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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Causes, complications and short-term outcome of acute Kidney injury in a resource-limited setting(SAGE-Hindawi Access to Research, 2024-12) Herath, N.; De Silva, S.; Liyanage, P.; Kumara, S.; Devi, S.; Abeysekara, V.; Mallawarachi, R.; Perera, S.; Karunathilaka, I.; Samarasinghe, S.; Weerakoon, K.AIMS The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. METHODS Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. RESULTS Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p=0.017). More severe AKI was associated with type 2 diabetes (p=0.0042), hypertension (p < 0.0001) and multiple comorbidities (p=0.0014). Persons with no comorbidities had less severe AKI (p=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and p=0.047). CONCLUSIONS AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.Item Fathers’ attitudes towards father-child interaction and how they interact with their children aged 2 - 2 ½ years in the home setting in the Puttalam District.(University of Kelaniya, Sri Lanka, 2023) Perera, S.; Hamsa, S.OBJECTIVE/S: The general objectives of this study were to describe fathers’ educational level and socioeconomic status and their effect on their attitudes about father-child interaction, and the quality and the frequency of home-based language strategies used by them with their children aged 2 - 2 ½ years in home setting in Puttalam District. The specific objectives were; To determine whether fathers’ educational level affects their attitudes about father-child interaction and home-based language strategies used by them. To determine whether the fathers’ educational level affects the frequency of home-based language strategies used by them. To determine whether fathers’ socioeconomic status affects their attitudes about father- child interaction and home-based language strategies used by them. To determine whether the fathers’ socioeconomic status affects the frequency of home- based language strategies used by them. METHODS: A Quantitative Cross-sectional study design was conducted with 300 participants who were fathers of typically developing children aged 2 - 2 ½ years. Participants were recruited from MOH clinics in Puttalam District. Data collection of the study was done onsite through a self- administered questionnaire including 4 parts as family demographics, fathers’ educational and socioeconomic status (SES), fathers’ attitudes towards father-child interaction, and quality and frequency of father-child interaction. Data was analyzed using SPSS software. RESULTS: Most of the participants with good attitudes about father-child interaction are fathers aged 40-50 years and fathers whose educational level is from Advanced to graduate level. Most home-based language strategies are also used by fathers aged 40-50 but by fathers with educational levels below Advanced Level. A minority of the participants with good attitudes about father-child interaction are young fathers aged 20-40. Most participants in the self-employing sector have good attitudes about father-child interaction. Fathers who work less than 8 hours per day interact more with their children than fathers who work more than 8 hours per day. CONCLUSION/S: The findings of this study conclude that the educational level and the SES of the fathers affect their attitudes about father-child interaction and the quality and frequency of home-based language strategies used by them. The findings describe that attitudes are ‘good’ when the educational level and the SES are high. But, the quality and the frequency of home-based language strategies are ‘good’ when educational level and SES are low. The age level of fathers directly affects their attitudes and usage of 25 home-based language strategies. The findings confirm that mature fathers have ‘good’ attitudes and high quality and frequency of home-based language strategies than young fathers. Furthermore, the findings describe that fathers’ working hours per day affect their time of interaction with their children. It contributes to determining that the interaction time decreases when the working hours per day increase.Item Development and assessment of psychometric properties of model medication adherence (MMA) questionnaire to measure adherence to oral medication among patients with type 2 diabetes mellitus(College of Community Physicians of Sri Lanka, 2023) Perera, S.; Abeysena, C.INTRODUCTION: Medication adherence among patients with type 2 diabetes (DM) is assessed in everyday clinical practice. OBJECTIVES: To develop a questionnaire to measure adherence to oral medication among patients with DM and to assess its psychometric properties METHODS: The “Model Medication Adherence (MMA)” questionnaire was developed using the evidence from literature review and interviews with key stakeholders and patients. Answers were set on a five-point Likert scale that scored from 1 to 5, with 15-73 as the possible range of the total score. MMA was drafted in English and translated to Sinhala language by forward- backward translation. A descriptive cross-sectional study was carried out among adult patients with type 2 DM who attended clinics in Gampaha District General Hospital (DGH). A sample of 150 patients was recruited consecutively. The construct validity of MMA was assessed by Exploratory Factor Analysis (EFA) through Principal Component Analysis (PCA) with Varimax rotation RESULTS: EFA yielded four factors; sick role behaviour, autonomy, forgetfulness, and barriers that explained 64.36% of the variance of the total score of MMA. Internal consistency was acceptable (Cronbach’s alpha 0.73). The testretest reliability coefficient was 0.85 (p=0.01). Acceptability of the MMA was established by non-response items (none) and the time taken to complete (20 minutes). CONCLUSIONS & RECOMMENDATIONS: MMA is a simple valid