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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Establishment and evaluation of real-time PCR based SELEX platform for the identification of protein binding aptamers: A pilot study in Sri Lanka(National Science Foundation of Sri Lanka, 2025-01) Abeykoon, A.I.; Kumarasinghe, K.M.N.; Chandrasekharan, N.V.; Wickramasinghe, P.M.T.B.Aptamers are single-stranded DNA (ssDNA) affinity reagents capable of substituting conventional antibodies in processes of molecular recognition. Their higher affinities, lower costs of production and longer shelf lives of aptamers are making them increasingly popular and replacing conventional antibodies in the fields of diagnostics and therapeutics. Systematic evolution of ligands by exponential enrichment (SELEX) is a well-established and efficient technology for generation of aptamers with high affinity against various targets including whole cells, isolated proteins, and small molecules. This study is the first to report efforts in exploring SELEX for isolating protein-binding aptamers using a quantitative PCR and NGS-based approach in a local context. A low-cost selection platform was developed by coating microwell plates with human serum albumin, the target protein of interest, for quantitative and qualitative solid phase immunoassays. Changes in affinity and diversity were monitored through analysis of amplification plots, melt curves, remelt curves and high-resolution melt curve (HRM). Following eight selection cycles, the enriched DNA was subjected to high-throughput sequencing, and the two most abundant sequences were identified. The sequences were evaluated through in-silico binding assays, which resulted in comparable binding affinities expected for aptamers. Among the monitoring techniques, the amplification curve analysis was a valuable tool in understanding changes in pool affinity. Although the melt curve initially lacked sufficient resolution in the early stages of SELEX, the re-melt curve and HRM analysis accurately reflected pool diversity during this time. Thus, we demonstrate that it is feasible to use locally available technology for the successful development of aptamers. This highlights the potential to produce affinity reagents locally on a commercial scale in the future.Item Anatomy of the thoracic duct: a cadaveric study(The College of Surgeons of Sri Lanka, 2025-01) Abeysuriya, V.; Nuwantha, A.A.S.; Kumarage, S.No abstract availableItem Effective use of an innovative learning method: a perspective from a Sri Lankan setting(South East Asia Regional Association for Medical Education (SEARAME), 2025-01) Dayasiri, K.; Kiridana, V.; Mudiyanse, R.INTRODUCTION Numerous medical schools have incorporated humanities and narrative medicine into their curricula to cultivate compassion and foster essential interpersonal abilities in medical students. These progressive educational approaches prove effective in cultivating empathy, ethical conduct, and professionalism among future healthcare practitioners. METHODS This qualitative study was conducted at the Faculty of Medicine, University of Kelaniya to study the effectiveness of an innovative learning method in enhancing active learning, critical thinking and personal professional development amongst first-year medical students. Newly graduated medical students, following exposure to a Training of the Trainer (TOT) program, served as facilitators for the training program, and insights from facilitators were gathered through audio-recorded focus group discussions. Following this, a thematic analysis was conducted to explore the interplay and correlations among the identified domains. RESULTS The study revealed that facilitators experienced a sense of empowerment after participating in the facilitator training program. They acknowledged that learning about learning itself was a novel experience, which they hadn't encountered during their time as students. Further, the findings indicated that junior medical graduates can successfully undergo training to facilitate a combination of five innovative active learning methods aimed to boost critical thinking and personal professional development among fresh medical students, resulting in high levels of acceptance and satisfaction among the facilitators. CONCLUSION The results of this study support the idea that training facilitators can improve their skills in delivering programs that promote critical thinking and active learning among first-year medical graduates. Feedback from newly graduated medical professionals acting as facilitators indicated that with enthusiasm and motivation, junior healthcare workers could be successfully trained to facilitate in settings with limited resources.Item The adaptation, implementation, and performance evaluation of intake24, a digital 24-h dietary recall tool for South asian populations: the South asia biobank(Elsevier Inc, 2025-01) Bhagtani, D.; Amoutzopoulos, B.; Steer, T.; Collins, D.; Abraham, S.; Holmes, B.A.; Rai, B.K.; Pradeepa, R.; Mahmood, S.; Shamim, A.A.; Mathur, P.; Athauda, L.; De Silva, L.; Khawaja, K.I.; Jha, V.; Kasturiratne, A.; Katulanda, P.; Mridha, M.K.; Anjana, R.M.; Chambers, J.C.; Page, P.; Forouhi, N.G.BACKGROUND South Asia's diverse food supply, food preparations, and eating behaviors require dietary instruments that reflect the consumption patterns of South Asians to enable context specific dietary assessment. Such instruments are not readily available for detailed dietary assessment at scale in South Asia.OBJECTIVES We describe the adaptation, implementation, and performance evaluation of Intake24, an open-source digital 24-h dietary recall tool, for dietary assessment in South Asia.METHODS We