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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study
    (Elsevier Science Ireland Ltd, 2021) Niriella, M.A.; Ediriweera, D.S.; Kasturiratne, A.; Gunasekara, D.; de Silva, S.T.; Dassanayake, A.S.; de Silva, A.P.; Kato, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.
    OBJECTIVES: Despite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. METHOD: In an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. RESULTS: Of 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007). At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. CONCLUSIONS: Only moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying individuals who need medical intervention even among those with milder degrees of fatty liver. We therefore recommend using increased hepatic echogenicity, and not only the more stringent criteria (which include signal attenuation and/or vascular blunting), for the diagnosis of fatty liver in individuals with NAFLD. KEYWORDS: Cardiovascular events; Fatty liver; NAFLD; Outcomes; Ultrasonography; Ultrasound criteria.
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    Hilar cholangiocarcinomas - from nihilism to aggressive treatment
    (The College of Surgeons of Sri Lanka, 2012) Liyanage, C.; Nawaratne, M.; Pathirana, A.; Gunasekara, D.; Pranahewa, L.; Prasad, R.; Wijeratne, T.; Bogammana, M.; Wijesooriya, R.; Siriwardhana, R.
    INTRODUCTION: Hllar-Cholangio-carcinomas (HCC) are aggressive tumours with a dismal prognosis. The general tendency amongst all specialities is to palliate them. As response to adjuvant therapy is marginal we have embarked on aggressive management of these patients with the available surgical and endoscopic expertise. METHODS: Patients presenting to the North Colombo Teaching hospital· and the Gastrointerology unit of the National hospital in 2011 were included . All had Tri phasic CT , MRCP or ERCP prior to be discussed at MDT with all the above authors regarding further management. Patients with Bismuth 1 v lesions and unfit for surgery underwent Combination ERCP/doublestenting/RFA of lesion/Rendezvous procedure/Percutaneous, stenting or PTC. RESULTS: 32 patients were treated .5/32 had radical surgical resections (2 extended right hepatectomy with bile duct resecton and lymphadenectomy (BDR+LA), 2 extended left hepatectomy +BDR+LA, and 1 extended heft hepatectomy with BDR+LA+Reconstruction of Right hepatic artery and right portal vein. I underwent segment iii bypass. 7 patients underwent ERCP and serial RFA with stenting. 3/5 patients are alive and disease free at 6-12 months. CONCLUSIONS: Where possible HCC patients should be offered a curative resection. RFA gives longer and better palliation compared to standard stenting. These patients should be managed by a specialized team as aggressive management may improve their survival.
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    Encapsulation of essential oil blend in β-CD nanoparticles as a repellent for slow release
    (Moleclar Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2015) Jayaweera, V.; Eliyapura, A.; Gunasekara, D.; Weerasinghe, L.; Gunathilaka, P.A.D.H.N.; Abeyewickreme, W.; Karunaratne, V.
    BACKGROUND: Malaria, dengue, and other tropical diseases carried by arthropods such as mosquitoes, ticks and fleas have greatly affected life expectancy, infant mortality, quality of life and work productivity. Essential oils such as citronella, lemon eucalyptus, peppermint, lemon, eucalyptus, lemongrass, geranium, and lavender are known for their mosquito repellency. Due to high volatility of essential oils, these are needed to be reapplied to the skin every 30–60 minutes. Therefore, development of a long lasting mosquito repellent is needed for effective repellent activity. The aim of this experiment is to develop a new blend which encompasses citronella, lemon eucalyptus, lemon and lavender. This oil blend is encapsulated using β-Cyclodextrin (β-CD) to decrease the volatility of the oil blend and increases the long-lasting repellency. METHODS: Citronella, lemon eucalyptus, lemon and lavender were obtained in 15% v/v, 15% v/v, 1% v/v and 1% v/v respectively for a total volume of 100 ml. These oils were mixed with 0.2% w/v of β-Cyclodextrin for encapsulation. The blend was sonicated for 20 min and dissolved in ethanol. This final encapsulated mixture was subjected to bioassays using 110 adult Aedes albopictus mosquitoes against the control. Sitting and biting mosquito behavior patterns were studied against the releasing time. RESULTS: The bioassay results indicated that the encapsulated repellent product is effective against the mosquitos up to 6 hours with zero sitting and biting comparatively to the control. In the 7th hour showed single mosquito sitting with zero biting. CONCLUSION: The encapsulated repellent is effective against the Ae, albopictus mosquitoes for 6 hour time period. Therefore, it is a long-lasting repellent that protect against dengue fever caused by mosquitoes.
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    Association between serum homocysteine and markers of insulin resistance
    (Sri Lanka Medical Association, 2010) Chackrewarthy, S.; Wijayasinghe, Y.S.; Gunasekara, D.; Wickremasinghe, A.R.; Kato, N.
    OBJECTIVE: To investigate the association between serum homocysteine and markers of insulin resistance in a Sri Lankan population. Similar studies conducted in other ethnic groups have shown conflicting results. METHODS: 177 apparently healthy volunteers (91 men and 86 women) aged 35-65 years were randomly selected from residents in the Ragama MOH area. Anthropometric indices and blood pressure were measured and information on diet, lifestyle factors and medical history were recorded. Fasting plasma glucose and serum levels of homocysteine, insulin, creatinine, folate and lipid profiles were determined using standard protocols. RESULTS: Mean fasting serum homocysteine levels were higher in males compared to females (14.67 (imol/1 ± 6.02 Vs.10.16 u.mol/1 ± 4.28, p
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    The Burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka
    (Wiley-Blackwell, 2013) Pinidiyapathirage, M.J.; Kasturiratne, A.; Ranawaka, U.K.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Warnakulasuriya, T.; Wickremasinghe, A.R.
    AIMS: To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS: Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes
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