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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Development of size charts of symphysis pubis height measurement for Sri Lankan Population(Wiley-Blackwell, 2015) Dias, T.; Pathmeswaran, A.; Abeykoon, S.; Gunawardena, C.; Pragasan, G.; Padeniya, T.INTRODUCTION Fetal growth restriction is responsible for majority of explained and unexplained intrauterine deaths. Screening and diagnosis of fetal growth restriction is one of the main objectives of the antenatal care. Symphysis pubis height measurement (SFH) is routinely measured to assess the fetal growth during antenatal period. Use of SFH charts made elsewhere may either under or overestimate the fetal size in our population. The aim of this study was to construct new size charts for SFH for Sri Lankan population. METHODS This was a prospective, cross-sectional study carried out at the District General Hospital Ampara. In order to increase generalisability 1220 women with normal nutritional and health status and minimal environmental constraints on fetal growth were enrolled during first trimester. Fetal crown–rump length measurement between 11+0 and 13+6 was considered for gestational age assessment in all patients. Each mother considered only once for measurement of SFH for the purpose of this study at gestations between 24 and 41 weeks. SFH was measured using non-elastic, blinded tape using standard technique. For SFH measurement separate regression model was fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived from this mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age. RESULTS A total of 387 mothers had their SFH measured directly. New charts were created for SFH. 10th, 50th and 90th centile values for SFH at 40 weeks are 34, 37 and 41 cm. CONCLUSIONS We have constructed new size chart for SFH. This chart can now be used to assess the fetal size of Sri Lankan population.Item Seven–minute neurocognitive test battery: A reliable test for dementia(Elsevier, Inc. (2020-Wiley), 2006) de Silva, A.; Pathmeswaran, A.; de-Jager, C.; Kuruppuarachi, L.A.BACKGROUND: The increasing prevalence of Alzheimer’s disease (AD) suggests that there is an increasing need for accurate and easily administered screening instruments to assess cognitive function. OBJECTIVE(S): To examine the reliability of the 7-minute screen as a cognitive screening instrument for AD in a Sri Lankan population. METHODS: 53 patients with mild-moderate AD, 34 with other dementias, 36 with mild cognitive impairment (MCI) referred to a memory clinic, and 60 patients with depression with no evidence of dementia and 56 healthy volunteers (controls) were recruited to the study after informed consent. All were community-dwelling and aged _60 years. Patients with severe dementia, receptive aphasia, visual and motor impairment, and severe depression were excluded. All diagnoses were made according to established criteria and the diagnosis of depression was confirmed after psychiatric evaluation. All subjects underwent cognitive assessment with the Mini Mental State Examination (MMSE) and the 7-minute screen. This screen consists of four components (enhanced cued recall, temporal orientation, verbal fluency, and clock drawing) that assess memory, orientation to time, fluency of expression, and executive function, cognitive functions typically compromised in AD. RESULTS: Baseline characteristics did not differ significantly in the five groups. (see the table). CONCLUSIONS: The 7-minute neurocognitive screen is a highly sensitive instrument to screen for AD and was more reliable than the MMSE to detect AD, MCI, and other dementias in this Sri Lankan population. However, the accuracy of the screen may be confounded by the presence of depression.Item Incidence and time trends in prevalence of stroke and vascular risk factors in an urban Sri Lankan population: A population- based cohort study(Asia Pacific Stroke Organization, Hong Kong Stroke Society and Jiangsu Stroke Association & karger publishing, 2017) Mettananda, C.; Wickramarathna, B.; Pathmeswaran, A.; Ranawaka, U.BACKGROUND AND RATIONALE: Prevalence of stroke is increasing in developing countries. However, population data on time trends in prevalence of stroke in Sri Lanka not. METHODS: We screened a population-based cohort 35–64 year selected by stratified random sampling from an urban health administrative area in 2007 evaluated them again in 2014. Identified possible stroke patients were independently reviewed by a Neurologist and a Physician with regard to diagnosis and vascular risk factors. Incidence and time trends in prevalence of stroke and vascular risk factors in 50–65-year age group were compared between 2007 and 2014. RESULTS: Of 2985 baseline study population in 2007 (females 54.5%, mean age 52.4 ± 7.8 years), 2204 attended follow-up in 2014. Of them, 45 have had a stroke/TIA, (female 51.1%, mean age 52.9 ± 5.4 years). 