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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Heart rate variability among gas station attendants exposed to benzene, toluene, and xylenes (BTX) in Sri Lanka(Springer Nature., 2021) Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; de Silva, D.; Ariyawansha, J.; Rathnayaka, P.; Dissanayaka, T.; Fernando, S.; Devanarayana, N.M.; Scheepers, P.T.J.Introduction: Benzene, toluene, and xylenes (BTX) exposure among gas station attendants in Sri Lanka is high. Cardiovascular morbidity and mortality are reported to be higher among those exposed to BTX. A hypothesis is based on alterations in the autonomic nervous system, especially disruption of autonomic regulation of the heart. Autonomic regulation of cardiac functions can be assessed by short-term heart rate variability (HRV), which measures the fluctuations in the interval between sequential sinus heartbeats. Objective: To determine whether BTX exposure affects the heart rate variability (HRV) among gas station attendants. Methods: Forty-nine gas station attendants from the Gampaha district of Sri Lanka, aged between 19 and 65 years, were recruited for the study. Age and gender-matched controls (n = 46) without occupational exposure to fuel were used as controls. Ethical approval for the study was granted by the Ethics Review Committee of the Faculty of Medicine, University of Kelaniya, Sri Lanka. Informed written consent was obtained from each participant. Demographic data were collected, and a physical examination was performed before the HRV assessment. We measured SDNN, RMSSD, pNN50, HF, LF, and LF: HF ratio as HRV indices. Pre- and post-shift samples of end-exhaled air were collected and analyzed for BTX using a thermal desorption gas chromatography–mass spectrometry system (TD-GC-MS) among 24 gas station attendants and 14 controls. As a proxy of shift exposure, we calculated the increase from pre-shift (as a baseline) to postshift and reported this as ‘delta’. Results and discussion: For gas station attendants (n = 24) median pre-/post-shift exhaled air concentrations (ng/L) were: benzene 10.47/ 19.00; toluene 10.41/21.86; m/p-xylene 1.63/2.14; o-xylene 0.93/1.42. For controls (n = 14) these values were 9.40/11.05, 3.19/3.91, 1.23/ 1.43 and 0.47/0.47. The heart rate variability (HRV) analysis showed significantly higher SDNN and SD2 among the gas station attendants (n = 49) than controls (n = 46) (Mann Whitney U = 842.00, p = 0.034 and Mann Whitney U = 843.50, p = 0.035, respectively). RMSSD, pNN50, Total power, HF, and SD1 among gas station attendants negatively correlated at a significant level with the mean increment in exposure to BTX (p\0.05).Conclusions: Exposure to BTX alters the HRV indices, indicating an effect on autonomic cardiac regulation. Funding: University of Kelaniya research grant: RP/03/04/03/01/ 2017, Foreign Award 2017 of the Dutch Occupational Hygiene Society (NVvA).Item Cardiovascular autonomic functions of gas station attendants in Sri Lanka(Springer Nature., 2021) Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; de Silva, D.; Ariyawansha, J.; Rathnayaka, P.; Dissanayaka, T.; Fernando, S.; Devanarayana, N.M.Introduction: Sri Lanka, a middle-income country in South Asia, has seen a rapid expansion in motor vehicles and, associated with this, an increase in demand for fuel. The dispensing of fuel at fuel stations is performed manually by male fuel handlers, who have long working hours. Such workers are exposed to hydrocarbon fuels which are associated with multiple health effects. This study was performed to determine cardiovascular autonomic functions among fuel handlers in a densely populated district of Sri Lanka. Methods: Fuel handlers (n = 50) from the Gampaha district of Sri Lanka, aged between 19 and 65 years, were identified for the study from seven selected fuel stations. Age and gender-matched controls (n = 46) without occupational exposure to fuel were used as controls. All participants were male (females were not employed as fuel handlers). After obtaining written informed