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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Coagulopathy and fibrinolysis following the bite of a hump-nosed viper (Hypnale hypnale)(Oxford University Press, 1996) Premawardena, A.P.; Seneviratne, S.L.; Jayanthi, S.; Gunatilake, S.B.; de Silva, H.J.No abstract availableItem An audit of patient perception regarding labour pain and provision of analgesia in a teaching hospital.(College of Anaesthesiologists of Sri Lanka, 2005) Gunetilleke, B.BACKGROUND: Provision of adequate analgesia in labour remains a neglected aspect of our health care system. The perception and attitudes of patients regarding labour pain and analgesia has not received sufficient attention. METHODS: A questionnaire was adminlstered by the investigator to parturients In a teaching hospital prior to and after delivery. RESULTS: All patients had received regular antenatal care. Patients anticipated severe pain In labour (PItem A patient with polytrauma including a severe head injury, haemothorax and cardiac tamponade(College of Anaesthesiologists of Sri Lanka, 2009) Gunetilleke, B.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 Mental health status among females aged 15 to 45 years in Medical Officer of Health area, Kayts(College of the Community Physicians of Sri Lanka, 2007) Thatparan, R.; Abeysena, C.OBJECTIVE: To describe mental health status among females aged 15-45 years in Medical officer of Health area, Kayts. METHODOLOGY: This was a descriptive cross-sectional study carried out in Kayts MOH Division during the period between October and November 2006. The study population consisted of 365 females of age 15- 45 years. Data collection was made using the GHQ-30 and a self-administered questionnaire, which included socioeconomic data and exposure to adverse effects of war and social support received. Data analysis was done by applying chi-square test and multiple logistic regression. RESULTS: Of 365, 278 females had a GHQ-30 >5 giving a prevalence of poor mental health status of 76.4%. of them 27(7.7%) experienced loss of a limb, 126(35.9%) complained loss of assets such as jewelry or furniture, 17(4.8%) experienced disappearance of family members or relatives, 94(26.8%) had partially and 84(23.9%) fully damaged houses. There were statistically significant association between poor mental health status and single marital status (OR:2.2; 95% Cl:1.3-3.7; P=0.005), experience of displacement (OR:2.4; 95 % Cl: 1.1-5.2; P=0.03) and receiving of any form of assistances (OR:0.3; 95% Cl: 0.2-0.6; P=O.OO1). There were no statistically significant associations between poor mental health status and age, religion, educational level, employment, income, experience of injury, loss of a family member and property or having partially or fully damaged houses. After controlling for confounding effect by applying multiple logistic regression statistically significant associations were observed between poor mental health status and experience of displacement (OR:3.4; 95% Cl: 1.4-8.2; P=0.006) and receiving any form of assistance (OR:0.3; 95% Cl: 0.1-0.5; P=O.OOO). There was no statistically significant association between poor mental health status and single marital status (OR: 1.7; 95% Cl: 0.9-3.0; P=O.08). CONCLUSION: Prevalence of poor mental health status was very high in the area. It was associated with experience of displacement and receiving assistance.Item Presenting symptoms/conditions and selected aspects of health care quality at the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital, yakkala(College of the Community Physicians of Sri Lanka, 2007) Wanigasekara, C.; Weerasinghe, P.; Weerasinghe, A.; Weerasooriya, S.; Wellagiriya, S.; Wickramarathne, S.; Wijerathne, B.; Abeysena, C.OBJECTIVE: To describe the presenting symptoms/conditions and selected aspects of health care quality of the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital. METHODOLOGY: A descriptive cross sectional study was conducted on patients seeking treatment from the CPD oi the Wickramarachchi Ayurvedic Hospital. Yakkala between February to April 2007. A pre-tested interviewer administered questionnaire was used to gather information from 250 patients. RESULTS: Fever, cold and respiratory symptoms (44.2%; n=46), musculoskeletal complaints (28.8%; n=30) and dermatological conditions (14.4%; n=15) were the commonest presentations among persons up to 40 years old. Musculoskeletal complaints (26.8%; n=38). lever, cold and respiratory symptoms (24.6%; n=35) diabetes and hypertension (20.4%; n=29) and eye problems (9.8%; n=14) were the commonest presentations among persons above 40 years. Out of 