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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Location and causes of road traffic accidents related to motorcycle riders and three-wheeler drivers brought to Colombo North Teaching Hospital, Ragama(Sri Lanka Medical Association., 2019) Williams, H.S.A.; Amarasekara, P.P.K.; Anthony, K.L.J.M.; Ariyawansha, A.B.M.; Aththanayaka, A.M.A.U.; Alwis, D.N.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Road traffic accidents (RTAs) is a leading cause of morbidity and mortality in low and middle income countries. Human, vehicle and environmental factors are identified as causative agents. The objective was to identify location and causes of RTA related to motorcycle and three-wheeler drivers brought to Colombo North Teaching Hospital (CNN). METHODS: A descriptive cross sectional study was conducted from 15/12/2018 to 10/12/2019 at the CNTH. 104 motorcycle riders and 49 three-wheeler drivers following an accident were included. Data related to human, vehicle, road factors and demographic details were collected using an interviewer administered questionnaire. The location of accident was mapped using Google earth with colour coding for category of hurt, to identify geographical distribution. RESULTS: Motorcycle Accidents: 17.3% were under the influence of alcohol at the time of accident. Mean speed of vehicle at the time of accident was 42.2 kmph. 42.3% of riders who did not wear the helmet properly sustained grievous injuries. 42.5% of employed riders experienced an income loss. Three-wheeler Accidents: 22.4% were under the influence of alcohol at time of accident. Mean speed of vehicle at the time of accident was 46.94 kmph. 49% of accidents took place at a turn. 63.6% of employed drivers experienced an income loss. Mean income loss for motorcycle and three-wheeler drivers were Rs. 2326 and Rs.2816, respectively. CONCLUSION: Human and environmental factors have been responsible for majority of accidents. There are areas in Ragama where drivers should be cautious.Item An assessment on foeto-maternal haemorrhage(Sri Lanka Medical Association, 2018) Dilhani, M.N.; Wijesinghe, P.S.; Ranasinghe, H.R.P.; Williams, H.S.A.INTRODUCTION AND OBJECTIVES: Foeto-maternal haemorrhage leading to maternal sensitization against foetal antigens occurs predominantly during delivery. This leads to rhesus haemolytic disease of the newborn and foetus in subsequent pregnancies. Accurate estimation of volume of such haemorrhage is important to provide the correct dose of anti-D for the prevention of haemolysis in subsequent pregnancies. Objective was to assess the volume and determinants offoeto-maternal haemorrhage at delivery. METHODS: A prospective descriptive study was conducted among 625 mothers admitted to the Professorial Obstetric unit for delivery from 2006 June. 2cc of Ethylene Diamine Tetra Acetic acid anticoagulated blood was taken within 2 hours of partus. Volume of foeto-maternal haemorrhage was assessed using the Keilhauer test.A minimum of 6000 adult red cells was counted to achieve a reasonable precision and to narrow 95% confidence limits to 95%. The volume of the haemorrhage was reported to the ward for necessary action An interviewer-administered questionnaire was filled at the time ofvenepuncture. RESULTS: Only 1.76% (n=l l ) mothers had more than 4ml hemorrhage (Range 6ml-52ml) to be qualified as a large bleeder, requiring additional doses ofanti-D. The toal number oflarge bleeders identified were too small to make inferences on determinants of large haemorrhages but still, some important observations were made: None of the mothers were multiparous but most were primi (n=6). All were single cephalic presentations (n=l l) delivered vaginally (n=9) or by a caesarean section (n=2). One had a placenta praevia, but none of the pregnancies were . complicated with antepartum or postpartum haemorrhage, polyhydramnios, manual removal of placenta or external cephalic versions or asssisted by instruments which are already known factors for such large bleeds. CONCLUSION: Clinically significant foeto-maternal haemorrhage requiring additional anti-D was <2% in our study population. Prospective epidemiological study including a larger study population will help to identify factors associated with increasing volume of foetal haemorrhageItem Haemoglobin, BMI and productivity of apparel factory workers(Sri Lanka Medical Association, 2018) de Alwis, R.A.S.D.; de Costa, M.C.N.; de Zoysa, E.C.E.S.; Dias, I.D.A.P.M.; de Silva, N.D.D.N.; Williams, H.S.A.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: Apparel exports bring the largest amount of foreign exchange in to the country. Thus the productivity of the apparel sector is an important factor in the -economic development of Sri Lanka. Therefore, it is paramount to identify factors associated with productivity in this sector. Previous studies in the plantation sector have shown a significant correlation of productivity with haemoglobin levels. Thus the objective of this study was to determine the association of haemoglobin levels and BMI with the productivity. METHODS: A cross sectional analytical study was performed on 148 women workers from an apparel factory. Data was collected using a self-administered questionnaire. Height, weight, haemoglobin and blood pressure were measured. A star score system (ranging from 1 to 4) used by the management was taken as the measure of productivity. RESULTS: The mean age of the participants was 32. 