consent, demographic data were collected, and general physical examination performed before autonomic function assessment. Non-parametric methods were used for data analysis. Ethical approval was granted by the ethics review committee of the Faculty of Medicine, University of Kelaniya, Sri Lanka. Results: There were no significant differences in weight, height or BMI among the study and the control populations (p[0.05). Both the systolic (SBP) and diastolic (DBP) blood pressures were significantly higher among the fuel handlers compared to controls (SBP, Mann Whitney U = 743.5, p = 0.003) and (DBP, Mann Whitney U = 686.5, p = 0.001). Valsalva ratio was significantly higher among the fuel handlers (Mann Whitney U—874.00, p = 0.043). The rise in DBP during sustained handgrip, a sympathetic parameter, was significantly higher among the controls (Mann Whitney U = 863.00, p = 0.049). Conclusions: Altered sympathetic:parasympathetic balance was observed among the fuel handlers. Monitoring of the health, using personal protective equipment, and curtailing hours of employment per week is recommended for those employed at fuel stations.Item Factors associated with Urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing organisms in Sri Lanka(Elsevier, 2016) Fernando, S.; Luke, N.; Wickramasinghe, S.; Sebastiampillai, B.; Gunathilake, M.; Miththinda, N.; Silva, S.; Premaratna, R.BACKGROUND: Urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing organisms are a major burden in clinical practice. Hospitalization in the past 3 months, antibiotic treatment in the past 3 months, age over 60 years, diabetes mellitus, Klebsiella pneumoniae infection, previous use of second or third-generation cephalosporins, quinolones or penicillins are known associations and risk factors for ESBL-UTI. METHODS & MATERIALS: A descriptive study was conducted over a period of 6 months from January - July 2015 recruiting patients with UTI caused by ESBL producing organisms, who were admitted to the Professorial Medical unit, Colombo North Teaching Hospital, Ragama Sri Lanka in order to identify risk factors and associations. Data were obtained using a pre-tested interviewer administered questionnaire and from relevant medical records after obtaining informed written consent. RESULTS: 52 patients were recruited; males 30 (57.7%), mean (SD) age 64.1(.12.6)years. Of them, 46 (88.5%) had diabetes mellitus, 32 (61.5%) had hypertension and 10 (19.2%) had chronic liver disease as comorbidities.20 (38.5%) had ultrasonographic evidence of acute pyelonephritis. At presentation16 (30.8%)had biochemical and/or ultrasonographic evidence of chronic or acute on chronic kidney disease. History of constipation was observed in 18 (34.6%), hospitalization during the past 3 months was seen in 24(46.2%)and history of urinary catheterization in 16(30.8%). Features of obstructive uropathy such as hydronephrosis, hydroureter and prostatomegaly were seen in 4 (7.7%) patients each. Antibiotic treatment within the past 3 months was observed in 32(61.5%);penicillins in 18(34.6%), 3rd generation cephalosporins in 16(30.8%),quinolones in 14(26.9%) and 2nd generation cehalosporins in 12 (23.1%). 18 (34.6%) had received more than one antibiotic within the past 3 months. 8(15.4%)patients studied were on prophylactic antibiotics for recurrant UTIs. None of them had recent Klebsiella pneumonia. CONCLUSION: Similar to other studies,diabetes mellitus, recent antibiotic treatment, hospitalization and catheterization were observed in our patients with ESBL-UTI. The fact thatonly 53.8% patients had received antibiotics at community level and 38.5% patients had never received antibiotics prior to developing ESBL-UTIsuggest high prevalence of ESBL producing organisms at community level.Item Establishment of human endometriai stromal cell cultures as in-vitro models to test the effects of metalloestrogens in women with or without endometriosis(Sri Lanka Medical Association, 2012) Silva, N.; Tennekoon, K.; Senanayake, H.; Samarakoon, S.; Fernando, S.; Wickremasinghe, A.R.; John, R.P.INTRODUCTION: Effects