25 (55.6%) of them were strokes within the 7 year follow up (annual incidence-1.66 per 1000 population). Prevalence of stroke in 50–65-year age group was of the 45 stroke patients reviewed in 2014, 28 (62.2%) had. Of 27 were definite strokes, 15 probable strokes and 3 TIAs. CONCLUSION: Prevalence has increased over time in urban Sri Lanka lie between developed and developing counties.Item Carotid artery stenosis in patients with ischaemic stroke in a tertiary care centre: Prevalence and associated factors(Ceylon College of Physicians, 2019) Ranawaka, U.K.; Mettananda, K.C.D.; Eshani, M.D.P.; Wettasinghe, L.M.; Somaratne, S.; Premadasa, H.M.S.D.; Sirigampola, C.; Upasena, A.; Sathkorala, W.; Pathmeswaran, A.OBJECTIVES: Data on the prevalence of carotid artery stenosis (CAS) among Sri Lankan stroke patients is limited. We sought to determine the prevalence and associated factors of significant CAS in patients with ischaemic stroke admitted to a Sri Lankan stroke unit. METHODS: We prospectively studied all stroke patients admitted to a stroke unit in a tertiary care hospital over a five-year period. Presence and degree of CAS was evaluated by doppler ultrasonography (US). Degree of CAS was classified as low {<50%), moderate (50-69%), significant (70-99%) or total occlusion (100%) according to NASCET criteria. Factors associated with significant CAS were identified by stepwise multiple logistic regression analysis. RESULTS: Out of 867 stroke patients studied, 704 (81.2%) had ischaemic strokes (59.7% male, mean age 59.0 ± 10.3 years), and 550 (78.1%) of them had carotid doppler data available. 528 (96.0%) had low degree stenosis, 12 (2.2%) had moderate stenosis, 7 (1.3%) had significant stenosis and 3 (0.5%) had total occlusion. Older age was associated with significant CAS (OR 1.14, p=0.011) on stepwise multiple logistic regression analysis. Sex, smoking, BMI, total cholesterol, LDL cholesterol, history of diabetes mellitus, hypertension, hyperlipidemia or ischemic heart disease, and premorbid aspirin or statin use were not associated with significant CAS. CONCLUSIONS: Significant CAS is seen in only 1.8% of Sri Lankan patients with ischaemic stroke at this tertiary care centre. These figures are much lower compared to Western data. Our findings have implications for the use of management approaches such as thrombectomy and carotid endarterectomy in Sri Lankan patients. ACKNOWLEDGEMENTS: EMDP and WLM were supported by a research grant from the National Stroke Association of Sri Lanka.Item Deficiencies in the provision and the barriers in accessing family planning services for women working in Avissawella export processing zone(Sri Lanka Medical Association., 2019) Pathirana, V.P.S.D.; Pathmeswaran, A.; Jayaratna, A.INTRODUCTION & OBJECTIVES: Women working in export processing zones (EPZs) are reported to have risky sexual behaviors leading to unwanted pregnancies. The purpose of this study was to describe the deficiencies in the provision and the barriers in accessing family planning (FP) services for reproductive age women working in Avissawella EPZ. METHODS: Deficiencies in provision and barriers in accessing FP services were explored and described by individual interviews and focus group discussions conducted with a purposively selected sample of 55 comprised of EPZ workers, factory managers and healthcare workers. A semi-structured interviewer guide was used. Thematic analysis of data was done using inductive method. RESULTS: Non-availability of FP services after working hours was the main perceived deficiency in service provision and high opportunity cost for visiting clinics for FP services was the main barrier in accessing FP services among women working in Avissawella EPZ. No major bad comments on the staff, availability of contraceptive items of infrastructure facilities were given although overcrowding and need for improvement of privacy of clients and punctuality of the staff were highlighted by some women. They had more trust on government services than the private sector. Myths and misconceptions were not enormously highlighted as barriers to use of contraceptives. Side effects were