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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Prevalence and associated factors of burnout among doctors working in hospitals with COVID-19 treatment units in Anuradhapura district, Sri Lanka during the COVID-19 pandemic: A descriptive cross-sectional study(Sri Lanka Medical Association, 2023) Rambukwella, G.U.; Isuru, A.; Ediriweera, D.INTRODUCTION: The COVID-19 pandemic led to an enormous burden on the already compromised health system, particularly in remote areas of the country. Evaluation of the rate of burnout among doctors working in COVID-19 units is important to understand the extent of the issue and for planning interventions. OBJECTIVES: To estimate the prevalence and associated factors of burnout among doctors working in hospitals with COVID-19 treatment units in Anuradhapura district. METHODS: A cross-sectional descriptive study was conducted among doctors working in hospitals with COVID-19 treatment units in Anuradhapura District of Sri Lanka during the third wave of the pandemic. The calculated sample size was 383. Self-administered data collection form was designed as an online and printed forms. Burnout was assessed using the Professional Fulfilment Index. Prevalence rates and associated factors for burnout were evaluated, and the binary logistic regression method was used to identify the risk factors of burnout. RESULTS: The prevalence of burnout was 41.6% (95%CI:36.6-46.7). Binary logistic regression analysis showed lack of professional fulfilment (OR=2.79,95%CI:1.69-4.65,p=0.0001), excessive workload (OR=3.87,95%CI:2.30-6.62,p=0.0000), lack of psychological support from services (OR=1.86,95%CI:1.07-3.30,p=0.0300), lack of psychological support from family (OR=1.95,95%CI:1.14-3.37,p=0.0159), being an intern house officer (OR=4.06,95%CI:1.27-13.45,p=0.0193), and less number of years of work experience (OR=3.52,95%CI:1.54-8.62,p=0.0040) as risk factors for developing burnout in this study population. CONCLUSIONS: The prevalence of burnout was high among doctors working in hospitals with COVID-19 units in rural Sri Lanka. Addressing this important issue is vital to improving the quality of life of doctors and the services they rendered during any crisis situation such as the COVID-19 pandemic.Item Prevalence and correlates of cognitive impairment in schizophrenia: a cross-sectional study from a teaching hospital southern Sri Lanka(BioMed Central, 2022) Goonathilake, P.; Ediriweera, D.; Ruban, R.; Isuru, A.Introductions: This study assessed the prevalence of cognitive impairment, the degree of impairment in individual cognitive domains and sociodemographic and clinical correlates among patients attending to psychiatry clinics at Teaching Hospital, Karapitiya, Sri Lanka. Methods: A cross-sectional study was carried out at the psychiatry outpatient clinics of Teaching Hospital, Karapitiya, Sri Lanka. Their cognitive functions were assessed using the culturally validated Sinhala version of Addenbrooke's Cognitive Examination - III (ACE-III-S). ACE-III-S score below 85.5 was considered as significant cognitive impairment. Linear regression analysis was used to assess the factors associated with cognitive impairment. A P value of 0.05 is considered significant. Results: One hundred forty patients with schizophrenia were assessed. Of this, 125 patients had significant cognitive impairment with a prevalence of 89.3% (95% CI:84.1-94.5). Impairment in each cognitive domain was as follows: 60% in attention, 65.7% in memory, 55% in fluency, 61.4% in language, and 63.6% in visuospatial skills. Impairment was not different between cognitive domains. Advancing age (P < 0.001), shorter duration of formal education (P = < 0.001), longer duration of illness (P = < 0.001) and not having a full-time employment (P = 0.020) showed a positive association with cognitive impairment. Conclusions: Nine out of ten patients with schizophrenia experienced significant cognitive impairment. Patients showed more than 50% impairment in all cognitive domains. The cognitive domains did not show disproportionate impairment. This study highlights the importance of introducing routine cognitive assessment protocols in patients with schizophrenia.Item Prevalence and correlates of depression in patients with epilepsy in Sri Lanka(The Sri Lanka Medical Association, 2021) de Silva, S.; Isuru, A.; Rodrigo, A.; Kuruppuarachchi, L.Background: Depression is one of the most common psychiatric disorder in patients with epilepsy and it is often associated with poor quality of life, increased risk of suicide and poor seizure control, yet remains underdiagnosed and undertreated. The prevalence and associations for depression in patients with epilepsy vary between studies reflecting regional and cultural influences. Therefore, it is important to identify unique attributes within a community on this phenomenon This is the first study from Sri Lanka on the prevalence and correlates of depression in patients with epilepsy. Method: We conducted this cross-sectional study at the Epilepsy clinic, Colombo North Teaching Hospital, Ragama. All consenting patients with a diagnosis of epilepsy followed up at the clinic, during study period, were enrolled. Symptoms of depression were screened with Beck Depression Inventory II and diagnosis was confirmed with a clinical assessment by psychiatrist. Results: Of 150 participants, majority were female 63.3%. (95) and 36.7% (55) of the sample were between 26-45 years. The prevalence of depressive disorder was 22% (33). The prevalence of depression was significantly associated with the recent diagnosis of epilepsy, use of multiple antiepileptic medications and duration of seizure free period (p<0.05). There is a statistically significant association between prevalence of depression with the use of carbamazepine, topiramate, clobazam and phenobarbitone. Regression analysis revealed higher the duration individuals suffering from epilepsy were at lower odds of having depression compared with that of individuals suffering from lower duration of epilepsy. For each year in increase of duration of epilepsy, the odds of depression decreased by 2% (95% CI 0.3% to 5.1%) Conclusion: The prevalence of depression is high in patients with epilepsy. Risk of having depression is higher during the early phase of the illness. Therefore, it is important to screen patients with epilepsy for depressive disorder during the early course of the illness.Item Locked in grief: a qualitative study of grief among family members of missing persons in