1 years (SD = 8.9). The mean haemoglobin level was 12.24 g/dL (SD: 1.13). 18.9% of participants were anaemic (Haemoglobin< 11.5g/dL). Anaemia was associated with low productivity (OR= 3.0; p-value = 0.01). Mean BMI was 24.36 kg/m2 (SD= 5.84). 21.1% of the participants were below 18.5kg/m2 suggesting chronic energy deficiency. 23.8% of the participants were overweight and 14.3% had obesity. No significant association was found between BMI and productivity (p-value = 0.54). CONCLUSION: Prevalence of anaemia was lower in this population compared to the non-pregnant women of the general population. There was a significant association between anaemia and low productivity.Item Prevalence of psychological morbidity in an urban population: Is it related to modifiable physical risk factors?(Sri Lanka Medical Association, 2013) Williams, S.S.; Pinidiyapathirage, M.J.; Wijeratne, L.T.; Kasturiratne, A.; Peris, M.U.P.K.; Williams, H.S.A.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: To determine the prevalence of psychological morbidity and its relationship to diabetes mellitus, hypertension and alcohol use in an urban population in Sri Lanka. METHODS: This study was conducted in the Ragama Health Study cohort that consists of 2986 individuals, between 35-64 years of age, living in the Ragama Medical Officer of Health area in the district of Gampaha. Subjects were selected using age-stratified random sampling, from the electoral lists in 2007, and investigated using clinical, bio¬chemical and anthropometric examinations. Psychological morbidity was estimated using a pre-validated K10 questionnaire which has high sensitivity and specificity for non psychotic psychiatric disorders and a self administered GHQ 30 questionnaire. Baseline age-adjusted prevalence and three year incidence of hypertension and diabetes were estimated. Odds ratios for independent risk factors were calculated. RESULTS: The prevalence of psychological morbidity identified using the K10 questionnaire ranged from 18- 26% in a total population of 2919. Females had a higher prevalence of psychologrcal morbidity than males (28.6% vs 22.4%; p<0.001). Diabetic or hypertensive status and alcohol use did not predict psychological morbidity. A self report of overall low health status was predictive of psychological morbidity OR1.925 (95% CI 1.62 - 2.28). DISCUSSION: High prevalence of psychological morbidity was identified in this community study. Females are more at risk. In the initial analysis, psychological status was not associated with diabetes mellitus, hypertension or alcohol use.Item Effect of single dose methyl prednisolone in severe illness associated with dengue fever(Sri Lanka Medical Association, 2010) Premaratna, R.; Jayasinghe, K.G.N.U.; Liyanaarachchi, E.W.; Weerasinghe, O.M.S.; Pathmeswaran, A.; Williams, H.S.A.; de Silva, S.T.; de Silva, A.P.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Role of steroids in the management of severe illness associated with dengue fever (SIDF) remains controversial. However, steroids are widely used in severe dengue. METHODS: Patients admitted to Professorial Medical Unit, CNTH, with SIDF during the recent dengue fever outbreak, a single dose intravenous methylprednisolone (MP) was administered as a rescue measure. Clinical and management data of 18 such patients (6 males) who were treated with MP (Group A) are presented here. [Definition of SIDF: fever >100F persisting after the fourth day of illness, without evidence of secondary bacterial infection together with a systolic BP <100mmHg and a postural drop of >20mmHg and the presence of or rapidly developing ascites or pleural effusions]. Fresh frozen plasma (FFP) rather than crystalloids were used to prevent worsening of third space fluid loss and pulmonary oedema on recovery. RESULTS: The mean(SD) age [yrs] 29 (11), and clinical parameters when SIDF was detected; duration of illness[days]: 5.6(1.9), fever[F]; 102(1) , systolic BP[mmHgj; 91(12), Hb[g/dl]: 14.2(3.1), PCVjTTJ: 42(7.2), platelets[xlOy/L]: 25(13), and resuscitation parameters; crystalloids [L/Kg]: 0.32(0.1), FFP[u]: 2(1.1). deaths: 0/18, time to defervasence[days); 1(2)], time to haemodynamic stability[Hrs]: 5.8(5.8), number needing ICU care 5/18. CONCLUSIONS: These preliminary observations appear to suggest beneficial effects of timely given single dose MP in the management of SIDF.Item Unusual pancytopenia secondary to haemophagocytosis syndrome in rickettsioses(Oxford University Press, 2009) Premaratna, R.; Williams, H.S.A.; Chandrasena, T.G.A.N.; Rajapakse, R.P.V.J.; Kularatne, S.A.M.; de Silva, H.J.We report two patients who presented with a long-lasting febrile illness associated with pancytopenia. Both of them had evidence of hypercellular marrow with haemophagocytosis. They were confirmed as having rickettsial infections by serology and had a rapid haematological recovery with anti-rickettsial antibiotics. We highlight the importance of considering rickettsial infections in patients with such clinical presentations, especially in areas where these infections are endemic or re-emerging. Empirical use of anti-rickettsial antibiotics in such situations could be beneficial, when facilities to diagnose rickettsial diseases are not readily available.