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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Use of fiber optic goniometer to objectively assess the angle and reflex time of knee jerk in professional rugby players(Edizioni Minerva Medica, 2022) Senavirathna, C.S.; Gunawardena, S.; Karunanayake, A.L.; Mallawaarachchi, A.P.BACKGROUND: Rugby, being a contact and collision game, results in sudden application of forces on lower limb muscles which may injure them unless an immediate reflex contraction of the muscle occurs. This study aimed to assess the knee jerk reflex parameters of professional rugby players. METHODS: Knee jerk parameters (latency, peak time, total duration, relaxation time and angle) of rugby players were assessed. The angle was measured by a bipolar joint angle sensor in the fiber optic goniometer. An electronic tendon hammer was used to elicit the knee jerk. These instruments were connected to a data acquisition hardware and data were recorded on LabChart 8 software (AD Instruments,Sydney,Australia).RESULTS: Mean (SD) of age, height, weight and BMI were 27.4 (3.9) years, 1.72 (0.07) m, 83.4 (14) kg and 27.8 (4.3), respectively (N.=59). There is no correlation between BMI and reflex parameters (P>0.05 for all parameters). Knee jerk parameters from left and right sides did not show a statistically significant difference (P>0.05). Similarly, there was no statistically significant difference between the dominant and non-dominant sides. Individual parameters measured in right side showed a significant correlation (P<0.01) to their counterparts from the left. Latency showed a negative correlation with other parameters from the same leg while other parameters showed a positive correlation between each other. CONCLUSIONS: A fiber optic electronic goniometer and an electronic tendon hammer along with data acquisition hardware and software can be used to objectively measure knee jerk parameters of rugby players.Item The effect of 6-week core stability training on core endurance and physical performance in professional rugby players: A randomized controlled pilot study(Nepal Journal online, 2021) Senavirathna, C.S.; Mallawaarachchi, A.P.; Karunanayake, A.L.; Gunawardena, S.BACKGROUND: Core stability training (CST) is used to enhance sports performance. The relationship between core endurance and physical performance in rugby players had not been evaluated before in Asia. AIMS AND OBJECTIVES: This study aims to determine the effects of a 6-week specific CST program on the core endurance and physical performances (speed, upper body power, lower body power, and agility) following a CST intervention in male rugby players. MATERIALS AND METHODS: Professional rugby players (n=8, intervention and n=8, control) were randomly selected. Mean (SD) age, height and weight of intervention group were 25.25 (2.4) years, 1.64 (0.03) m, and 69.6 (14.9) kg, respectively. In the control group, corresponding values were 29.75 (4) years, 1.66 (0.04) m, and 72.3 (19.1) kg, respectively. Intervention group was trained CST sessions complementary to the usual physical training, 3 times/week for 6 weeks. The control group followed the usual physical training. Subjects were tested for four physical performances (using 40 m sprint, vertical jump, 3 kg medicine ball put, and agility T tests) and four core endurance tests (back extension, abdominal fatigue [AF], and left and right bridges). RESULTS: AF, left bridge, right bridge, and total core endurance were significantly increased in the intervention group (P=0.028, P=0.006, P= 0.008, and P=0.001, respectively). Agility and AF were increased significantly in the control group (P=0.048, P=0.027). The right side bridge endurance (P=0.024) was significantly increased in the intervention group compared to the control group. CONCLUSION: The results suggest that the CST improves core endurance without improving physical performances in rugby playersItem Anatomical variations of the common peroneal nerve (cpn) and the deep pereoneal nerve (dpn) in the lateral compartment of the leg: A cadaveric study(College of Surgeons of Sri Lanka, 