seemed to be having a higher impact on non-use of contraceptives. Importance of use of social media to disseminate to be having a higher impact on reproductive health and FP among workers in EPZs was highlighted. CONCLUSION: There is a need for workplace based client friendly FP service integrated with other health services.Item Predictors of mortality in a cohort of adult Sri Lankans(Sri Lanka Medical Association., 2019) Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION & OBJECTIVES: There is limited knowledge on early predictors of mortality among Sri Lankans. We investigated predictors of mortality in the Ragama Health Study cohort 10 years after recruitment. METHODS: The study population (35-64-year-olds selected by age-stratified random sampling from the Ragama Medical Officer of Health area) was initially screened in 2007 for socio-demographic, lifestyle, anthropometric and clinical risk factors with informed written consent. Their vital status was assessed in 2017 and the causes of death of the deceased were retrieved from death certificates available with the next-of-kin or declaration of death records from the hospital where the death occurred. RESULTS: Of the 2986 enrolled in 2007, 169 [Males: 107 (63.3%)] had died over the 10-year period, giving an overall mortality rate of 5.7% (95% CI: 5.0 % - 6.4%). The number of deaths due to cardiovascular and cancer related causes were 73/169 and 31/169, respectively. On multivariate analysis using Cox's proportional hazards model, advancing age, male sex, lower educational level, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of all-cause mortality. Advancing age, male sex, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of cardiovascular mortality, while advancing age and unsafe alcohol consumption were the only independent predictors of cancer-related mortality. CONCLUSION: Unsafe alcohol consumption and the presence of metabolic syndrome were important modifiable risks for mortality in this population. Addressing these risks in early adulthood will help to improve longevity.Item Awareness and usage patterns of substances among pre-clinical phase students at a Medical Faculty in Sri Lanka(Sri Lanka Medical Association., 2019) Hapangama, A.; Fernando, R.; Pathmeswaran, A.; Kuruppuarachchi, K.A.L.A.INTRODUCTION AND OBJECTIVES: Availability and usage patterns of psychoactive substances have changed worldwide. Knowledge about new trends of substance use is important for future generation of medical professionals to deliver appropriate treatment. Objective of the study was to determine the awareness and prevalence of substance use among pre- clinical phase medical students in a university in the Western Province, Sri Lanka. METHODS: A cross-sectional descriptive study was carried out using a self-administered questionnaire. RESULTS: Out of 162 students, 61.7% were female, 97.5% were between 20-25 years. 99% were aware of alcohol being a substance of abuse. 34% and 30% were not aware that heroin and cannabis were substances of abuse. Less than half of participants were aware of corex-D (44.4%), volatile substances (39.5%), and methamphetamines (32.7%). Figures for awareness about Psilocybin (9.9%), MDMA (8.6%), LSD (8%), GHB (4.3%), DXM (2.5%). Main sources of information regarding substances were peers and internet. 21% and 18 % of participants had used alcohol and betel respectively at least once while tobacco and corex-D was used among 7.4% and 6.2% respectively. 69% of substance users were male. Use of substances was significantly associated with male gender. CONCLUSION: Alarmingly majority of the participating pre-clinical phase students were not aware of the abuse potential of heroin and cannabis as well as of newer generation recreational drugs. Awareness regarding current trends and misuse potential of psychoactive substances and their consequences should be enhanced among medical students.Item Environmental pollution by traffic noise in the city of Colombo, Sri Lanka(IOS Press, 2016) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Wickremasinghe, A.R.; Sathiakumar, N.Traffic noise levels in most cities of the world are higher than the recommended levels. Exposure to high levels of noise may cause adverse health effects such as ischemic heart diseases and noise induced hearing loss. We conducted a cross-sectional study to determine road traffic noise levels at 60 selected locations in the city of Colombo, Sri Lanka. On randomly selected days we measured equivalent continuous sound pressure level (LAeq) for