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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Exploring the impact of occupational exposure: A study on cardiovascular autonomic functions of male gas station attendants in Sri Lanka(Wiley periodicals LLC on behalf of the physiological society and the American physiological society, 2024-10) Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; Rathnayake, P.; Ariyawansa, J.; Dissanayake, T.; Sandeepani, P.; De Silva, D.C.; Devanarayana, N.M.Fuel dispensing at fuel stations is performed manually by unprotected male gas station attendants in Sri Lanka, who have long working hours. These workers are exposed to hydrocarbon fuels associated with multiple health effects by modulation of the autonomic nervous system. This study was performed to determine cardiovascular autonomic functions among fuel pump attendants in Sri Lanka. Fuel pump attendants (n = 50) aged between 19 and 65 years were identified for the study from seven fuel stations. They were compared with age- and gender-matched controls (n = 46) without occupational exposure to fuel. A physical examination was performed before the autonomic function and heart rate variability (HRV) assessment. There were no significant differences in weight, height, or BMI between the study and the control populations (p > 0.05). Both the systolic blood pressure (SBP) (Mann Whitney U (MWU) = 743.5, p = 0.003) and diastolic blood pressure (DBP) (MWU = 686.5, p = 0.001) were significantly higher among the gas station attendants compared to controls. Valsalva ratio was significantly higher among the study group (MW U = 874.00, p = 0.043) compared to controls. The HRV analysis showed significantly higher SDNN and SD2 (MWU = 842.00, p = 0.034, and MWU = 843.50, p = 0.035 respectively) among the gas station attendants compared to controls. The changes to the cardiovascular autonomic parameters among those exposed to fuel vapor as a gas station attendant indicate an increase in sympathetic outflow to the vessels. In the occupational setting as fuel pump attendants need periodic monitoring.Item Comparison of urban diabetics with optimal and suboptimal control(British Medical Association, London, 2011) Pinidiyapathirage, M.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekera, 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 A review of oculotoxicity in iodine overdose(College of Ophthalmologists of Sri Lanka, 2019) Medagoda, K.; Salvin, K.A.Item A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature(Elsevier, 2022) Medagoda, K.; Salvin, K.A.; Mahendra, B.A.G.G.Purpose: This is a case report of a patient with a conjunctival myxoid stromal tumor (COMST), mimicking a phlyctenulosis. Tumors of the conjunctiva and cornea occupy a large spectrum ranging from benign lesions of myxoma to aggressive, life-threatening malignancies. Phlyctenulosis and phlyctenular keratoconjunctivitis are hypersensitivity reactions to a foreign antigen. Observations: A 64-year-old male presented with six-month history of non-painful lump in the conjunctiva of the left eye. It was a mobile, non-tender, non-ulcerated, non-hemorrhagic, non-pigmented lesion and was non-adherent to the sclera. The differential diagnosis of phlyctenulosis or a soft tissue tumor was considered. The lesion was completely excised. The microscopy showed an ill-defined hypocellular myxoid lesion composed of stellate and spindle-shaped cells with eosinophilic cytoplasm, containing round-ovoid and spindle-shaped nuclei with a vesicular chromatic pattern. The tumor cells were diffusely and strongly positive for vimentin and CD 34 and were negative for S100. The immunomorphological features were compatible with a conjunctival myxoid stromal tumor. Complete systemic evaluation excluded the possible association with systemic myxomas. Conclusions and importance: Myxoid tumors of the conjunctiva are benign tumors, however, they can mimic other benign conditions like phlyctenulosis or more sinister lesions like malignant tumors. Therefore, it is important to do an excisional biopsy to ascertain the definitive pathology of an indeterminate conjunctival lesion. COMST may be the index presentation for the detection of previously undiagnosed myxoma syndromes. One such association is with cardiac myxomas, which can result in vascular embolic events. Therefore, it is important to do cardiac screening in all patients diagnosed with a COMST.Item Heterotopic salivary gland tissue in the gastro-oesophageal junction: a rare entity(College of Pathologists of Sri Lanka, 2021) Dharani, K.; Medagoda, K.; Kumarage, S.K.; Mahendra, B.A.G.G.Introduction: Gastric and pancreatic heterotopia are the two most common types of heterotopias seen in the gastrointestinal tract (GIT). These are the two most common types of heterotopias seen in the oesophagus as well. The occurrence of heterotopic salivary gland tissue (HSGT) in the GIT is rare, and most reported cases are colorectal and anal lesions with only a few cases involving the oesophagus. Case report: A 69-year-old man presented with a seven-month history of gastro-oesophageal reflux disease (GORD). The upper gastrointestinal endoscopy showed a moderate hiatus hernia with a pale pink mucosal patch close to the gastro-oesophageal junction. The biopsy showed oesophageal tissue with morphological changes of mild reflux oesophagitis. The submucosal tissue contained organized glandular structures with mucinous glands and intercalated ducts resembling mature salivary gland tissue. There was no evidence of Barrett oesophagus, dysplasia or neoplasm. Discussion and conclusion: HSGT is most commonly seen in the head and neck region of the body, and its occurrence in the GIT is rare. Occurrence of oesophageal HSGT is extremely rare and most cases have presented with symptoms of GORD. Although HSGT is usually benign and a rare phenomenon, clinicians and pathologists need to be aware of this condition to prevent a delay in diagnosis and inappropriate management.Item The effects of personal protective equipment on the mental wellbeing of health care workers(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Martin, T.; Wickramaarachchi, H.; Samarathunga, P.; Medagoda, R.; Jayamanne, S.; Medagoda, K.Introduction: Personal protective equipment (PPE) has become the key method to prevent the spread of the current SARS-CoV-2 virus pandemic among health care workers (HCWs). PPE varies from the face mask to complete overall suit with a hood. Objectives: To determine the effects of PPE on the mental wellbeing of HCWs. Methods: A descriptive study was conducted at Colombo North Teaching Hospital and, three private hospitals around Ragama. Data were collected from the medical, nursing, laboratory, and supporting staff using a self-administered questionnaire. Results: Out of 263 HCWs, 82% were females. The average age was 35 years. 71% were nursing officers. 60.8% of the participants wore either a face mask or a complete overall suit with a hood for 8-16 hours and, 35 % did not change the PPE during that period. 66.5% had difficulty in concentrating on routine work. 50% behaved at least with mild arrogance. Claustrophobia was seen in 15.8% and 21.7% had anxiety. 44.9% wanted to remove PPE as soon as possible. Following their shift, increased tiredness, low mood, and short temper were reported in 61%, 34.7% and 36.4% respectively. In 89.8% these effects lasted 2-6 hours. Conclusions: Wearing PPE has adversely affected the mental well-being of the HCWs during the shift and thereafter. The main mental effects were difficulty in concentration, arrogance, increased tiredness, low mood and, a short temper. Designing user-friendly PPE and reduction of the working shift may help to uplift the mental wellbeing of the HCWsItem Lung function of fuel handlers exposed to volatile organic compounds(Journal of the Ceylon College of Physicians, 2020) Wadasinghe, D.; Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Ariyawansa, J.; Rathnayake, P.; Dissanayake, T.; de Silva, D.; Amarasiri, L.; Devanarayana, N.M.; Scheepers, P.INTRODUCTION AND OBJECTIVES: The respiratory system is a target for effects from air pollutants, including vehicle emissions composed of volatile organic compounds (VOC), particulate matter and other noxious gasses. Our objective was to study the association between selected VOCs and lung function in a cohort of fuel handlers. METHOD: Forty-four fuel handlers (men) from the Gampaha district of Sri Lanka aged 19-65 years were selected using consecutive sampling with a group of 38 males matched by age, without occupational exposure to fuel recruited as controls. Spirometry was performed using a Vitalograph Alpha Touch spirometer, according to ATS guidelines. Pre and post shift VOC levels were measured in end exhaled air samples. RESULTS: The spirometry parameters were not significantly different between the two groups but obstructive (47.72% vs.34.21%) and restrictive ventilatory patterns (31.81% vs. 21.05%) were higher among the fuel handlers. FVC and FEV1 negatively correlated with age (r=-0.672, p<0.001 and r=-6.888, p<0.001 respectively) and number of days of exposure (r=-0.329, p=0.033 and r=-0.306, p=0.049 respectively). Among the fuel handler's, benzene exposure negatively