2015) Salgado, L.S.S.; Karunanayake, A.L.; Hasan, R.; Salvin, K.A.; Fernando, E.D.P.S.; Ranaweera, M.S.L.; Padeniya, A.G.P.M.; Senevirathne, S.P.; Ranaweera, K.R.K.L.K.INTRODUCTION: The aim of this study is to demonstrate anatomy of CPN and DPN in the lateral compartment and identify high risk area/s which is important in high tibial osteotomy, in total knee arthroplasty, in external fixation of leg and CPN decompression surgery. MATERIAL AND METHODS: Thirty cadaveric legs (female-14, male-16) were dissected to demonstrate the bifurcation of the CPN and the exit point of the DPN from the lateral compartment. The ethical clearance was obtained. RESULTS: None of the specimens showed bifurcation of the CPN proximal to the apex of the fibular head. Musculoaponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The mean distance from the apex of the fibular head to the opening of the fibular tunnel was 28.4mm (SEM±1.4mm). Of 30 specimens respectively 21(70%), 7(23.33%) and 2(6.66%) had bifurcation vertically distal to, on and proximal to the entry point with the average of 8.0mm and 12.0mm from the entry point. Eleven legs had muscular branches of the DPN in the lateral compartment of the leg. The mean exit point of the DPN/its longest muscular branch was observed 66.5mm (SEM±2.6mm) distal to the apex of the fibular head. CONCLUSIONS: Variations of the CPN bifurcation in relation to the fibular tunnel and muscular branches of the DPN in the lateral compartment were observed. From the apex of the fibular head, distance of 25.6mm-71.6mm was identified as the high risk area for surgeries involving in the upper part of the lateral compartment.Item Anatomical variations of the musculocutaneous nerve - A cadaveric study(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.Item Variants of acan gene associate with severity of lumbar disc degeneration(Sri Lanka Medical Association, 2016) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Structural integrity of aggrecan (coded by ACAN gene) plays a major role in lumbar disc degeneration (LDD). Single nucleotide polymorphisms (SNPs) of ACAN gene have been implicated in LDD. The study aimed to determine the associations between SNPs of ACAN gene and the severity of disc space narrowing (DSN) and osteophytes (OS) of lumbar spine in patients with chronic mechanical low back pain (CMLBP). METHOD: A descriptive cross-sectional study was carried out on 120 patients with CMLBP. Lateral lumbar X-rays were assessed for severity of DSN and OS using a semiquantitative scores (grade 0-3). Twenty-seven exonic SNPs of the ACAN gene were genotyped on a Sequenom mass array iPLEX platform. Multiple linear regression analysis was carried out adjusting for age and body mass index. RESULTS: Mean age was 51.46 ± 10.43 years. 82 (68.3%) were females. 30 (25%) were obese. 31 (25.8%) and 47 (39.2%) had grade 1 DSN and AOS respectively, while 42 (35%) and 13 (10.8%) had grade ≥ 2 DSN and AOS, respectively. “A” allele of rs2882676 (regression coefficient (β) = -0.25, p<0.03), “A” allele of rs1042630 (β = -0.28, p<0.01) and “T” allele of rs1042631 (β = -0.28, p<0.02) were negatively associated with the severity of DSN. “T” allele of rs16942341 (β = 0.4, p<0.02) and “G” allele of rs28407189 (β = 0.4, p<0.02) were positively associated with the severity of AOS. CONCLUSION: SNPs of ACAN gene are associated with severity of degenerative changes of the lumbar spine.Item Single nucleotide variants of candidate genes in aggrecan metabolic pathway are associated with lumbar disc degeneration and modic changes(Public Library of Science, 2017) Perera, R.S.; Dissanayake, P.H.; Senarath, U.; Wijayaratne, L.S.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION: Lumbar disc degeneration (LDD) is genetically determined and severity of LDD is associated with Modic changes. Aggrecan is a major proteoglycan in the intervertebral disc and end plate. Progressive reduction of aggrecan is a main feature of LDD and Modic changes. OBJECTIVES: The study investigated the associations of single nucleotide variants (SNVs) of candidate genes in the aggrecan metabolic pathway with the severity of LDD and Modic changes. In-silico functional analysis of significant SNVs was also assessed. METHODS: A descriptive cross sectional study was carried out on 106 patients with chronic mechanical low back pain. T1, T2 sagittal lumbar MRI scans were used to assess the severity of LDD and Modic changes. 