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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Approach to study the efficacy and safety of new complementary and alternative medicine formulations: Lesson during COVID-19 from Sri Lanka(Wolters Kluwer - Medknow, 2023) Pilapitiya, S.; Jayasinghe, S.; Silva, A.; Wickremasinghe, R.; Paranagama, P.; de Silva, J.; Lekamwasam, S.; Kularatne, S.A.M.; Wanigasuriya, K.; Kaluthota, S.; Sumathipala, S.; Rathnnasooriya, C.; Siribaddana, S.COVID-19 affected Sri Lanka from early 2020, a time of considerable ignorance accompanied by wide media coverage of a devastating epidemic in Italy and Europe. Many were attracted to complementary and alternative medicine (CAM) or traditional medicine (TM) in this desperate situation. Several preparations were claimed to be effective against COVID-19 globally. Dammika Bandara Syrup© was one such preparation promoted for preventing and treating SARS-CoV-2 infection. It was based on bees' honey, pericarp and mace of Myristica fragrans (nutmeg), the seed of Foeniculum vulgare and fresh rhizome of Zingiber officinale, all believed to have anti-viral properties. Following an unpublished clinical study claiming efficacy, Dammika Bandara Syrup© gained wide media publicity and political patronage. The producer claimed of Goddess Kali revealing the formula added an anthropological, cultural, and religious complexity to the issue. The demand for the product increased rapidly as a debate raged both in public and in the parliament on utilizing such products in combating COVID-19. The Department of Ayurveda, which is statutorily responsible for regulating CAM/TM had to respond to the situation. The legislation to regulate such indigenous medicinal products was weak, and the crisis deepened as thousands converged to the production facility, defying mobility restrictions introduced to control COVID-19. This led to the Ministry of Health requesting academics to form a team and conduct a clinical trial to prove its efficacy. This paper outlines the process and issues faced during the regulatory approval for the trial in a polarized political environment. Some health professionals accused the researchers of bowing to political pressure and questioned the scientific justification for the trial. However, the team considered this as an opportunity to streamline a path for research into CAM/TM therapies in situations such as COVID-19. Several processes were identified and addressed, such as the provisional registration of CAM preparations, assessing the potential efficacy of a CAM product, confirmation of authenticity and safety, standardization and supervision of production respecting cultural identities, obtaining approval for human use, choice of comparators, and ethical issues. We believe the study has helped set standards and a benchmark for CAM and TM research in Sri Lanka.Item Acute fatty liver of pregnancy(Taylor and Francis Group, 2021) de Silva, J.; Padumadasa, S.No abstract availableItem Non-alcoholic fatty liver disease: a Sri Lankan perspective(The Sri Lanka Medical Association, 2022) Niriella, M.; Dassanayake, A.; de Silva, J.No Abstract availableItem Perceived impact of the COVID-19 pandemic on psychiatric training among final-year medical undergraduates in Sri Lanka: an online survey of students from eight universities(American Psychiatric Press, 2022) Baminiwatta, A.; Dayabandara, M.; de Silva, J.; Gadambanathan, T.; Ginige, P.; Premarathne, I.; Rajapaksha, H.; Wickramasinghe, A.; Sivayokan, S.; Wijesinghe, C.Objective: This study aimed to assess the perceived impact of the COVID-19 pandemic on undergraduate psychiatry training in Sri Lanka and to explore several potentially associated factors. Methods: An online survey was distributed among students from eight medical schools who recently faced their final exam. Their perceptions on the impact of the pandemic on the psychiatry training and exam performance were rated on a 10-point scale. Resilience was assessed using a two-item scale. Results: A total of 644 students responded (69.5% female, mean age=27.5 years). Among them, 164 (25.5%) reported being quarantined; 25 (4%) reported becoming infected with COVID-19; and 170 (28.6%) reported ward closure for over a week during the clerkship. Greater impact was reported for patient availability (mean=7.08), mental status assessments (mean=6.3), developing rapport (mean=6.2), and diagnostic skills (mean=5.9), whereas the impact on peer-learning (mean=5.5) and self-study (mean=3.6) was relatively lower. Impact on clinical components of the final exam (mean=6) was rated higher than on theory components (mean=4.5). The majority (70.3%) reported that COVID-19-related stress affected their exam preparations. Higher resilience predicted lower perceived impact on all aspects of training/exam performance. Female gender and ward closure predicted greater impact on diagnostic skills, overall training, and clinical exam performance, whereas being quarantined predicted greater impact on peer-learning and self-study. Conclusion: The pandemic has significantly affected the undergraduate psychiatry training in Sri Lanka, particularly its clinical components. Increasing clinical exposure to patients, managing students' stress, and building their resilience should be key concerns for medical educators during the pandemic.Item Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 2](The College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Hettiarachchi, D.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Fernando, M.; Hettiarachchi, D.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; Wijesuriya, R.; Liyanage, C.; Siriwardana, R.; Dissanayake, J.; Wijesuriya, N.; Rodrigo, U.; Rodrigo, U.; Mudalige, A.; de Silva, J.Globally, an estimated one million deaths occur annually due to complications of cirrhosis. Cirrhosis with end stage liver disease [ESLD] is a leading cause death due to non- communicable diseases in Sri Lanka. Non-alcoholic fatty liver disease [NAFLD] and alcohol related liver disease [ARLD] are the principal causes of ESLD due to cirrhosis in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multiorgan dysfunction and hemodynamic instability characteristic of ESLD adds to the complexity of perioperative care in liver transplantation. Maintenance of stable hemodynamics including optimal hemostasis forms the core of the anaesthetic strategy in liver transplantation.Item Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 1](College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Wijesuriya, N.; Rodrigo, U.; Mudalige, A.; Fernando, M.; Hettiarachchi, D.; Dissanayake, J.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; de Silva, J.; Siriwardana, R.; WIjesuriya, R.; Liyanage, C.ABSTRACT: Cirrhosis with end stage liver disease (ESLD) is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation is the only curative treatment for patients with ESLD. The complex multisystem involvement and unique cardiovascular profile characteristic of ESLD present formidable challenges during liver transplantation. Management of the rapid and varied hemodynamic changes during surgery requires an in depth understanding of the physiological effects of each intervention. Based on the current literature and the experience gained at our center during the management of 50 liver transplants, we present optimization strategies and perioperative hemodynamic interventions which we use to ‘Fast track’ recovery following liver transplantation. KEYWORDS: Liver transplantation, cirrhosis, non-alcoholic fatty liver disease, alcohol related liver diseaseItem Barriers for cataract treatment among elderly in Sri Lanka(Hindawi Publication Corporation, 2019) Nishad, N.; Hewage, S.A.; Arulmoly, K.; Amaratunge, M.S.; de Silva, J.; Kasturiratne, K.T.A.A.; Abeysundara, P.K.; Wickremasinghe, A.R.Cataract is still the leading cause of blindness. Many government institutes and voluntary organizations in Sri Lanka are providing free treatment services to patients with cataract. Still people are not patronizing the available free services; thus they have to live with impaired vision or blindness. This paper describes the barriers for cataract treatment among the population over 60 years of age. Out of 470 elders, 379 were found to have some kind of cataract. This study demonstrated lack of awareness and knowledge, socioeconomic factors, and misconceptions as the main barriers for cataract treatment which has led to a lower cataract surgery rate irrespective of the high cataract prevalence reported. Findings of this study highlight the importance of cataract as a common health problem in elderly and need for removal of the barriers for its treatment which should be given due prominence in the formulation of public health policy in Sri Lanka at the earliest.Item Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, postmenopausal, urban Sri Lankan females: a community cohort follow-up study(Wiley Publishing, 2017) Dias, T.; Niriella, M.; de Silva, S.; Motha, C.; Palihawadana, T.S.; Ediriweera, D.; de Silva, J.OBJECTIVES: Metabolic syndrome (MetS) has been recognised as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old female cohort by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: 813/1636(49.7%) of the original female cohort attended follow-up; ET was measured in 567(69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57(10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95%CI:1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95%CI:1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95%CI:0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95%CI:0.10–0.89, p<0.05] were protective. CONCLUSIONS: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.Item Study on age-ralated variation in ovarian volume and proportion of endometrial thickness abnormalities in women of advanced and post-reproductive age(Wiley Publishing, 2016) Pieris, V.; Dias, T.; Palihawadana, T.S.; de Silva, J.OBJECTIVES : To describe the variations in endometrial thickness and the ovarian volume among peri and postmenopausal women. METHODS : A cross-sectional analysis was done in a study population of a longitudinal study. This was a community-based study and included 888 women randomly selected from the Ragama, Sri Lanka. This was done as part of a larger ongoing study, the “Ragama Health Study”. All study participants underwent a transvaginal pelvic ultrasound scan and the endometrial thickness and the ovarian size were measured. The ovarian volume was calculated using the formula for a prolate ellipsoid (0.523 h x w x l). RESULTS: The mean age of the study population was 59.45 yrs (SD=7.601) and 85.8% (n = 762) of them had undergone menopause. The prevalence of an endometrial thickness (ET) > 10 mm among premenopausal women was 14.98% while 0.9% (n = 1) had an ET>15 mm. Among postmenopausal women an ET >4 mm was seen in 16.01%. This included 1.3% (n = 10) who had an ET >10 mm. The mean of average ovarian volumes of the study population, according to age is shown in the figure. CONCLUSIONS : The study demonsatrated the proportion of asymptomatic women with a thickened endometrium among perimenoausal and poatmenopausal women (>15 mm and >4 mm resepectively) that necessitate evaluation is around 1%. It also described the age related changes in ovarian volume.Item Study on age-ralated variation in ovarian volume and proportion of endometrial thickness abnormalities in women of advanced and post-reproductive age(John Wiley & Sons, 2016) Pieris, V.; Dias, T.; Palihawadana, T.S.; de Silva, J.Objectives: To describe the variations in endometrial thickness and the ovarian volume among peri and postmenopausal women. Methods: A cross-sectional analysis was done in a study population of a longitudinal study. This was a community-based study and included 888 women randomly selected from the Ragama, Sri Lanka. This was done as part of a larger ongoing study, the “Ragama Health Study”. All study participants underwent a transvaginal pelvic ultrasound scan and the endometrial thickness and the ovarian size were measured. The ovarian volume was calculated using the formula for a prolate ellipsoid (0.523 h x w x l). Results: The mean age of the study population was 59.45 yrs (SD=7.601) and 85.8% (n = 762) of them had undergone menopause. The prevalence of an endometrial thickness (ET) > 10 mm among premenopausal women was 14.98% while 0.9% (n = 1) had an ET>15 mm. Among postmenopausal women an ET >4 mm was seen in 16.01%. This included 1.3% (n = 10) who had an ET >10 mm. The mean of average ovarian volumes of the study population, according to age is shown in the figure. Conclusions: The study demonsatrated the proportion of asymptomatic women with a thickened endometrium among perimenoausal and poatmenopausal women (>15 mm and >4 mm resepectively) that necessitate evaluation is around 1%. It also described the age related changes in ovarian volume.
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