250 patients, 56(22.4%) had visited the Ayurvedic Hospital as the first preference for the current illness and the balance 194(77.6%) patients had taken treatment from other health care institutions. The majority (86%: =168) sought ayurvedic medicine after taking western medicine. The most common reason for giving up previous treatment methods was treatment failure (69%; n=135). The distance between home and the hospital was <10 km for 52.4%(n=137) patients and >20 km for 11.6%(n=54) patients. Median total expenditure for one visit to the Ayurvedic hospital was Rs.200 (Range Rs. 00500 to 3000.00) and 57.6%(n=144) had spent Rs.100-500 for one visit. Median waiting time for consultation was 90 minutes (Range 5 — 300min). Consultation time was <5 minutes in 52%(n=131) and >10minutes in 24%(n=60) of patients. Two hundred and seven (83%) patients were satisfied with treatment given and 224 (69.6%) on facilities provided by the Ayurvedic hospital. Statistically significant associations were observed between high satisfaction and low educational level (p<0.001) and previous treatment failure from other systems (p<0.001). CONCLUSION: Patients seek ayurvedic treatment for various symptoms/diseases irrespective of their severity. patient's age and the distance to the hospital. The commonest reason for seeking ayurveda treatment was treatment failure at other methods. A majority were satisfied with the treatment provided and facilities available.Item Introduction of a Safe Water System (SWS) In a tsunami attuned community In Hikkaduwa, Sri Lanka(College of the Community Physicians of Sri Lanka, 2007) Pinidiyapathirage, M.J.; Wijeyaratnez, P.; Wickremasinghe, A.R.; Kalluri, P.INTRODUCTION: The SWS is an intervention that employs simple, robust, and inexpensive technologies to make drinking water safe at the point oi use through disinfection and safe storage. OBJECTIVE: To introduce a sale water system using household chlorination and washing of hands with soap in the community. METHODS: A commercially prepared solution of 0.9% sodium hypochlorite ('Chlovathura') in 130ml plastic bottles and a 20-liter plastic container with a narrow mouth and a lid was provided tree 01 charge. Trained community assistants distributed and promoted the use of the SWS using interpersonal communication methods. Hand washing using soap was promoted simultaneously. Surveys were conducted at baseline (n=452). six months (n=100) and 18 months (n=200) post- intervention to assess use. RESULTS: All were aware of the product ’Chlovathura' by six months of its introduction. 0t those who were aware oi the product, 49% (n=98) correctly described how it should be used at baseline and this percentage improved to 75% (n=149) post-intervention. When stored water at household level was tested for chlorine, it was present in the specified concentration in 6% 01:26), 27% (n=27) and 34% (n=67) at baseline, six months and 18 months respectively. The incidence of a diarrhoeal episode within the past two weeks among children under 5 years in the sample reduced to 4.8% (n=4) at 18 months from 5.4% (n=8) at baseline (p>0.05). CONCLUSION: The SWS was accepted and correctly practiced by more than one third of the target population. The SWS can be promoted in other areas with remote access to safe drinking water and may be a solution to reduce the morbidity due to diarrhoeal diseases in the country.Item Risk factors for Pregnancy induced Hypertension(College of the Community Physicians of Sri Lanka, 2007) Perera, N.; Abeysena, C.OBJECTIVE: TO determine the risk factors for pregnancy induced hypertension (PIH). METHODOLOGY: The study was a case control study which was carried out at Castle Street Hospital for Women during August to September 2006. Hundred mothers newly diagnosed as having PlH. were Chosen as cases and 100 with uncomplicated pregnancies as controls. Both cases and controls had a period of amenorrhoea of >20 weeks. Psychosocial Stress was measured using General Health Questionnaire -30 (GHQ) and Modified Life Event inventory. Maternal socio-demographic information and other data were collected using an interviewer administered questionnaire and a record sheet. Multivariate logistic regression analysis was applied to control for confounders and the results were expressed as odds ratios (OR) and 95% confidence intervals (95%Cl). RESULTS: After adjusting for confounding effect experience of ≥2 life events during pregnancy (OR:2.1, 95%Cl:1.1 - 10.9), a maternal BMl of ≥26kg/m2 (OR:2.4, 95%Cl:1.1- 5.0), maternal age of ≥28 years (OR:3.9, 95%Cl:2.0-7.5), history of ante partum haemorrhage (OR:3.4, 95%Clz1.1 - 10.9) and standing for >1.5 hours at one stretch per day (OR:3.4, 95%Cl:1.6 - 7.4) had statistically significant associations with developing PlH. A GHQ score of >5 was not associated with PlH (OR:3.0, 95%Cl: 1.0 -10.0). CONCLUSION: Experience of 22 life events during pregnancy, BMl ≥26 kg/m2, maternal age of ≥28 years, history of antepartum haemoghage and standing for more than 1.5 hours at one stretch per day were risk factors for PlH.Item Risk factors for spontaneous abortions.