of metalloestrogens like cadmium (Cd), lead (PbJ and nickel (Ni) are difficult to demonstrate in-vivo due to toxicity and therefore requires suitable in-vitro models. AIMS: To establish endometriai stromal cell (ESC) cultures as in-vitro models to demonstrate the effects of metalloestrogens in women with and without endometriosis. METHODS: Stromal cells were isolated from eutopic endometriai samples from five women with endometriosis (patients) and five women without endometriosis (controlsj. ESC cultures were established and maintained in RPMI medium. Cultures were treated with Cd, Pb and Ni at concentrations of 10-6M, 10-9M and 10-9M respectively. At 24 h and 48 h, cell number was counted using the Neubauer haemocytometer. Sulphorhodamine(SRB) cytotoxicity assay was used to test the effect of different concentrations of metals on ESC cultures. After 24 h of treatment, caspase levels in ESC cultures were evaluated with a commercially available ELISA kit Relative cell proliferation, SRB assay results and caspase levels were analyzed with ANOVA. RESULTS: ESC cultures were maintained up to 30 days. In both patients and controls Cd, but not Pb or Ni increased the relative proliferation in ESC cultures (p<0.05). At 48 h, Cd induced ESC proliferation was higher in patients than in controls (p=0.02). SRB assay results and caspase levels were similar in the two groups. CONCLUSIONS: Established ESC cultures served as stable in-vitro models. Cd induced the proliferation of ESC from women with endometriosis which appears to be independent of reduced apoptosis. Similar effects of Pb and Ni could not be demonstrated in this in vitro model.Item Traditional beliefs and practices during the puerperium(Sri Lanka Medical Association, 2012) Athauda, L.K.; Basnayake, R.; Gunawardena, M.; lyshwarya, M.V.; Deduwela, R.S.; Mendis, U.R.R.; Lakmuthu, W.S.D.; Siriwardhana, A.A.R.Y.; Nadeesha, M.G.; Ranga, M.P.; Disnani, H.K.T.; Fernando, S.INTRODUCTION: Descriptive qualitative study was carried out to identify knowledge, attitudes and practices of women based on traditional beliefs during puerperium. Aims: To describe beliefs and practices by women during the puerperium, on hygiene, sexual practices & contraception, physical activity and food taboos. METHODS: Qualitative descriptive study was conducted among Sinhalese, Buddhist women to identify beliefs and practices during puerperium following a normal vaginal delivery. Females admitted at CSTH during the months of September - December 2009 were selected. Three focus group discussions were conducted among women aged 25- 35 years, 45 - 55 years, over 65 years using a focus group study guide. RESULTS: Women abstained from bathing up to 1 month post delivery, to avoid clotting of breast milk. Substitute for bathing is fermentation of back, abdomen & breast with leaves. Water for bath is heated with sunlight for disinfection. Breast feeding is postponed until mother's hair dries completely after a bath. Clothes are disinfected by fumigation with herbs. Cloth straps worn around waist strengthen the abdominal muscles. Episiotomy care involves sitting in a warm salt-water tub, avoiding use of soap and fumigating the site with herbal fumes. Sexual abstinence is practiced for one to three months post partum. Strenuous activity and squatting is avoided in the peuperium. Major food taboos include coconut milk, oil, green leaves, saltwater fish, and pineapple and ana-malu banana. CONCLUSIONS: Families y pressurize younger females to conform with these practices. Older women consider these beliefs and practices as traditional. The basis of these beliefs and practices need further exploration.Item Hysterectomy-need of a paradigm shift(Sri Lanka College of Obstetricians and Gynaecologists, 2012) Fernando, S.No Abstract AvailableItem Attitudes toward prenatal diagnosis and termination of pregnancy for genetic disorders among healthcare workers in a selected setting in Sri Lanka(Wiley, 2008) de Silva, D.C.; Jayawardana, P.; Hapangama, A.; Suraweera, E.G.D.N.; Ranjani, D.; Fernando, S.; Karunasena, C.; Jinadasa, S.