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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Is splenic stiffness measurement(SSM) better than Baveno VII criteria to predict oesophageal and cardio- fundal varices in patients with compensated advanced liver cell disease (cACLD)?(Sri Lanka Medical Association, 2023) de Silva, A.P.; Niriella, M.A.; Nishad, A.A.N.; Samarawickrama, V.T.; Jayasundara, H.; Ranawaka, C.K.; de Silva, S.T.; Withanage, M.; Ediriweera, D.; de Silva, H.J.INTRODUCTION: Liver and splenic stiffness measurements (LSM and SSM) using transient elastography (TE) are being increasingly used as a screening tool to predict varices. OBJECTIVES: We aimed to test the utility of Baveno-VII criteria (LSM>25kPa, LSM>20kPa with platelet count <130,000 and LSM>15kPa with platelet count <110,000) and SSM to predict oesophageal and cardio-fundal varices in a cohort of Sri Lankan patients with aALCD. METHODS: Consecutive patients with newly diagnosed Child’s class A cALCD (non-viral, BMI<30) were recruited prospectively. They underwent upper gastrointestinal endoscopy by an endoscopist followed by a Fibroscan by an operator who is unaware of endoscopy findings using ECHOSENS-Fibroscan-502 to measure LSM and SSM. Validity measurements of three Baveno-VII criteria and SSM values to predict oesophageal and cardio-fundal varices were calculated. RESULTS: One hundred and seventy-four individuals were recruited [Mean (95%CI) age 61.4 (59.7-62.8) years, 110 males], and 106 had varices. Our results indicate that the three Baveno VII criteria had sensitivities of 61%, 63% and 42%, and specificities of 79%, 77% and 87%. SSM>30kPa alone or in combination with LSM>15kPa had sensitivity of 81&75%, specificity of 72&83%, PPV of 82&87%, NPV of 71&67% and accuracy of 78&78% consecutively to predict oesophageal and cardio-fundal varices. CONCLUSION: Baveno VII criteria had low sensitivity but high specificity to predict oesophageal and cardio-fundal varices. SSM>30kPa alone or in combination with LSM>15kPa seemed to predict oesophageal and cardio-fundal varices better.Item Pseudoainhum associated with lepromatous leprosy: A very rare association in modern world(Chinese Medical Association Publishing House, 2023) Nishad, A.A.N.; Pathman, M.; Uwyse, S.A.; Mendis, A.; Abeysundara, P.K.; de Silva, A.P.INTRODUCTION: Pseudoainhum (dactylolysis spontanea) is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation. Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions. Here, we present a rare case of pseudoainhum patient, which describes a very rare association of pseudoainhum with leprosy. CASE PRESENTATION: A 48 year old male with lepromatous leprosy, with resorption of digits, charcot joints and tropical ulcers was seen in the clinic. The forth digit of the left hand had a narrowing due to a fibrous band at the 2nd inter phalangeal joint with shiny tethering distal phalanx. He could not recall the duration of the ainhum. He was not suffering from any pain.DISCUSSION: The current report describes a very rare association of pseudoainhum with leprosy. The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum. CONCLUSION: This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits, especially in leprosy.Item Neurological melioidosis complicated by cerebral venous sinus thrombosis(Ceylon College of Physicians, 2020) Abeysundara, P.K.; Nishad, A.A.N.; Perera, W.N.M.; de Silva, H.; Piyarathne, R.; Rathnayaka, R.M.P.M.; Arulmoly, K.; Umakanth, M.; Premaratna, R.; Tilakaratne, Y.ABSTRACT: Melioidosis is a systemic disease endemic in Southeast Asia and Northern Australia. The spectrum of the disease varies from asymptomatic infection to severe systemic manifestations. Timely diagnosis and treatment of melioidosis is a challenge due to its atypical presentations. We report a case of melioidosis causing cerebral abscesses and cerebral venous sinus thrombosis. Occurrence of these neurological manifestations in melioidosis is rare and it is a difficult condition to diagnose and treat. Timely diagnosis was a challenge in this patient due to the atypical presentation and the use of empirical antibiotics in the primary care setting. Limited laboratory diagnostic capability also contributed to this delay. KEYWORDS: Melioidosis, Cerebral abscess, Cerebral venous sinus thrombosisItem Validation of the Tamil translation of the International Consultation on Incontinence modular Questionnaire on Vaginal Symptoms (ICIQ-VS)(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Wijesinghe, P.S.; Pathmeswaran, A.; Samaranayake, K.U.; Herath, C.; Nishad, A.A.N.OBJECTIVES: To translate and validatethe International Consultation on Incontinence Modular Questionnaire on vaginal symptoms (ICIQ VS) from English to Tamil. METHOD: With permission, ICIQ-VS questionnaire was translated to Tamil and a validation study was done on women attending the gynaecology clinics at district general hospitals, Mannar and Vavuniya. RESULTS: The basic characteristics of women with prolapse (n=63) versus women without prolapse (n=83) were as follows; age 60.68 (SD 11.64), median parity=4 (IQ1-IQ3=3-5), BMI 23.90 kg/m2 (SD 3.36) versus age 40.49 (SD 12.54), median parity=2(IQ1IQ3=1-3), BMI 25.84 kg/m2 (SD 4.84) respectively. Content validity was assessed by the level of missing data which was less than 3% for each item. Internal consistency as assessed by Cronbach’s coefficient alpha score was 0.83 (0.80-0.84). Kappa values for test–retest reliability of individual items ranged from0.59 to 0.74. The questionnaire differentiated between patients and controls in vaginal symptoms score(VSS) (P<0.001), sexual symptoms score(SSS) (p<0.05) and quality of life p<0.001). There was a positive correlation between pelvic organ prolapse quantification system (POP-Q) scores and VSS (rs= 0.67, p<0.001), SSS (rs= 0.26p<0.05) and quality of life (rs = 0.62, p<0.001).Vaginal symptoms (n=24) and quality of life (n=21) showed an improvement following surgery(Wilcoxon matched– pairs signed-rank test p<0.001 and p<0.001 respectively). CONCLUSION: The preliminary results for ICIQ VS (Tamil) validation are satisfactory and once completed it will be invaluable to objectively assess vaginal and sexual symptoms in Tamil speaking population in Sri LankaItem Burnout among Intern Medical Officers in selected Teaching Hospitals: a cross-sectional descriptive study(Sri Lanka Medical Association, 2016) de Silva, S.T.; Dahanayaka, N.; Ralapanawa, U.; Nishad, A.A.N.; Silva, F.H.D.S.; Shyamali, N.L.A.; Wanigasuriya, K.INTRODUCTION: Burnout is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, occurring due to chronic emotional and interpersonal stressors. Burnout is well recognized among medical doctors. Identifying and, where possible, treating burnout is critical, as it has a major impact on the quality of life of doctors, patient safety and health outcomes. OBJECTIVES: Research on burnout in the medical community of Sri Lanka is scarce. Our objective was to determine the prevalence and risk factors for burnout among intern medical officers (IMOs), who are likely to be at high risk. METHOD: Consenting IMOs in Medical, Surgical, Paediatrics and Obstetric and Gynaecology Units of Teaching Hospitals in Colombo South, Colombo North, Peradeniya, Kandy and Karapitiya were administered three standard, validated, self-administered questionnaires on burnout. RESULTS: 124 IMOs participated; 79(62.9%) were females. Mean age was 27.4 years. Oldenburg Burnout Inventory: 75/124(60.5%) suffered from disengagement, and 77/124(62%) from exhaustion. Abbreviated Maslach Inventory: 47/124(38%) suffered from emotional exhaustion, 20/124(16.1%) from depersonalization, and 6/124(5%) from poor personal accomplishment. Work and lifestyle-related causes (ie heavy and monotonous work-load, lack of control over work-load, chaotic work environment, inadequate rest and sleep, lack of help, and absence of a supportive relationship) were significantly associated with higher burnout scores. CONCLUSIONS: Burnout appears to affect approximately 1 in 3 IMOs in our sample. Most work and lifestyle related risk factors for burnout are modifiable. Further studies are needed to identify causes of burnout among IMOs. A system to detect and treat burnout, particularly among IMOs, is an urgentItem Histological types of Gynaecological tumours in the teaching hospital, Ragama over a 9 year period(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Nishad, A.A.N.; Herath, H.M.R.P.; Padumadasa, S.G.J.; Wijesinghe, P.S.; Feranando, W.S.; Rathayake, R.M.U.S.; Hewavisenthi, S.J.de S.INTRODUCTION: Gynaecological malignancies contribute significantly to the mortality of women. The pathological spectrum of ovarian and uterine malignancies is wide and diverse. Differences in incidence of histological types and stages at presentation have been reported. OBJECTIVE: To describe the histological types of ovarian, uterine and fallopian tube malignancies diagnosed at Professorial unit Ragama during the period of 1st January 1999 to 1st May 2008. METHODOLOGY: