only 24 of 41 (58.5%) cases. Selective testing on the basis of risk factors using WHO criteria for diagnosis of GDM would miss over 40% of all cases in our population. Hence, this study supports the policy of universal screening for GDM in populations similar to oursItem Acute pelvic inflammatory disease in a gynecological casualty setting(Elsevier, 2000) Wagaarachchi, P.T.; Fernando, L.; Fernando, D.J.S.No Abstract AvailableItem Fertility following ligation of internal iliac arteries for life-threatening obstetric haemorrhage: case report(Oxford University Press, 2000) Wagaarachchi, P. T.; Fernando, L.Bilateral ligation of internal iliac (hypogastric) arteries (BIL) is a life-saving operation in cases of massive obstetric haemorrhage. This operation preserves reproductive function as opposed to the more commonly performed emergency hysterectomy in such situations. We report on effectiveness and future fertility in 12 women who had internal iliac ligation to control severe obstetric haemorrhage: in 10 out of the 12 women, BIL was successful. Of the two women who subsequently needed emergency hysterectomy, one woman died of disseminated intravascular coagulation. Of the eight women we were able to follow-up to assess reproductive performance, two did not desire future fertility. Three had subsequent pregnancies (50 percent), of whom two proceeded to term. We conclude that BIL is a safe and effective procedure for treating life-threatening obstetric haemorrhage with preservation of future fertility. This technique should be performed more often when indicated.Item Failure of postexposure treatment of rabies in children(Oxford University Press, 1996) Wilde, H.; Sirikawin, S.; Sabcharoen, A.; Kingnate, D.; Tantawichien, T.; Harischandra, P.A.; Chaiyabutr, N.; de Silva, D.G.H.; Fernando, L.; Liyanage, J.B.; Sitprija, V.Five failures of postexposure treatment of rabies in small children with multiple severe bites on the face and head are discussed. All had received rabies immune globulin and a potent tissue-culture vaccine. However, not all wounds had been infiltrated with immune globulin. Surgical closure prior to wound injection with immune globulin was performed in three cases. Another patient had wounds sutured after an intramuscular injection of immune globulin, without wound infiltration.