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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Chronic musculoskeletal symptoms following COVID-19 in a cohort of Sri Lankan patients(Ceylon College of Physicians, 2022) Kurukulasuriya, S.A.; Karunanayake, A.L.INTRODUCTION AND OBJECTIVES: Musculoskeletal symptoms of myalgia and arthralgia after recovery of COVID-19 is a pressing issue. Objective of this study was to assess the prevalence of persistent myalgia and arthralgia and likelihood of developing rheumatoid arthritis (RA), six weeks following COVID-19. METHODS: A descriptive longitudinal study was conducted in selected private sector hospitals in Colombo, Sri Lanka. PCR positive COVID-19 patients were recruited by consecutive sampling until required sample size of 333 was fulfilled. They were contacted over the phone six weeks after the discharge. Interviewer administered questionnaire was used to evaluate the presence of symptoms of myalgia and arthralgia. Those with positive symptoms were invited for a consultation to conduct further investigations. RESULTS: Of the 333 patients, 96 (28.8%) had persistent arthralgia, myalgia or both, six weeks after recovery from COVID-19. Among them, 56.3% had only arthralgia, 10% had only myalgia and 33% had both myalgia and arthralgia. Two patients (4.8%; 95% CI: 0.6-16.2%) were confirmed of having RA. CONCLUTIONS: More than one fourth of patients, suffered with persistent symptoms of myalgia and arthralgia six weeks following COVID-19 and 2 patients (4.8%) were confirmed to have rheumatoid arthritis..Item Effectiveness of anapana, body scan and metta meditation techniques on chronic neck and shoulder region pain and disability in adult patients in Sri Lanka: study protocol for a cluster clinic-level randomised controlled trial(BioMed Central, 2022) Karunanayake, A.L.; Solomon-Moore, E.; Coghill, N.Background: Chronic neck and shoulder region pain affects many people around the world. This study aims to compare the effectiveness of three 8-week meditation training programmes (each using a different meditation technique: Anapana, Body scan or Metta) on pain and disability in a patient population affected with chronic neck and shoulder region pain, with a usual care control group and with each other. Methods: This four-arm parallel clinic-level randomised controlled trial will be conducted with male and female patients aged 18-65 years, who are affected with chronic neck and shoulder region pain, and who attend one of four clinics held on four different days of the week in a single medical centre in the Colombo North region, Sri Lanka. Clinics will be considered as clusters and randomly allocated to intervention and control arms. Data will be collected using validated questionnaires, clinical examinations and focus groups. To compare primary (differences in changes in pain (Numeric Pain Rating Scale) at 8 weeks) and secondary (differences in changes in pain, physical disability, range of movement and quality of life (SF-36) at 4 and 12 weeks) outcomes between groups, a two-way ANOVA will be used if data are normally distributed. If data are not normally distributed, a nonparametric equivalent (Kruskal-Wallis) will be used. Focus group transcriptions will be thematically analysed using the Richie and Spencer model of qualitative data analysis. Discussion: This is a four-arm trial which describes how three different 8-week meditation technique (Anapana, Body Scan, Metta) interventions will be implemented with adult patients affected with chronic neck and shoulder region pain. The effectiveness of each meditation intervention on the pain, physical and psychosocial disabilities of patients will be compared between groups and with a usual care control group. The results of this study will contribute to recommendations for future meditation interventions for chronic neck and shoulder pain.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 Physical modalities used in rehabilitation of musculoskeletal injuries sustained during sports and physical exercises (Review Articles )(Sri Lankan Sports Medicine Association, 2020) Karunanayake, A.L.ABSTRACT: Injuries are common during sports and exercise. In addition to medication, physical exercise and massage therapy, rehabilitation specialists use a variety of physical modalities to reduce pain, facilitate healing and restore function. These include the use of therapies such as cold, heat, light, ultrasound, extra corporeal shock wave and electrical stimulation. However, if used in an incorrect manner these modalities can cause further harm and delay healing. Hence proper usage is important to maximize benefits and avoid harmful effects. This narrative review will discuss the different physical modalities and techniques, together with their indications, contraindications and techniques of usage. KEYWORDS: Physical modalities, Rehabilitation, MusculoskeletalItem Hand book on examination of spine, upper limb joints and lower limb joints : book 1(S. Godage & Brothers, 2011) Karunanayake, A.L.No abstract availableItem Effectiveness of early stretching exercises for range of motion in the shoulder joint and quality of functional recovery in patients with burns - a randomized control trial(Tirupati: IJPHY publishers, 2017) Perera, A.D.; Perera, C.; Karunanayake, A.L.BACKGROUND; This study evaluated the effects of an early stretching exercises programme on the range of motion of the shoulder joint and functional recovery in patients with burns. METHODS; A randomized controlled study was conducted. Patients from 15 to 55 years of age with a total burn injury surface area (TBSA) of 10% to 45% involving the shoulder joint including axilla were eligible. Participants were randomized into two groups&59; intervention and a usual care control group, with 110 patients in each group. A standardized protocol was used in the management of intervention group for 14 days. The control group was subjected to usual protocol currently used. The range of Motion (ROM) was measured, and Functional recovery (FR) was assessed with the Quick DASH questionnaire and the Abduction Ladder. Data were obtained before and after the intervention phase and at 3, 6 and 12 months of post-burn period. RESULTS; The mean (SD) age of intervention group and control group were 29.76 &91;9.81&93; and 30.31 &91;9.45&93; respectively. The mean (SD) TBSA% of intervention group and control group was 26.15&91;9.45&93; and 24.60&91;9.56&93; respectively. There is a significant beneficial difference (p&61;&60;0.0001) in ROM and FR between the intervention group and the control group. CONCLUSION; This study demonstrated that an early sustained stretching exercise regime significantly improved the ROM and functional recovery of the shoulder joint after a severe burn involving the axilla.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.