Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
16 results
Search Results
Item Associations of emotional behavior with nutritional status and lifestyle habits among schoolchildren aged 5-10 years in Sri Lanka.(Basel : MDPI, 2021) Shinsugi, C.; Gunasekara, D.; Takimoto, H.We aimed to examine the relationships of lifestyle habits and nutritional status with emotional behavior among schoolchildren in Sri Lanka. Five hundred and eight schoolchildren (195 boys and 313 girls) aged 5-10 years were included. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire. Nutritional status was used for body mass index-for-age z-score. Breakfast consumption, daily moderate- to vigorous-intensity physical activity (MVPA), wake-up time, and bedtime were considered lifestyle habits. The mean total difficulties score ± standard deviation was 12.0 ± 5.3, and the mean prosocial behavior score was 7.4 ± 1.9. In total, 89.2% children ate breakfast, and 41.3% engaged in at least 60 min of MVPA per day. After adjustment for confounding factors, multiple logistic regression analyses showed that breakfast skipping was associated with high scores on conduct problems (adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI): 1.50 to 5.77, p < 0.01) and that late bedtime was related to low prosocial behavior scores (aOR = 2.43, 95% CI: 1.17 to 5.03, p < 0.05). Our findings suggest that promoting regular lifestyle habits helps reduce psychological difficulties in schoolchildren. However, further research, including longitudinal studies, are required to identify the mechanism underlying this relationship.Item Detection of Leishmania donovani DNA within field-caught Phlebotomine Sand Flies (Diptera: Psychodidae) in three cutaneous leishmaniasis endemic foci of Kurunegala District, Sri Lanka(Hindawi Pub. Corp., 2021) Wijerathna, T.; Gunathilaka, N.; Gunawardena, K.; Fujii, Y.; Gunasekara, D.ABSTRACT: Leishmaniasis is a parasitic infection transmitted through the bite of female phlebotomine sand flies. Microscopy is the gold standard to detect parasites within the sand flies and for vector incrimination. However, molecular-based detection has become more popular nowadays in the identification of Leishmania parasites since it provides detection and species identification simultaneously with no need of laborious procedures. The entomological surveys were conducted monthly from May to October 2017 using standard entomological techniques. Field-caught sand flies were identified to the species level followed by DNA extraction. The polymerase chain reaction (PCR) was performed using species-specific primers to detect Leishmania donovani parasites. A total of 1,662 sand flies were encountered from the entomological surveys, and the majority of them were Phlebotomus argentipes (n = 1517; 91.27%), while others were Sergentomyia punjabiensis (n = 140; 8.72%). Leishmania donovani parasite DNA was detected only from P. argentipes (2.3%; n = 2). The detection of Leishmania DNA in P. argentipes suggests the possible role of this species as a vector for leishmaniasis in Sri Lanka.Item 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.Item Correction: Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka.(Public Library of Science, 2020) Shinsugi, C.; Gunasekara, D.; Gunawardena, N.K.; Subasinghe, W.; Miyoshi, M.; Kaneko, S.; Takimoto, H.[This corrects the article DOI: 10.1371/journal.pone.0224222.]. Erratum for Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka. PLoS One.2019;14(10):e0224222.Item Descriptive Investigation of Strongyloidiasis Infection and Characterization of Strongyloides stercoralis Using Morphological and Molecular-Based Methods(Hindawi Pub. Corp., 2020) Gunathilaka, N.; Chandrasena, N.; Wijerathna, T.; Fuji, Y.; Gunasekara, D.; Gunatilaka, R.P.; Premaratna, R.ABSTRACT: Strongyloidiasis is caused by the nematode Strongyloides stercoralis which has the unique ability to reproduce and complete its entire life cycle within the human host through its autoinfection cycle. Diagnosis of this infection is important because of its potential to cause fatal hyperinfection syndrome or disseminated infections in those with defective cellular immunity. Parasitological methods based on faecal microscopy and culture often fail to detect low-intensity infections. A multiplex polymerase chain reaction (PCR) assay was developed for the detection of S. stercoralis, Ascaris lumbricoides, and Enterobius vermicularis by designing primers specific for the ITS1 region of ribosomal DNA of S. stercoralis and A. lumbricoides and 18S region of rRNA of E. vermicularis. A 61-year-old patient presented with chronic gastrointestinal and respiratory symptoms and weight loss with a stool microscopy positive for helminth larvae. Stool cultures with the Harada-Mori technique yielded L3 larvae which were identified as S. stercoralis based on morphology. The multiplex PCR performed on DNA extracted from stool elicited the expected band at 129 bp on gel electrophoresis of the PCR yield providing molecular evidence of