adapted Intake24 for dietary assessment in the South Asia Biobank (SAB), a large population-based study in Bangladesh, India, Pakistan, and Sri Lanka. Intake24 adaptation encompassed the development of a South Asian food database with commonly consumed foods, linked with corresponding portion sizes, food probes, and nutrient information. Trained interviewers conducted the 24-h recalls. Performance of Intake24 was evaluated in 29,113 South Asian adults.RESULTS The South Asia Intake24 food database included 2283 items and demonstrated good coverage of foods consumed across SAB regions. Median recall completion time was 13 min. Quality control metrics showed 99% of recalls included >8 items and 8% had missing foods. Median energy intake was higher in younger individuals compared to older, and in males compared to females. Underweight participants reported lower energy intake, with no discernible difference across other BMI categories.CONCLUSIONS Intake24 enables comprehensive dietary assessment in regions of South Asia and will facilitate the analysis of dietary patterns, food and nutrient intake, and their relationship with health outcomes among South Asians.Item Psychometric properties of an aptitude test administered to Sri Lankan first-year medical students(National University of Singapore (NUS), 2025-01) Sanchayan, S.; Dharmaratne, S.; Pathirana, S.; Godamunne, P.; Chandratilake, M.INTRODUCTION Selection for basic medical training is highly contextual. The use of cognitive aptitude tests, which commonly supplement measures of prior academic achievement in the selection process of medical schools internationally, is rarely reported from resource-constrained settings in South Asia. We report on the psychometric properties of an aptitude test designed based on the UCAT format, administered to first-year medical undergraduates to determine its utility. METHODS The aptitude test was administered online to first-year medical students shortly after their admission to two medical faculties in Sri Lanka (n=328). The reliability of the test was determined using Cronbach’s alpha. Overall and subtest scores were computed, and the scores of different demographic groups were compared using the t-test. Factor analysis of the subtests was performed.RESULTS The internal consistency of the test was 0.63. The difficulty and discrimination indices were within the acceptable range. The mean score of the aptitude test (AT) was 70.9/100 (SD 8.88). The mean score for females was higher than for males (p=0.04). No statistically significant differences in AT scores were observed between different ethnicities or religions. The entry academic scores demonstrated a weak correlation with the overall AT score (Pearson’s correlation coefficient r=0.27), verbal reasoning (r=0.24), the human body (r=0.19), quantitative reasoning (r=0.18), and situational judgement (r=0.128). Factor analysis indicated items that need revision.CONCLUSION The results indicate the potential value of aptitude tests in Sri Lanka and in similar jurisdictions where selection criteria have yet to expand beyond prior academic performance. A way forward in introducing such tests has been outlined.Item Effect of Mindfulness Meditation on Symptoms of Stress and Depression in Cancer outpatients of Sri Lanka. (MeSADISC study)(Ibn Sina Medical College, 2025-01) Dayasiri, K.; Rajapakshe, D.; Goonewardane, N.D.V.; Jayarathne, COBJECTIVES This intervention study aimed to evaluate mindfulness meditation as a method of treatment for cancer outpatients for stress reduction and control of symptoms of depression and to find out effects of socio demographic differences.METHOD Cancer outpatients were randomly selected on separate clinic dates at the National Cancer Institute of Sri Lanka and were enrolled as cases (n=44) and controls (n=30). Volunteers followed training sessions once weekly in addition to home based mindfulness meditation. All participants were asked to complete the “Beck’s Depression” and “Symptoms of Stress” questionnaires prior to intervention and at each session. Controls were assessed based on the identical questionnaire at start and end of 9 weeks. Both groups were heterogeneous in age, sociodemographic characteristics and cancer types / stage.RESULT At the end of the intervention, patients in the intervention group had significantly lower scores of depressions and stress. Reduction in Beck’s depression score was from 33.21 to 24.56 (p<0.001) in the treatment group, compared to 34.5 to 32.34 (p>0.05) in the control group. Reduction in Symptoms of Stress Inventory from 21.21 to 10.76 (p<0.001) was seen in the intervention group, compared to 22.50 to 25.5 increase in controls. Significant changes (p<0.05) were seen in all age categories, gender, education, income and levels of social interactions.CONCLUSION Mindfulness meditation programme was effective in decreasing levels of depression and stress in people with cancer, irrespective of socio-demographic backgrounds and cancer types or stages.Item Clinical epidemiology of inflammatory bowel disease among adults in the South Asian region: A systematic review and meta-analysis(Elsevier Ltd, 2025-01) Niriella, M.A.; Martinus, C.K.; Withanage, M.Y.; Darshika, S.; Illangasinghe, M.; Perera, H.R.; Ediriweera, D.S.; De Silva, H.J.OBJECTIVES Inflammatory bowel disease (IBD) is an emerging disease in the South Asia. We conducted a systematic review to determine the characteristics and overall prevalence of IBD among South Asian adults.DESIGN We searched the PubMed database and included descriptive, epidemiological studies with satisfactory methodological quality, reporting the epidemiology of IBD with histological confirmation. The quality of the studies