questionnaire that adds a novel concept to the adherence literature; sick role and autonomy. It has a good factor structure with established construct validity and is recommended to be used in the clinical setting.Item Hemitruncus arteriosus: A rare congenital cardiac anomaly diagnosed and treated during the neonatal period(Sri Lanka College of Paediatricians, 2023) Pathiraja, H.; de Livera, R.; Wickramaratne, S.; Perera, S.; Mugunthan, M.S.; Mettananda, S.No abstract availableItem 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 Real-time laboratory surveillance of Dengue antigen (NS1) - Best proposed early warning and response system for Dengue in Sri Lanka? - Results from a pilot study(The Sri Lanka Medical Association, 2021) Ranwala, L.; Wedisinghe, Y.; Perera, S.; Jayamanne, D.Introduction: During the recent past, dengue fever and associated complications have been the most important concern for health policy makers of Sri Lanka. The current notification system has considerable inevitable delays in preventive measures. Objectives: Implementing a laboratory-based real-time antigen(NS1) surveillance system for notification coupled with a rapid preventive response within the Colombo district as a pilot project and compare the notifications with existing national surveillance systems. Methods: An online notification platform was established with a centralized database. Seven main laboratories of the private sector linked with the notification system, where they can create new notifications at the central database, whenever the NS1 test detected as positive. Relevant Medical Officers of Health should update action implemented to complete the response process. A dashboard was designed to visualize each notification and its status with a predefined color code. Results: Patients from 14 Medical Officer of Health (MOH) areas out of 15 were captured. The immediate preventive response was recorded from the field preventive staff for 90% of the reportings. All most all attended patients have given health advice on awareness, prevention, and source reduction through premise inspection by trained field staff with 24hrs of notification. Conclusions: Salient features of the novel system are notification of antigen-positive patients, the rapidity of notification(real-time) and response, user-friendliness, access to multiple stakeholders simultaneously without data duplication, early involvement of the field staff, the ability to trace the cases using checklists and a color-coding system from a dashboard.Item A Systematic review on diagnostic methods of red cell membrane disorders in Asia(Blackwell Scientific Publications, 2022) Silva, R.; Amarasinghe, D.; Perera, S.; Premawardhena, A.Membranopathies are a group of inherited blood disorders where the diagnosis could form a challenge due to phenotype-genotype heterogeneity. In this review, the usage and limitations of diagnostic methods for membranopathies in Asian countries were evaluated. A systematic review was done using articles from PubMed, Google Scholar, and EBSCO from 2000 to 2020. Thirty-six studies conducted in seven Asian countries had used different diagnostic methods to confirm membranopathies. In 58.3% of studies, full blood count (FBC), reticulocyte count, and peripheral blood smear (PBS) were used in preliminary diagnosis. The combination of the above three with osmotic fragility (OF) test was used in 38.8%. The flowcytometric osmotic fragility (FC-OF) test was used in 27.7% where it showed high sensitivity (92%-100%) and specificity (96%-98%). The eosin-5-maleimide (EMA) assay was used in 68.1% with high sensitivity (95%-100%) and specificity (93%-99.6%). About 36.1% of studies had used sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) as a further diagnostic method to detect defective proteins. Genetic analysis to identify mutations was done using Sanger sequencing, next-generation sequencing (NGS), and whole-exome sequencing (WES) in 33.3%, 22.2%, and 13.8% of studies, respectively. The diagnostic yield of NGS ranged from 63% to 100%. Proteomics was used in 5.5% of studies to support the diagnosis of membranopathies. A single method could not diagnose all membranopathies. Next-generation sequencing, Sanger sequencing, and proteomics will supplement the well-established screening and confirmatory methods, but not replace them in hereditary hemolytic anemia assessment.Item Work-related health problems and their associated factors among teachers in schools of Western Province(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Gurusinghe, A.; Perera, H.; Perera, S.; Samaraweera, R.; Subasinghe, S.; Amarasinghe, C.; Alagiyawanna, D.; Goonewardena, S.Introduction: The teaching profession is characterized by high levels of stress and physical complaints. These occupation-related health problems affect the effectiveness of teachers influencing the quality of education. Objectives: To describe the proportion of work-related health problems among teachers and their associated factors in selected schools in Western province. Methods: A descriptive cross-sectional study involving teachers aged 20-60 years old, who have one-year work experience in Western province. Data was collected using a structured self-administered questionnaire via a google form. Data was analysed using SPSS software version 26.0. P value less than 0.05 was considered as significant. Results: A total of 239 participated and there was a significant female predominance (82.8%). Mean age was 38.17 years (SD= 9.014). The common ergonomic problems reported are leg pain (45.2%), vocal discomfort (42.3%) and back pain (33.5%). The majority of females experienced leg pain (49%). The common co-morbidity reported was respiratory diseases (20.5%). Wearing high heel shoes (p= 0.02) and walking long distances in a school day (p= 0.002) were statistically significant with leg pain. There was significant association between