intestinal strongyloidiasis. The patient's gastrointestinal symptoms improved with a six-day course of albendazole (400 mg twice daily). Negative posttreatment stool microscopy, culture, and PCR confirmed successful clearance of infection. Molecular-based PCR assay is a promising tool to diagnose and assess the therapeutic efficacy of anthelmintics in intestinal helminthiases such as strongyloidiasis.Item Use of Mid-Upper Arm Circumference (MUAC) to predict malnutrition among Sri Lankan school children(MDPI Publishing, 2020) Shinsugi, C.; Gunasekara, D.; Takimoto, H.ABSTRACT:The double burden of malnutrition (under- and overnutrition) is a serious public health issue in childhood. The mid-upper arm circumference (MUAC) is a simple tool for screening nutritional status, but studies of the optimal cutoff to define malnutrition are limited. This study aimed to explore the prediction of malnutrition by MUAC in Sri Lankan schoolchildren. The participants were 538 students (202 boys, 336 girls) aged 5-10 years. Spearman's rank correlation was calculated for MUAC and both body-mass-index-for-age z-score (BAZ) and height-for-age z-score (HAZ). Receiver operating characteristic (ROC) analysis was conducted to assess the ability of MUAC to correctly classify malnutrition, after stratifying for age and birth weight. MUAC correlated significantly with BAZ (r = 0.84) and HAZ (r = 0.35). The areas under the ROC curve for thinness, overweight, obesity, and stunting were 0.88, 0.97, 0.97, and 0.77, respectively. The optimal MUAC cutoff values for predicting thinness and stunting were 167.5 mm and 162.5 mm, respectively; the optimal cutoffs for predicting overweight and obesity were 190.5 mm and 218.0 mm, respectively. These cutoffs differed after stratification by age group and birth weight. Our results confirm MUAC to be a useful tool for monitoring growth in schoolchildren. KEYWORDS: BMI-for-age z-score; Sri Lanka; anthropometry; child malnutrition; cutoffs; height-for-age z-score; mid-upper arm circumference; overweight and obesity; schoolchildren; thinness and stunting.Item Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka(Public Library of Science, 2019) Shinsugi, C.; Gunasekara, D.; Gunawardena, N.K.; Subasinghe, W.; Miyoshi, M.; Kaneko, S.; Takimoto, H.Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5-10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child's body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08-5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16-0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition. Erratum in: PLoS One. 2020;15(3):e0230785.Item 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.Item Comparison of urban diabetics with optimal and suboptimal control(BMJ Publishing Group, 2011) Pinidiyapathirage, J.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.INTRODUCTION: The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. METHODS: A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. RESULTS: There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. CONCLUSIONS: Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.Item Risk estimates of cardiovascular diseases in a Sri Lankan community(Sri Lanka Medical Association, 2016) Ranawaka, U.K.; Wijekoon, C.N.; Pathmeswaran, A.; Kasturiratne, A.; Gunasekara, D.; Chackrewarthy, S.; Kato, N.; Wickremasinghe, A.R.OBJECTIVES: Quantifying the risk of cardiovascular disease (CVD) in a community is important in planning preventive strategies, but such data are limited from developing countries, especially South Asia. We aimed to estimate the risks of coronary heart disease (CHD), total CVD, and CVD mortality in a Sri Lankan community. METHODS: A community survey was conducted in an urban health administrative area among individuals aged 35- 64 years, selected by stratified random sampling. Their 10-year CHD, total CVD, and CVD mortality risks were estimated using three risk prediction tools: National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III), Systematic Coronary Risk Evaluation (SCORE), and World Health Organisation/ International Society of Hypertension (WHO/ISH) charts. RESULTS: Among study participants (n=2985), 54.5% were females, and mean age (SD) was 52.4 (7.8) years. According to NCEP-ATP III (‘hard’ CHD risk), WHO/ISH (total CVD risk), and SCORE (CVD mortality risk) criteria, 25.4% (95% CI 23.6-27.2), 8.2% (95% CI 7.3-9.2), and 11.8 (95% CI 10.5-13.1) respectively were classified as at ‘high risk’. The proportion of high risk participants increased with age. ‘High risk’ was commoner among males (30.3% vs 20.6%, p<0.001) according to NCEPATP III criteria, but among females (9.7% vs. 6.7%, p<0.001) according to WHO/ISH criteria. No significant gender difference was noted in SCORE risk categories. CONCLUSIONS: A large proportion of individuals in this community are at risk of developing cardiovascular diseases, especially in older age groups. Risk estimates varied with the different prediction tools, and were comparatively higher with NCEP-ATP III charts.