was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Two authors screened and extracted data independently. A random-effects meta-analysis of characteristics and overall prevalence of IBD was performed.RESULTS This review analysed data from over 9000 IBD patients from 21 studies across multiple South Asian countries. It found a higher prevalence of ulcerative colitis (UC) compared to Crohn's disease (CD) (2:1). There was a male predominance and modest familial aggregation of IBD cases. Left-sided colitis was the most common disease extent for UC. Colonic involvement was more frequent than ileal involvement for CD. The non-stricturing, non-penetrating behaviour was dominant in CD cases. Joint manifestations were commonly reported in both UC and CD. Immunomodulators, such as azathioprine, were used in a significant proportion of patients, particularly for CD. The use of biological agents like infliximab was relatively low. Surgical intervention rates were lower than in Western cohorts but higher in CD compared to UC.CONCLUSIONS This study provides an epidemiological overview of adult IBD characteristics, phenotypes, and treatment patterns in the South Asian region. There were epidemiological, clinical, phenotypic and treatment differences compared to western IBD.Item Community-based snakebite risk mapping for resource prioritisation in Eastern province, Rwanda(Oxford University Press, 2025-01) Ediriweera, D.S.; Hakizimana, D.; Diggle, P.J.; Schurer, J.M.BACKGROUND Snakebite envenoming is a medical emergency that requires rapid access to essential medicines and well-trained personnel. In resource-poor countries, mapping snakebite incidence can help policymakers to make evidence-based decisions for resource prioritisation. This study aimed to characterise the spatial variation in snakebite risk, and in particular to identify areas of relatively high and low risk, in Eastern Province, Rwanda.METHODS Snakebite surveillance of people bitten in 2020 was conducted in Eastern Province through household visits and case verification. Geostatistical modelling and predictive mapping were applied to data from 617 villages in six districts to develop sector-level and district-level risk maps.RESULTS There were 1217 individuals bitten by snakes across six districts. The estimated population-weighted snakebite incidence in Eastern Province was 440 (95% predictive interval 421 to 460) cases per 100 000 people, corresponding to 13 500 (95% predictive interval 12 950 to 14 150) snakebite events per year. Two sectors in the southwest, Gashanda and Jarama, showed >1500 snakebite events per 100 000 annually. The lowest incidence was observed in the north.CONCLUSIONS Considerable differences exist in snakebite risk between sectors in Eastern Province, with the highest risk concentrated in the southwest. Policymakers should consider prioritising resources related to snakebite prevention, essential medicines and health worker training in this regionItem A comprehensive review of biological and genetic control approaches for leishmaniasis vector sand flies; emphasis towards promoting tools for integrated vector management(Public Library of Science, 2025-01) Kumari, Y.; Gunathilaka, N.; Amarasinghe, D.BACKGROUND Leishmaniasis is a health problem in many regions with poor health and poor life resources. According to the World Health Organization (WHO), an estimated 700,000-1 million new cases arise annually. Effective control of sand fly vector populations is crucial for reducing the transmission of this disease. Therefore, this review aims to comprehensively examine and evaluate the current methods for controlling sand fly populations, focusing on biological and gene drive techniques.METHODS AND FINDINGS A detailed, comprehensive literature search was carried out using databases including Google Scholar, PubMed, ScienceDirect, and the National Library of Medicine (NIH). These searches were done using specific keywords related to the field of study. This current review identified several promising methods, including genetically modified sand flies, using transgenic approaches by taking advanced gene editing tools like Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR/Cas9) and genetic modification of symbiotic microorganisms for controlling sand fly populations, which appeared to be proven under laboratory and field settings.CONCLUSION Genetic control approaches have many benefits over chemical control, including long-lasting effects on targets, high specificity, and less environmental impact. Advances in genetic engineering technologies, particularly CRISPR/Cas9, sterile insect techniques, and gene drive insect modification, offer new avenues for precise and efficient sand fly management. Future research should prioritize optimizing rearing and sterilization techniques, conducting controlled field trials, and fostering collaboration across disciplines to realize the potential of genetic control strategies in combating leishmaniasis.Item APAGE position statements on green and sustainability in gastroenterology, hepatology, and gastrointestinal endoscopy(Blackwell Scientific Publications, 2025-01) Ang, T.L.; Hang, D.V.; Li, J.W.; Ho, J.C.L.; Sy‐Janairo, M.L; Ali, R.A.R.; Makharia, G.K.; Sundaram, S.; Chantarojanasiri, T.; Kim, H.G.; Isayama, H.; Pausawasdi, N.; Wu, K.; Syam, A.F.; Aye, T.T.; Rehman, S.; Niriella, M.A.; Jurawan, R.; Wang, L.; Leung, W.K.; Liou, J.M.; Rizan, C.; Wu, J.C.Y.; Ooi , C.J.BACKGROUND AND AIM The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability.METHODS A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.RESULTS There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.CONCLUSION The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.