vocal discomfort and using blackboards (p<0.05). Older age, BMI above 23, teaching experience exceeding 10 years, increasing number of working periods and walking long distances in a school day were associated with high prevalence of back pain (p<0.05). Conclusions: Majority had ergonomic problems and most of them were females. Remedial measures should be given to teachers to counteract these ergonomic problems which hider their teaching and thereby the quality of life.Item Oxidative status in the β-thalassemia syndromes in Sri Lanka; a cross-sectional survey(Elsevier Science-Pergamon Press, 2021) Allen, A.; Perera, S.; Mettananda, S.; Rodrigo, R.; Perera, L.; Darshana, T.; Moggach, F.; Crawford, A.J.; Heirene, L.; Fisher, C.; Olivieri, N.; Rees, D.; Premawardhena, A.; Allen, S.ABSTRACT: In the β-thalassemias, oxidative stress, resulting from chronic hemolysis, globin chain imbalance, iron overload and depleted antioxidant defences, likely contributes to cell death, organ damage, anemia, hypoxia and inflammation. We assessed variations in these parameters in β-thalassemia syndromes in Sri Lanka. Between November 2017 and June 2018, we assessed children and adults attending two thalassemia centres in Sri Lanka: 59 patients with HbE β-thalassemia, 50 β-thalassemia major, 40 β-thalassemia intermedia and 13 HbS β-thalassemia. Median age was 26.0 years (IQR 15.3-38.8), 101 (62.3%) were female and 152 (93.8%) of Sinhalese ethnicity. Methemoglobin, plasma hemoglobin, heme and ferritin were measured as sources of oxidants; plasma total antioxidant capacity, haptoglobin, hemopexin and vitamins C and E assessed antioxidant status; plasma thiobarbituric acid reactive substances and 8-hydroxy-2'-deoxyguanosine assessed oxidative damage; hemoglobin, plasma erythropoietin and transferrin receptor assessed anemia and hypoxia and plasma interleukin-6 and C-reactive protein assessed inflammation. Fruit and vegetable intake was determined by dietary recall. Physical fitness was investigated using the six-minute walk test and measurement of handgrip strength. Oxidant sources were frequently increased and antioxidants depleted, with consequent oxidative damage, anemia, hypoxia and inflammation. Biomarkers were generally most abnormal in HbE β-thalassemia and least abnormal in β-thalassemia intermedia but also varied markedly between individuals with the same thalassemia syndrome. Oxidative stress and damage were also more severe in splenectomized patients and/or those receiving iron chelation therapy. Less than 15% of patients ate fresh fruits or raw vegetables frequently, and plasma vitamins C and E were deficient in 132/160 (82.5%) and 140/160 (87.5%) patients respectively. Overall, physical fitness was poor in all syndromes and was likely due to anemic hypoxia. Studies of antioxidant supplements to improve outcomes in patients with thalassemia should consider individual patient variation in oxidative status both between and within the thalassemia syndromes. KEYWORDS: antioxidants; oxidative damage; oxidative stress; thalassemia; vitamins C and E.Item Perception of Sri Lankan medical students about teaching methods in medical schools.(Yong Loo Lin School of Medicine., 2016) Mettananda, C.; Perera, S.; Jayakody, K.; Palihana, A.AIMS: Although English is a second language, Sri Lankan medical students are also taught using the same teaching methods used in developed countries where English is the 1st language because there are no data on Sri Lankan medical students' views and expectation about the teaching methods used in medical schools. Therefore, we aimed to evaluate Sri Lankan Medical students perception on teaching methods used in medical schools. METHODS: We evaluated views and expectations on teaching methods of 3rd and 4th year medical students of Faculty of Medicine, University of Kelaniya, Sri Lanka in an observational study using a self-administered questionnaire. RESULTS: 102 3rd-year (mean age 23.4 years, female 64.7%) and 96 4th-year (mean age 24.3 years, female 74.0%) medical students volunteered for the study. All students have had> 55/100 marks for English language at Ordinary level (O/L) (year 11) exam, but only 88% had > 55/100 marks for English language at Advanced level (NL) (year 13) exam. Majority of students were form not so rural areas; Gampaha - 33%, Kurunegala -15% and Colombo - 14%. Half of the students were from families where their parents have studied only up to O/L. 78% students preferred lectures while 10%, 7% and 6% liked problem based learning (PBL), practical sessions and tutorials respectively as the teaching method of choice, but there was no significant association with their English results. The main reasons why they liked lectures were that they can get expert knowledge (57%) by attending lectures and that the lecturer knows the subject well (12%) than when it is taught as a PBL by few non-experts. Majority preferred to have 45 minutes long (74%), multimedia assisted (89%), interactive (75%) lectures. More than 85% students liked if the lecturer highlights the important aspects and especially if they relate it to exam and to practice as a doctor, use simple language to explain the subject and if handouts were given at the end. However, only 52% and 57% students viewed respecting students and giving cognitive breaks in-between lectures are important. The main reasons for students to attend a particular lecture depended on if the lecturer is a good teacher (87%), importance of topic to exam (82%) and to carrier as a doctor (74%). But the decision to attend lecture was not much related to appearance of the lecturer (13%), how famous the lecturer is (29%), the fact that lecture handouts are not given (18%) or the lecture being compulsory (39%). CONCLUSION: Views and expectations of this sample Sri Lankan medical students on teaching methods used in medical schools are more or less similar to that of developed world.