six hours during the day. From these measurements LAeq for eight hours were calculated and used as the average noise level of a particular location. LAeq (8 hrs) within Colombo ranged 76.6 to 84.0 dB; well above the Sri Lankan recommendation of 63.0 dB (an increase of 13.3 to 21.0 dB), and the WHO recommendation of 55.0 dB (an increase of 21.6 to 29.0 dB). These levels translate into increase of sound pressure level by 21.4 to 794.3 times above the recommendations on the logarithmic scale of dB. Thirty-eight of 60 locations recorded levels more than 80.0 dB. Road traffic noise levels in Colombo were well above the recommended levels. Though the increase in measured decibels might not appear to be too high, in reality this translates into an increase manifold times in the sound pressure level that reaches the earItem Review of the cervical cancer screening programme in the Puttalam district(Sri Lanka Medical Association., 2019) Fernando, Y.K.J.; Pathmeswaran, A.INTRODUCTION & OBJECTIVES: A well implemented screening programme is effective in preventing cervical cancer. ln order to improve programme effectiveness all programmes need to be reviewed periodically. The objective of this study was to review the cervical cancer screening program in Puttalam District. METHODS: Cross sectional descriptive study was done in 2015. Primary and secondary data was collected using data collection sheets, self-administered questionnaires and structured interviews from all stake holders involved in cervical cancer screening program in Puttalam District. RESULTS: Adequate number of clinics were available considering clinic to population ratio of 1: 15000 as the norm, but vacant positions existed in all staff categories. Colposcopes were unavailable and zero stock episodes of consumables were noted at MOH level. Target age group (35 years) Pap smear coverage, number of cervical visualizations, pap smears taken and positive pap smears were indicators used to monitor the programme. Positive cervical cytology reporting time was more than 10 weeks (mean was 72 days, range 2-334). Guidelines relating to quality control; obtaining a pap smear & cytology process and documentation regarding process of follow up care were not available. Coverage of target age group women (35 years) increased from 28.4% (2013) to 32.4 % (2015). Number of cervical cancers prevented could not be calculated as follow-up information was not available. CONCLUSION: Human resources and equipment relating to pap smear screening need improvement. Indicators sensitive to target population; cytology report turn-around time, and quality indicators need to be built in to program, guidelines developed and evaluated. Outcome of screened positives should be followed up and documented.Item Knowledge on family planning and use of contraceptives among women working in Avissawella export processing zone(Sri Lanka Medical Association., 2019) Pathirana, V.P.S.D.; Pathmeswaran, A.; Jayaratna, I.L.K.INTRODUCTION & OBJECTIVES: Women working in export processing zones (EPZs) are reported to have risky sexual behaviors leading to unwanted pregnancies.The purpose of this study was to describe the level of knowledge on family planning (FP) and prevalence of contraceptive use among reproductive-age women workers of Avissawella EPZ. METHODS: Descriptive cross-sectional study was conducted to assess knowledge on FP and use of contraceptives among 515 unmarried and 515 married women selected by stratified random sampling from factories in Avissawella EPZ. Pretested, self-administered questionnaire was used. RESULTS: Forty two percent (CI37.7-46.3) of married and 7% (CI4.8-9.3) of unmarried women had "Satisfactory Overall Knowledge" on FP. Asignificantly higher knowledge was observed among married women (OR=8.3; CI=5.5-12.5),who were over 35 years (OR=2.2;CI=1.5-3.3), having passed GCE (0/L) examination (OR=1.7) and having a monthly income of more than Rs.30,000/- (OR=2.2). Contraceptive prevalence rate (CPR) for married women for any method and any modem method were 47.8% (CI43.4% -52.2%) and 40.9% (CI 36.6%-45.2%) respectively. Oral contraceptive pill (11%), intrauterine device (8%) and injectable (6%) were the most commonly used methods by married women. Having "Satisfactory Overall Knowledge" on FP (OR= 1.6; Cl=1.7-3.9), age below 35 years (OR=2.2;CI=1.3-3.9) and having two or more children (OR=2.7;CI=1.6-4.5) were in dependently associated with higher CPR. CONCLUSION: Knowledge on FP and use of contraceptives were low among women of Avissawella EPZ.