southern Sri Lanka(BioMed Central, 2021) Isuru, A.; Bandumithra, P.; Williams, S.S.Introduction: The psychological and social issues experienced by family members of missing persons are diferent from normal grief following the death of a loved one. The term “Ambiguous loss” describes this psychological phenomenon. Ambiguous loss acts as a barrier to adjusting to grief, leading to symptoms of depression and intra and interpersonal relational conficts. An in-depth phenomenological understanding of this subjective experience is important. Method: A qualitative study was conducted among close family members of persons who had gone missing during the civil confict and the 2004 tsunami in southern Sri Lanka following formal ethical approval from an university ethics review committee. Purposive and snowballing sampling methods were used to recruit the participants. Theoretical sample saturation was achieved with 24 family members of missing persons. Responders were mothers, fathers, wives, husbands, and siblings of missing individuals. In-depth interviews were recorded with the help of a semi-structured guide, after informed consent. The recordings were transcribed and coded by three independent investigators. The investigators through consensus arrived at the phenomenological themes and grounded them through refexivity. The triangulation process involved cross-checking observational notes made by the interviewers and consulting the interviewees. Results: We interviewed 24 frst degree relatives of missing individuals. Twenty-one of the interviewees were unsure about the fate of the missing individual, while three of them believed the missing individual to be dead. Of the 24 missing individuals, 20 were males and 18 had gone missing in civil conficts and 6 in the Indian Ocean Tsunami. Six predominant phenomenological themes were identifed. Those were lack of closure, hope, guilt, helplessness, perpetual sufering, and an emotional vacuum. These phenomenological experiences are highlighted by the interviewees through a range of utterances that hold profound cultural, social and emotional signifcance of unresolved and vacillating grief. Conclusion: The highlighted phenomenology of grief in surviving family members of those who go missing following traumatic events demands a response from health and social services in every country that experiences disaster. The surviving loved one is ‘locked in grief’ indefnitely and future research on evidence-based interventions to overcome this predicament is warranted.Item Betel-quid use and its effects on symptoms of schizophrenia and extrapyramidal symptoms among a group of patients in a tertiary care hospital in Sri Lanka.(Sri Lanka College of Psychiatrists, 2020) Isuru, A.; Ediriweera, D.; Pathmeswaran, A.; Embuldeniya, A.; Narammalage, H.; Warnakulasuriya, S.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.BACKGROUND: There is limited research regarding the prevalence of betel quid use and its effects on symptoms of patients with schizophrenia. Available studies suggest an association between betel chewing and positive symptoms among males with schizophrenia. AIMS: This study aimed to compare the prevalence of betel quid chewing between patients with and without mental illness, and to explore the association between betel quid use, symptoms of schizophrenia and side effects of psychotropic medication. METHODS: A cross sectional descriptive study was carried atoutpatient clinics at a tertiary care hospital in Sri Lanka. A structured interview schedule was administered to all participants. RESULTS: Out of 1000 participants, 20.9% chewed betel quid (95%CI: 18.4% - 23.4%). The rate of betel chewing among patients with and without a mental illness was 20.7% (95% CI: 17.0% - 24.4%) and 21.0% (95% CI: 17.6% - 24.5%) respectively and there was no significant difference between the two groups. There was no statistically significant difference between the occurrence of positive or negative symptoms and extra pyramidal side effects in patients with schizophrenia who did and did not chew betel. Female gender (p=0.004) and betel quid chewing (0.002) were associated with more anticholinergic side effects. CONCLUSIONS: There was no association between betel quid usage and the occurrence of positive or negative symptoms of schizophrenia or extra pyramidal side effects. KEYWORDS: Schizophrenia, Betel quid, Positive symptoms, Negative symptoms, Extra pyramidal side effectsItem A Randomized, double-blind, placebo-controlled trial on the role of preemptive analgesia with acetaminophen [paracetamol] in reducing headache following electroconvulsive therapy [ECT](BioMed Central, 2017) Isuru, A.; Rodrigo, A.; Wijesinghe, C.; Ediriweera, D.; Premadasa, S.; Wijesekera, C.; Kuruppuarachchi, L.BACKGROUND: Electroconvulsive therapy (ECT) is a safe and efficient treatment for several severe psychiatric disorders, but its use is limited by side effects. Post-ECT headache is one of the commonest side effects. Preemptive analgesia is effective in post-surgical pain management. The most commonly used analgesic is acetaminophen (paracetamol). However, acetaminophen as a preemptive analgesic for post-ECT headache has not been studied adequately. This study was conducted to compare the incidence and severity of post-ECT headache in patients who were administered acetaminophen pre-ECT with a placebo group. METHODS: This study was a randomised, double-blind, placebo-controlled trial. Sixty-three patients received 1 g acetaminophen and 63 patients received a placebo identical to acetaminophen. The incidence and severity of headache 2 h before and after ECT were compared between placebo and acetaminophen groups. The severity was measured using a visual analog scale. Generalised linear models were used to evaluate variables associated with post ECT headache. RESULTS: Demographic and clinical variables of placebo and acetaminophen groups were comparable except for the energy level used to induce a seizure. Higher proportion of the placebo group (71.4%) experienced post-ECT headache when compared to the acetaminophen group (p < 0.001). The median pain score for headache was 0 (Inter quartile range: 0-2) in acetaminophen group whereas the score was 2 (IQR: 0-4) in placebo group (P < 0.001). Model fitting showed that the administration of acetaminophen is associated with less post-ECT headache (odds ratio = 0.23, 95% CI: 0.11-0.48, P < 0.001). CONCLUSION: A significant reduction was seen in both the incidence and severity of post-ECT headache with preemptive analgesia with acetaminophen.