62 SNVs in ten candidate genes (ACAN, IL1A, IL1B, IL6, MMP3, ADAMTS4, ADAMTS5, TIMP1, TIMP2 and TIMP3) were genotyped on Sequenom MassARRAY iPLEX platform. Multiple linear regression analysis was carried out using PLINK 1.9 in accordance with additive genetic model. In-silico functional analysis was carried out using Provean, SIFT, PolyPhen and Mutation Taster. RESULTS: Mean age was 52.42±9.42 years. 74 (69.8%) were females. The rs2856836, rs1304037, rs17561 and rs1800587 variants of the IL1A gene were associated with the severity of LDD and Modic changes. The rs41270041 variant of the ADAMTS4 gene and the rs226794 variant of the ADAMTS5 gene were associated with severity of LDD while the rs34884997 variant of the ADAMTS4 gene, the rs55933916 variant of the ADAMTS5 gene and the rs9862 variant of the TIMP3 gene were associated with severity of Modic changes. The rs17561 variant of the IL1A gene was predicted as pathogenic by the PolyPhen prediction tool. CONCLUSIONS: SNVs of candidate genes in ACAN metabolic pathway are associated with severity of LDD and Modic changes in patients with chronic mechanical low back pain. Predictions of in-silico functional analysis of significant SNVs are inconsistent.Item Gross anatomical variations of lumbar vasculature among Sri Lankan adults: a cadaveric study(Sri Lanka Medical Association, 2003) Karunanayake, A.L.; Jayasinghe, J.A.P.; Wijayaratne, L.S.; Pathmeswaran, A.BACKGROUND: Lumbar arteries supply intervertebral discs, vertebrae, muscles and ligaments in the lumbar region. Lumbar arteries can get damaged during urological and vascular surgery. According to textbooks of anatomy there are four pairs of lumbar arteries arising as individual stems from abdominal aorta and they travel posterior to crura of the diaphragm. There are no published studies in Sri Lanka either confirming this or describing the variations of lumbar arteries. OBJECTIVE: To describe the anatomy of lumbar arteries with regard to their numbers, origin and pathway. MATERIALS AND METHODS: This descriptive study was done on cadavers in anatomy departments of Kelaniya, Colombo and Sri Jayawardenepura Universities. Lumbar arteries were cleared from the origin of the abdominal aorta up to the point of passing deep to the Psoas major muscle. Their origin, number and pathway were noted. RESULTS: Dissected 109 cadavers. Ages ranged 43 -90 years. Mean age 70 years (SD 13.6). Males constituted 57% of the sample. The number of lumbar arteries varied from 3-5 pairs. In 12% of cadavers lumbar arteries originated as a common stem from the aorta and divided into two. These arteries traveled anterior to crura of the diaphragm in 17% of cadavers. CONCLUSIONS: There were variations with regard to the number, origin from abdominal aorta and pathway of lumbar arteries from what is described in textbooks. These findings will be useful for surgeons performing retroperitoneal surgery.Item Radiological features of chronic low back pain (LBP) in adult Sri Lankans; A case control study(Sri Lanka Medical Association, 2003) Karunanayake, A.L.; Fonseka, M.M.D.; Pathmeswaran, A.; Wijayaratne, L.S.BACKGROUND: Chronic LBP affects 30% of adult Sri Lankans. The presence of vertebral osteophytes, spondylolisthesis and disc space narrowing are thought to be important contributing factors of LBP. No studies have been done in Sri Lanka, investigating the importance of these in LBP. Objective: To determine the association between chronic LBP and vertebral osteophytes, spondylolisthesis and disc space narrowing. MATERIALS AND METHODS: A case control study was done in two hospitals in Ragama. Cases and controls were selected from medical, surgical and orthopaedic wards and clinics. They were matched for age and sex. Subjects who were 18 years and above with chronic LBP (more than three months) were selected as cases. Patients who were 18 years and above without LBP were selected as controls. They had symptoms such as abdominal pain and dysuria