(College of the Community Physicians of Sri Lanka, 2007) Samaraweera, N.Y.; Abeysena, C.OBJECTIVE: TO determine risk factors for spontaneous abortions. METHODOLOGY: A hospital based case control study was carried out at the gynecological wards and antenatal Clinics of the De Soysa Maternity Hospital during the period between August to December 2004. Cases were selected from mothers who had partial or full expulsion of foetus up to 28 weeks period of amenorrhoea (POA), which had been diagnosed by a Consultant Obstetrician. Controls were selected from the antenatal Clinics who were having a viable foetus after completion of 28 weeks of POA. Two hundred and thirty-eight cases and 496 controls were selected. A pre-tested interviewer administered questionnaire and modified life events inventory were administered to gather data. Univariate and multivariate logistic regression was applied and the results were expressed as Odds ratios (OR) and 95% confidence intervals (95%Cl). RESULTS: After controlling for confounding by multivariate logistic regression it was revealed that sleeping <8 hours/day (OR:3.9, 95%CI:2.7-5.7, p<0.001), walking >5 hours/day (OR:2. 4, 95%Cl: 1.6- 3.3, p<0. 001), standing >4 hours/day (OR: 2.3, 95%Cl: 1.6- 3.3, p<0. 001), exposure to kitchen smoke (OR: 3.,1 95%Cl: 1 .6-6. 1, p< 0.01), BMI of >26kg/m2 (OR:2.1, 95%Cl:1.3 - 3.6, p<0.01), drugs taken other than routine antenatal vitamins and supplements (OR:2.9, 95%Cl:1.3-6.4, p<0.01) were risk factors and a maternal height <153 cm was a protective factor (OR: 0.5, 95%Cl:0.3-0.7, p<0.001) for spontaneous abortions. CONCLUSIONS: Exposure to kitchen smoke, drugs taken other than routine ante natal supplements, sleeping <8 hours/day, standing >4 hours/day and walking >5 hours/day and maternal BMI of >26 kg/m2 were risk factors for spontaneous abortions. Maternal height < 153cm was a protective factor for spontaneous abortions.Item Comparison of selected occupational health problems among coir industry and coconut estate workers in the Puttalam District(College of the Community Physicians of Sri Lanka, 2007) Mohotti, S.; Jayawardana, P.OBJECTIVE: To compare the prevalence of selected occupational health problems among coir industry (SG) and coconut estate (CG) workers in Puttalam District. METHODOLOGY: A descriptive cross sectional study was carried out in the MOH areas of Dankotuwa, Marawila and Chilaw, in the Puttalam district. Sample size computed was 190 for each group. Sample was selected using Simple random sampling method. Interviewer administered questionnaire was used to determine the socio-demographic characteristics and prevalence of selected occupational health problems among the two groups. RESULTS: The mean duration of service was 12.3 (50:86) years for SG and 13.7(SD=9.9) years for CG. Musculoskeletal symptoms - prevalence of carpal tunnel syndrome (OR =2.8; 95 %Cl: 1.2-6.5) was higher among SG while knee joint pain was higher among CG (OR=O.5; 95% Cl: 0.3 - 0.7). Dermatological conditions - prevalence of fingertip wastage (OR=1.25; 95%Cl: 8.1-53.1), oedema of terminal phalanges (OR=5.5; 95%Cl: 2.9 -10.6) and paronychia (OR=5.4; 95%Cl: 3.2-9.0) were higher among SG, while the CG showed a higher prevalence of callosities (OR=undefined). Occupational injuries - prevalence of abrasions (OR=0.06; 95%Cl: 0.03-0.13), lacerations (OR=0.09; 95%Cl: 0.04-0.18), contusions (OR=0.07; 95%Cl: 0.03-0.15) and cut injuries (OR=0.13; 95%Cl: 0.06-0.27) were higher among the CG. Varicose veins - prevalence of varicose veins was higher among 8G (OR=1.87; 95%Cl: 1.12-3.13). Respiratory conditions - prevalence of sneezing (OR=1.74; 95%Cl: 1.11-2.79) and common cold (OR=2.28; 95%Cl: 1.46-3.57) were significantly higher among SG while nasal Obstruction (OR=0.21; 95%Cl: 0.10 - 0.45), breathlessness (OR=0.26; 95%Cl: 0.12 - 0.53) and asthma were significantly higher among CG (OR=0.34; 95%Cl: 0.18 - 0.62). CONCLUSIONS AND RECOMMENDATIONS: Prevalence of individual musculoskeletal, skin and respiratory conditions differed among coir workers and coconut estate workers. However, varicose veins were more among coir workers while occupational injuries were more among coconut estate workers. Recommend use of protective gear.