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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Awareness on malaria among healthcare providers and public during the prevention of re-establishment phase in Sri Lanka(European Society of Medicine, 2025-01) Hamsananthy, J.; Wickremasinghe, A.R.INTRODUCTION Prevention of re-establishment of malaria is a challenge for Sri Lanka due to the country’s high receptivity and importation risk. As imported malaria cases are being reported, awareness on malaria among both healthcare providers and the public is crucial to anticipate a resurgence and re-establishment of malaria in the country.OBJECTIVES The objective of this study was to assess the awareness on malaria among healthcare providers and the public during the prevention of re-establishment phase immediately after “malaria-free” certification by the World Health Organization (WHO).METHODOLOGY Two national surveys were conducted among 766 healthcare providers and 3454 households in 2016/17. Healthcare providers’ survey was conducted using stratified random sampling and administering a self-administered questionnaire. The household survey was conducted using multistage cluster sampling method. A marking scheme was developed and adjusted binary logistic regression analysis was used to assess the association between awareness and socio-demographic and economic factors, using IBM SPSS version 20 statistical software package.RESULTS The mean score for awareness on malaria among healthcare providers was 54.7% (SD=10.6%) and the heads of households was 28.6 % (SD = 9.03%). Awareness among healthcare providers was significantly associated with the sector of the institution, type of institution, but not with ever seen a malaria case. For the heads of households, awareness was significantly associated with age group, family income/wealth quintile, sector of residency, ever heard about malaria, seen/heard messages about malaria in the past 6 month and had been overseas within the last 3 years.CONCLUSIONS AND RECOMMENDATIONS The awareness on malaria among healthcare providers and public in Sri Lanka is poor during the prevention of re-establishment phase. Awareness programmes should be conducted for both public and healthcare providers to keep malaria on the radar through television, mobile phones and newspapers. Updates about malaria should be regularly conducted for healthcare providers.Item 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 A morphometric analysis of craniofacial features of the Coastal Indigenous people in Sri Lanka(Sociedad Chilena de Anatomia, 2024-12) Liyanage, S.; Devasingha, D. M. L. C. D.; Dissanayake, D. M. P. V.; Ranaweera, L.The existence of an indigenous community within a country is a source of pride and warrants significant attention. Sri Lanka is no exception, and, as a country with the fossil remains of anatomically modern Homo sapiens, it is hypothesized that Sri Lankan Indigenous people might harbor ancient genetic signatures. This study aims to establish baseline data of certain craniofacial anthropometric measurements in the Coastal Indigenous people and classify their head, face, and nose types. This study involved 126 (70 Male and 56 Female) unrelated individuals from six villages, representing the Coastal Indigenous population. Sixteen craniofacial measurements were obtained, providing calculations of three craniofacial indices: the Cephalic index, Facial index, and Nasal index. It was apparent that all craniofacial measurements, except nose protrusion of males, had significantly higher dimensions than those of the female participants. In addition to baseline quantitative raw data, the calculated indices are as follows: The mean cephalic, facial, and nasal indices of females were 78.50± 4.84, 88.37±13.06, and 93.93±12.23, respectively, whereas those of males were 78.85±5.76, 91.74±13.70, and 94.58±14.06, respectively. This is the first craniofacial study on Coastal Indigenous people in Sri Lanka. The most common head shape observed among both genders was mesocephalic. Males predominantly exhibited a hyperleptoprosopic facial type, while females mostly showed a leptoprosopic facial type. The most dominant nasal type recorded for both genders was the platyrrhine nasal phenotype. Interestingly, such platyrrhine nose is rarely present in other world populations, except in African populations.Item Sex differences in stroke in a Sri Lankan cohort(Karger, 2024-12) Ranawaka, U. K.; Mettananda, C. D.; Nugawela, M.; Pathirana, J.; