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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Distinct microbiome profiles and biofilms in Leishmania donovani-driven cutaneous leishmaniasis wounds(Nature Publishing Group, 2021) Kaluarachchi, T.D.J.; Campbell, P.M.; Wickremasinghe, R.; Ranasinghe, S.; Wickremasinghe, R.; Yasawardene, S.; de Silva, H.; Menike, C.; Jayarathne, M.C.K.; Jayathilake, S.; Dilhari, A.; McBain, A.J .; Weerasekera, M.M.The endemic strain of Leishmania donovani in Sri Lanka causes cutaneous leishmaniasis (CL) rather than more common visceral form. We have visualized biofilms and profiled the microbiome of lesions and unaffected skin in thirty-nine CL patients. Twenty-four lesions (61.5%) were biofilm-positive according to fluorescence in situ hybridization. Biopsies of biofilm-positive lesions were dominated by Pseudomonas, class Bacilli and Enterobacteriaceae and distinguished by significantly lower community evenness. Higher relative abundance of a class Bacilli OTU was detected in wound swabs versus contralateral skin. Wound swabs and biopsies had significantly distinct microbiome profiles and lower diversity compared to unaffected skin. Greater abundances of potentially pathogenic organisms were observed in wet ulcers, lesions with high parasite loads and large wounds. In summary, more than half of L. donovani associated CL wounds harboured biofilms and the wounds exhibited a distinct, less diverse, microbiome than unaffected skin.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 A child with intravenous immunoglobulin-resistant Kawasaki disease who responded to intravenous methyl prednisolone(Sri Lanka College of Paediatricians, 2019) Kankananarachchi, I.; Wickramasinghe, P.; Fernando, M.; Pussagoda, K.; Dissanayake, R.; Morawakkorala, R.; de Silva, H.No abstract availableItem Regulation of the medical profession in Sri Lanka: reform is urgently needed(Sri Lanka Medical Association, 2019) de Silva, N.; de Silva, H.No abstract availableItem Should male doctors in Sri Lanka wear a necktie to be recognized and respected?(Open Learning on Enteric Pathogens, 2019) Abeysundara, P.K.; Nishad, N.; Balendran, K.; Pabasara, M.; Bandara, P.K.; Perera, N.M.; de Silva, H.; de Silva, S.; Umakanth, M.; Wijesinghe, P.INTRODUCTION: European cultural norms have influenced physicians' attire in Sri Lanka. The necktie is one such item of clothing which is worn to be recognized and respected as professionals. This study was carried out to assess the perceptions of doctors and patients towards male doctors wearing neckties while providing patient care. METHODOLOGY: A descriptive cross-sectional study was carried out at the National Hospital of Sri Lanka. An interviewer-administered questionnaire was used to collect data from doctors and patients. RESULTS: The study included 105 doctors (57% males) and 333 patients (54% males). Mean ages of the doctors and patients were 37 years (95% C.I. 36-39) and 47 years (95% C.I. 45-49) respectively. Sixty-nine percent of the patients had completed secondary education or above. None of the patients were aware of the risk of spreading infections by wearing a necktie. Of the 41% of doctors who thought it was unnecessary to wear a necktie, 95% believed the necktie can spread infections. Ninety-five percent of patients believed doctors should wear neckties to be identified and respected and to maintain trustworthiness.CONCLUSIONS: None of the patients were aware of the possible risk of spreading infections by wearing a necktie, while most of the doctors who thought neckties were unnecessary also believed neckties can spread infections. Almost all patients thought that doctors should wear a necktie to be recognized and respected. Therefore, implementing a change in dress policy for doctors is a challenging task in Sri Lanka. KEYWORDS: doctors; hospital infections; neckties.Item Gillespie syndrome in a South Asian child: a case report with confirmation of a heterozygous mutation of the ITPR1 gene and review of the clinical and molecular features(BioMed Central, 2018) de Silva, D.; Williamson, K.A.; Dayasiri, K.C.; Suraweera, N.; Quinters, V.; Abeysekara, H.; Wanigasinghe, J.; de Silva, D.; de Silva, H.BACKGROUND: Gillespie syndrome is a rare, congenital, neurological disorder characterized by the association of partial bilateral aniridia, non-progressive cerebellar ataxia and intellectual disability. Homozygous and heterozygous pathogenic variants of the ITPR1 gene encoding an inositol 1, 4, 5- triphosphate- responsive calcium channel have been identified in 13 patients recently. There have been 22 cases reported in the literature by 2016, mostly from the western hemisphere with none reported from Sri Lanka. CASE PRESENTATION: A 10-year-old girl born to healthy non-consanguineous parents with delayed development is described. She started walking unaided by 9 years with a significantly unsteady gait and her speech was similarly delayed. Physical examination revealed multiple cerebellar signs. Slit lamp examination of eyes revealed bilateral partial aniridia. Magnetic resonance imaging of brain at the age of 10 years revealed cerebellar (mainly vermian) hypoplasia. Genetic testing confirmed the clinical suspicion and demonstrated a heterozygous pathogenic variant c.7786_7788delAAG p.(Lys2596del) in the ITPR1 gene. CONCLUSION: The report of this child with molecular confirmation of Gillespie syndrome highlights the need for careful evaluation of ophthalmological and neurological features in patients that enables correct clinical diagnosis. The availability of genetic testing enables more accurate counseling of the parents and patients regarding recurrence risks to other family members.Item Periodic deworming practice in Sri Lanka: Is it based on evidence, misconceptions or commercialism?(Sri Lanka College of Paediatricians, 2017) Mettananda, S.; de Silva, H.Item Stroke awareness in a Sri Lankan community introduction(Ceylon College of Physicians, 2016) Ranawaka, U.K.; de Silva, H.; Balasuriya, J.; Puvanendiran, S.; Jayasekara, B.; Wijesekera, J.C.OBJECTIVE: Knowledge regarding stroke is likely to influence treatment seeking and preventive behaviour. We sought to assess stroke awareness in a Sri Lankan community. METHODS: Adults and schoolchildren in 750 households in the Kelaniya Medical Officer of Health area selected by cluster sampling formed the study population. Knowledge about stroke was assessed using a pre-tested, structured, interviewer administered questionnaire. Level of knowledge was categorised into five groups using a composite score. RESULTS: 711 adults and 155 schoolchildren were studied. Only 36.8% recognised the brain as the organ involved in a stroke. Main presenting symptoms identified were unilateral weakness (93.9%) or sensory symptoms (88%), and speech difficulty (88%). Stroke was considered a cause of sudden death by 58.4%. Many recognised hypertension (74.3%) as a risk factor, but awareness was inadequate regarding diabetes (60.5%), heart disease (60.9%), hypercholesterolaemia (62.5%) and smoking (61.3%). Of the respondents, 60.1% considered stroke was preventable, 74% were aware that stroke could recur, 91.3% believed early treatment would improve outcome and 88.8% considered stroke an emergency. 43.3%, and ‘very good’ in only 0.7%. Majority were graded as average (46.8%), ‘poor’ (5.9%) or ‘very poor’ (3.4%). There was no significant difference in knowledge between adults and schoolchildren. Having a friend or a relative with a stroke was the commonest source of knowledge (61.5%). Doctors (32.2%) and other health workers (9.1%) were poor sources of information. CONCLUSIONS: Knowledge about stroke is deficient in many aspects. Health professionals need to play a greater role in improving awareness.Item A Coordinated national plan of action in child protection in Sri Lanka(Sri Lanka College of Paediatricians, 2007) de Silva, H.Child abuse is a phenomenon that has prevailed for centuries but has only captured worldwide attention in the past few decades. After many years of denial, Sri Lanka, too, has recognized the existence of many forms of violence and cruelty against children and the long and short-term ill effects of abuse on children. Initial work on the extent of sexual abuse and domestic child labour, the existence of physical abuse and description of the use of child soldiers as a form of child abuse, was recognized. As concern and care of children has been recognized in the traditions of Sri Lanka, the incidents of child abuse were denied or interpreted otherwise in many instances, until recently, in most part of the history. After a phase of denial, as a result of increased awareness and recognition in the society, the culturally justified abusive actions against children, such as physical abuse, and exploitations such as child labour and child involvement in armed conflicts, are increasingly recognized as forms of abuse. Although Sri Lanka was a signatory to the CRC in 1991, actual political commitment was recognized only after the appointment of a Presidential Task Force in December 1996. The task force recommended several legal amendments including the establishment of a National Child Protection Authority -NCPA (1998) by a Bill in Parliament. Prof. De Silva was the Chairman of both committees. One of the most important recommendations of the Presidential Task Force on Child Protection was the establishment of a National Child Protection Authority (NCPA). The NCPA bill was presented in parliament by the Minister of Justice in August 1998, and was passed unanimously in November 1998. (National Child Protection Authority (NCPA) Act, 1998). It was gazetted in January 1999; the board was appointed in June 1999. The NCPA has a wide mandate in all aspects of prevention and action as regards child abuse. The mandate of the NCPA would include a broad range of authority, objectives, and duties. These include: Advising government on National policy and measures regarding, prevention and treatment of child abuse as well as protection of children; creating an awareness of the right of the child to be protected from child abuse; consulting and co-ordinating with relevant ministries, local authorities, public and private sector organizations and recommending measures for prevention of child abuse and protection