requiring radiography. In both groups postero-anterior and lateral radiographic appearances of the lumbar spine were studied. RESULTS: There were 130 cases and 130 controls. Age range was 18 -82 years. Mean age of patients was 49.3 years (SD 15). Mean age of controls was 51.4 years (SD 17). Females constituted 62% of cases and controls. Vertebral osteophytes were present in 72% of cases and 64% of controls (P = 0.184). Spondylolisthesis was present in 8% of cases and 7% of controls (P = 0.959). Disc space narrowing was present in 15% of cases and 2% of controls (OR = 7.8, P =0.0004). CONCLUSIONS: Disc space narrowing was significantly higher in patients with LBP.Item Effect of atherosclerosis on lumbar intervertebral disc cells in a sample of Sri Lankan population: a postmortem study(Sri Lanka Medical Association, 2004) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.; Fonseka, M.M.D.BACKGROUND: Disc degeneration is an important cause of low backache. The cartilage cells of the disc are important to maintain the structure and function of intervertebral discs. Lumbar arteries provide blood supply to lumbar discs. OBJECTIVE: To describe the association between cell density of fourth lumbar intervertebral disc and atherosclerotic changes of fourth lumbar artery openings. METHODS: Descriptive study was done on 4th lumbar intervertebral disc and 4lh lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs. Atherosclerotic changes of lumbar artery openings were studied. By using a graticule number of cells per 4mm" were counted in each disc specimen in ten low power fields and mean cell density was calculated. Cell density of less than three was categorized as low cell density. Atherosclerotic changes of lumbar arteries were graded into three groups according to severity. Grade 1 was the least severe and grade 3 was the most severe. The chi-square for trend was used to find the association between the atherosclerotic changes of lumbar arteries and the cell density. RESULTS: 31 postmortem specimens. Age range 21 - 96 years. Median age 43 years. There was a significant association (P = 0.005) between atherosclerotic changes of lumbar arteries and low cell density. OR for gradcl, grade 2 and grade 3 was I, 4.5 and 18 respectively. CONCLUSIONS: Atherosclerotic changes of lumbar arteries had a significant negative association with the cell density.Item Association between pain and disability in patients with chronic mechanical low back pain(Sri Lanka Medical Association, 2015) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Low back pain is the leading cause of years lived with disability in developed countries as well as in South Asian countries. The aim of this study is to evaluate the association between the intensity of pain and disability in patients with chronic mechanical low back pain (CMLBP) who attended the rheumatology clinic, National Hospital of Sri Lanka (NHSL). METHOD: This is a descriptive study on 675 patients with CMLBP who attended the rheumatology clinic, NHSL, from May 2012 to May 2014, recruited according to inclusion and exclusion criteria. Intensity of pain was measured using the 101-point numerical pain rating scale (NRS) and the disability was measured using the modified Oswestry Disability Index (MODI). A multiple linear regression model adjusted for age, gender, level of education, duration and frequency of pain and duration of treatment was used to assess the association between the intensity of pain and disability. RESULTS: Majority (482, 71.4%) were females. Mean age was 49.19 ± 11.75 years. Mean score for NRS was 46.79 ± 20.38 and for MODI was 31.77 ± 14.16, while 84.3% had daily pain. Intensity of pain was positively associated with the disability (p<0.01) and the standardized regression coefficient was +0.627 after adjusting for confounders. Frequency of pain, female gender and aging were positively associated with disability (p<0.05) while level of education, and durations of pain and treatment did not reach significant level. Conclusion: Intensity of pain explains 63% of the disability associated with CMLBP. Frequency of pain, female gender and age were also associated with disability.