A descriptive, retrospective study was done using the histopathological reports during the study period. RESULTS: There were 96 ovarian, 44 uterine and 1 fallopian tube malignancies detected during the study period. Out of the 96 ovarian malignancies, 94 (97.9%) were primary ovarian tumours while 2 (2.1%) were secondary tumours. Epithelial tumours were the commonest accounting for 80.9% of primary ovarian malignancies while stromal and germ cell tumours contributed to 9.6% and 5.3% respectively. There were 39 (51.3%) serous tumours, 18 (23.7%) endometrioid tumours and 9(11.9%) mucinous tumours among the epithelial tumours. Immature teratomas were the commonest (60%) germ cell tumour. At presentation 22 (23.4%) were bilateral tumours. Majority 29 (31%) of ovarian malignancies were FIGO stage T11C at diagnosis. Among the uterine malignancies there were 33(75%) endometrial carcinoma, 3(7%) Endometrial stromal sarcoma, 2 (4.5%) leiomyosarcomas, ,and 6 (13.5%) other sarcomas. Most (67%) of the patients who had endometrial carcinomas were FIGO stage 1 at the time of diagnosis. DISCUSSION: Though the proportion of the epithelial tumours were similar to the standard figures, germ cell tumours seems to be less in number. Secondary ovarian tumours seem to be less in our study population. The fact that the ovarian malignancies are diagnosed late is evident by the study.Item Developing a severity index on day 4 to predict severe dengue infection in adults(Sri Lanka Medical Association, 2012) Wijewantha, H.S.; Premaratna, R.; Nishad, A.A.N.; Mabharana, I.D.M.; de Silva, A.P.; Waraketiya, P.R.; Niriella, M.A.; de Silva, H.J.INTRODUCTION: Dengue causes high morbidity and mortality among adults in Sri Lanka. Early prediction of severe illness would help to reduce morbidity and mortality. Studies to identify predictors of severe dengue in adults are sparse. AIMS: To identify predictors of severe dengue infection by the fourth day of illness. Methods: Symptoms, signs and investigation results on the 4th day of illness were compared between two groups of patients with serologically confirmed dengue over 6 months from 1st of March 2011; Group A (severe illness: evidence of fluid leakage, compensated shock, profound shock). Group B (non-severe illness). RESULTS: Of 117 adults 9meanage 32 yrs (SD= 13.3) and 95 males) 27 fell into Group A and 90 into group B. On day 4 of illness serum aminotransferases (AST and ALT) were significantly higher in Group A than group B [AST: 260 iu/1 (SD=168.8] vs 145 iu/l(SD 135.11), p=0.005; ALT: 247 iu/1 (SD= 161.5) vs 105 iu/1 (SD= 91.5), p=0.002]. Overall AST (r=0.3, p=0.038) and ALT (r=0.3, p=0.045) had a positive correlation with haematocrit (PCV). An index was developed using stepwi-se multivariate discriminant function analysis to predict severe infection by the 4th day. A severity Index, [(0.082 x PCVD4) + (0.02 x PlateIetD4) + (-0.006 x ASTD4) -3.677] of <-0.258 predicted severe infection with 73.7 % specificity, 73.8% sensitivity, 56% positive predictive value and 86% negative predictive value. CONCLUSIONS: A severity index <-0.258 calculated on the 4th day of illness may predict severe infection among adult dengue patients. This must now be validated prospectively.Item Does Sanders-Retzlaff-Kraff (SRK-2) formula suit a Sri Lankan population in phacoemulsification cataract surgery of medium axial length?(Sri Lanka Medical Association, 2012) Amaratunge, M.S.; de Silva, J.; Wasthuhewaarachchi, I.M.; Uyangoda, S.H.; Mallawaarachchi, M.A.J.I.; Premaratna, R.; Nishad, A.A.N.INTRODUCTION: After introduction of phacoemulsification with small incision techniques, intraocular lens (IOL) power calculation predictionhas become a crucial step for good refractive outcomes. SRK-2 formula is widely used for that purpose in many locations. AIMS: To evaluate the predictive accuracy of post operative refraction using SRK-2 formula in phacoemulsification of eyes with 22-26mm axial length. METHODS: Patients with senile cataracts undergoing phacoemulsification and IOL during 2011 in Gampaha district by a single surgeon were selected randomly. Single examiner measured simulated manual keratometry preoperatively, seven days postoperatively. Uncorrected visual acuity, slit lamp examination of anterior segment and best spectacle-corrected visual acuity (BSCVA) were measured. The implanted IOL power was used to calculate the predicted postoperative refractive error using time SRK-2 formula. RESULTS: Of 274 patients (56% females, mean (SD) age 65.3(10) years), the