of victims; recommending legal, administrative and other reforms for the effective implementation of national policy; monitoring implementation of the law, the progress of all investigations and criminal proceedings in cases of child abuse; recommending measures in relation to protection, rehabilitation and reintegration into society of children affected by armed conflict; taking appropriate steps for the safety and protection of children in conflicts with the law ('juvenile offenders'); receiving complaints from the public relating to child abuse; advising and assisting local bodies and NGOO to co-ordinate campaigns against child abuse; coordinating, promoting and conducting research on child abuse; organizing and facilitating, workshops, seminars etc; coordinating and assisting the tourist industry to prevent child abuse; preparing and maintaining a national database on child abuse; monitoring organizations providing care for children; serving as liaison to and exchanging information with foreign governments and international organizations.Item An overview of child maltreatment and denial(Sri Lanka College of Paediatricians, 2007) de Silva, H.Child abuse most probably existed from time beyond memory or record. At an early stage of human evolution, child abuse and incest may have been accepted as a norm like animals having sex with its own progeny and of course, animals would not have an 'age of consent'. History of sexual abuse: Ancient Egyptian, Jewish, Greek and Roman history reveals sexual abuse of boys and girls including commercial sexual exploitation in the form of boy brothels and 'rent a boy' services. Documentations in the North West Frontier Province (NWPF) of Pakistan has revealed a practice of older and rich men having "attractive beardless" youth for their sexual pleasures often referred to as 'Balkey' and in some areas referred to as 'Ashnas* (Khan, 2000). The 'Devadasi' system in India although now legally banned is still in existence. One of the first recorded cases of (what can now be interpreted as paedophilia>in Sri Lanka (Ceylon then) was recorded in the 'Kadugannawa Parcel Bomb Case1 in 1945. Corporal punishment and physical abuse: All over the world, including South Asia, society has justified corporal punishment of children through phrases like "spare the rod and spoil the child" and "the taste of the curry depends on how well it is stirred". Denial: Kempe & Heifer (1980) indicated that doctors often hesitated to refer to legal authorities. The description of a large number of cases of sexual abuse over a short period in Cleveland in 1987, led to widespread disbelief and denial. I We, as individuals, as a society, or as a nation, are proud of ourselves when one (or a team) of our nationals performs well I in sports or any other activity. Individuals in society who may not have had even the remotest affiliation to this success would try to identify with the success as a 'national' and would like to have 'ownership' to this success. However, iff contrast, when your national team has done badly, society would not accept responsibility or ownership, fearing that the negative effect would reflect on them. Similarly, when incidents of child abuse stigmatise our society, neither the society nor the individuals would like to belong to that society and it would be not be surprising for them to reject reality. It is also easy to justify this denial because of the hidden nature of abuse, Other forms of child abuse: Physical and sexual abuse of children would be described by other speakers. Child soldiers: Although the issues of other forms of child abuse are being addressed effectively, the internation« community has not yet been able to challenge the global impunity of child recruitment by terrorists or governments. Compared to most other forms of child abuse, which is caused by individuals, conscription is by organized groups that ara not answerable to the community, local lawmakers or the international community. The justification of children as brave soldiers and martyrs to facilitate fund raising in diaspora communities, children being paid less than adults, while eatinl and demanding less food or other conditions of work, would make conscripting children more attractive than adull^ These conditions become 'norms' the children would be obliged to endure. Commercial sexual exploitation of children: Sri Lanka is well known as a tourist destination for about 3 decades. Initiall unrestricted inflow of tourists in the seventies and cheap accommodation, as well as cheap flights, led to the influx oH undesirable tourists including drug addicts, sex tourists and paedophiles. Very soon, Sri Lanka became a "paradise" foff paedophiles especially on the Southern Coast, with beautiful beaches and new hotel complexes that came up with^T flourishing trade. The advent of the internet and its popularization resulted in the sale of children including pornographB on the net. Easy access to internet, even in not so developed tourist areas, has become a menace compared to its benefitsB Poverty, ignorance, domestic abuse, single parents, alcohol/drug use by parents often contribute to the problem