correlated with FVC (r=-0.552, p=0.012) and FEV1 (r=-0.476, p=0.034) and toluene exposure negatively correlated with PEF (r=-0.488, p=0.034). Although levels of all VOCs measured were significantly low among the controls, toluene exposure levels negatively correlated with all spirometry parameters (p<0.05). CONCLUSIONS: A decline in lung function is seen with more days of exposure as a fuel handler. The different vVOCs· affect the volume parameters and flow parameters uniquely and even non-occupational exposure causes an alteration of spirometry parameters among adult males.Item Autonomic functions among fuel handlers in the Gampaha District(Journal of the Ceylon College of Physicians, 2020) Medagoda, K.; Warnakulasuriya, T.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; Ariyawansha, J.; Rathnayaka, P.; Dissanayake, T.; de Silva, D.; Devanarayana, N.M.INTRODUCTION AND OBJECTIVES: Economic growth of Sri Lanka has increased the number of motor vehicles. Fuel stations employing more fuel handlers have been established to cope with the demand. The long working hours with exposure to hydrocarbon fuels result in adverse health effects and this study was done to assess the cardiovascular autonomic functions (ANF) including heart rate variations (HRV). METHOD: Fifty fuel handlers from the Gampaha district of Sri Lanka (19-65 years; all were males) from 7 fuel stations were recruited using consecutive sampling and compared with 46 age and gender matched individuals without occupational exposure to fuel (controls). Demographic data were collected after obtaining informed written consent and systematic examination was conducted. ANF assessment and HRV assessment were performed using validated protocols. RESULTS: There were no significant differences in age, weight, height or the BMI among the study and the control populations (p>0.05). Both systolic blood pressure (BP) (Mann Whitney U (MW)= 743.5, p=0.003), diastolic BP (MW= 686.5, p=0.001) and Valsalva ratio (MW= 874.00, p=0.043) were significantly higher among the fuel handlers compared to the controls. Rise in DBP in sustained handgrip, a sympathetic parameter was significantly higher among controls (MW= 863.00, p=0.049). Among HRV parameters, standard deviation of RR intervals was higher among the fuel handlers compared to controls (MW=842.QO, p=0.034). Parasympathetic parameters correlated with exposure hours per week (p<0.05). CONCLUSION: Altered sympathetic: parasympathetic balance was observed among the fuel handlers with a parasympathetic predominance suggesting that autonomic functions are affected on expo sure to air pollution and hydrocarbons.Item Serum adiponectin levels in overweight and obese women; discrimination between insulin resistance and abdominal obesity(American Association for Clinical Chemistry, 2016) Chackrewarthy, S.; Medagoda, K.; Marasinghe, E.; Wijayasinghe, S.INTRODUCTION: Insulin resistance and abdominal obesity are both associated with lower serum adiponectin concentrations. Since insulin resistance and abdominal obesity are related, the extent to which the association of adiponectin with insulin resistance is dependent on its relationship with abdominal obesity is not clear. The present study investigated the association between insulin resistance and abdominal obesity in its relationship with serum adiponectin. METHODS : Eighty-eight overweight or obese women (BMI>23) in the age group 35-65 years were enrolled. Anthropometric measurements, blood pressure were recorded and a fasting blood sample was obtained for biochemical parameters. Insulin resistance (IR) was quantified by homeostasis model assessment of insulin resistance (HOMA-IR). Abdominal obesity was assessed by waist circumference (WC). Subjects were divided according to WC quartiles: Q1) WC < 89cm (n = 21); Q2) WC 89-96cm (n = 21); Q3) WC 97-102cm (n = 25); and Q4) WC > 102cm (n = 21) and on the basis of insulin resistance. Data were analysed by SPSS 16.0. RESULTS: The mean serum concentration of adiponectin in women were 5.93±1.9 µg/mL. In linear regression analysis, significant correlates of serum adiponectin were serum insulin (r = -0.439, p=0.000) and insulin resistance (r = -0.415, p0.05). High-density lipoprotein (HDL) correlated positively with adiponectin level (p 2.5) subjects had significantly lower (p< 2.5) subjects irrespective of the level of abdominal adiposity. CONCLUSION: High adiponectin levels are associated with insulin sensitivity and a favourable lipid profile. Serum adiponectin levels are more tightly linked with insulin resistance than with abdominal obesity.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.