right eye was operated in 142(51.8%). On postoperative seventh day, 79% had VA of 6/6 and 14% to 6/9, 4% to 6/12 to 6/36 in the operated eye. Mean (SD) of IOL power used 21.50 (1.90)D. The predicted refractive error with SRK-2 was -0.3(0.145)0 and the achieved refractive error was -0.22(0.732)0. Difference between predicted and achieved refractive error presented a slight hyperopic shift (mean(SD) 0.054(0.397)0}. There was a negative Pearson correlation (-0.126) between the predicted refractive error and achieved refractive error (p=0.04). Predictive error was less than 0.5 in 80.2%, <0.75 in 88.6% and <1.0 in 96.7%. CONCLUSIONS: SRK-2 formula is a good option to predict the refractive error after cataract extraction by phacoemulsification in eyes with medium axial length.Item How Young adults with Thalassaemia major feel and what they want?(Sri Lanka Medical Association, 2012) Nishad, A.A.N.; Premawardhena, A.INTRODUCTION: During last few decades with introduction of regular blood transfusion and effective iron chelating therapy, life expectancy of Thalassaemia major patients has improved. There is little data regarding quality of life of these patients. METHODS: Prospective quantitative and qualitative study was carried out at Ragama and Kurunegala with transfusion dependent patients of 16 years or older during 2011. SF-36, Becks depression inventory, GHQ-30 and in-depth interviews were used. RESULTS: Of 37 patients (19 females) 64% had at least grade 11 education. Median age was 20(25ch=17, 75th=22] years. Forty percent girls and 33% of boys told illness had a negative impact on romantic relationships. Forty four percent boys, 10.5% girls wanted to marry. Thirty three percent boys and 5% girls wanted to have children. Seventy percent girls and 56% boys wanted to engage in an occupation. SF-36 (Cronbach alpha=0.88) analysis, found that 66% thought they get sick easily and 70% thought they were not healthy. But 70% thought their health would not get worse. Limitation of activities was seen (highly active=64%, moderately active=18%). But 81% did not limit routines and 61% had no routine work difficulty. Seventy seven percent had good life satisfaction although 39% felt a great tiredness. Becks depression inventory reported 31% (95%CI=19-48J had reduced sleep and 26% (95%CI=14-42) had disturbed sleep. Mild depression was seen in 5.4%. CONCLUSIONS: Patients with thalassaemia want to live a normal life like healthy people. They seem to have a satisfactory quality of life.Item Prevalence of diabetes mellitus and hypertension among three populations with cataract in Vavuniya and Gampaha districts in the post conflict era(Sri Lanka Medical Assosiation, 2012) Amaratunge, M.S.; de Silva, J.; Wasthuhewaarachchi, I.M.; Uyangoda, S.H.; Mallawaarachchi, M.A.J.; Premaratna, R.; Nishad, A.A.N.INTRODUCTION: Identification of socio economic factors and non communicable disease profiles of patients with cataract is important to plan vision related health services. AIMS: To compare prevalence of diabetes mellitus [DM] and hypertension (HT) among three groups of cataract patients. METHODS: Prevalence of diabetes-and hypertension was compared in groups of patients with cataracts during second quarter of 2011. Group A: a rural population in Vavuniya, B: semi-urban low socioeconomic group and C: semi-urban higher socioeconomic group in Gampaha. Standard criteria used to detect diabetes and hypertension. RESULTS: Population in A 167(36% males), B 207(62% males) and C 407(40% males). Mean (SD) age was 65(10) years. Male diabetes prevalence (95% CI) were A 20% (9.3-28), B 30%(22.6-38.4) and C 37.9%(30.8-45.6) (p=0.009). Prevalence (95%CI) of diabetes in females were A 17.8% (11.7-26), B 19% (11.9-29) and C 33.7% (28.1-39.9) (p=0.002). Hypertension prevalence in males (95%CI) A 23.3% (15- 35.4), B 35.4% (27.6-44) and C 36-6% (29.6-44.3) (>=0.16) a"d in females A 26.2% (18.8-35.2), B 15.2% (9-24.7) and C 45.1% (39-51.4) (p=0.001). Prevalence of either diabetes or hypertension among males A 31.7% (21-44), B 54.3% (45.7-62.7) and C 56% (48.2-63.3) (p=0.001) and among females A 34.6% (26- 44), B 26.6% (18-37.2) and C 57.8% (51,5-63.7) (p=0.001). Conclusions: Females in higher socioeconomic group of Gampaha district had higher diabetes and hypertension prevalence than in lower socioeconomic populations. Male groups showed same pattern for diabetes but not for hypertension. Overall prevalence of hypertension and diabetes mellitus were higher than for general population in Sri Lanka.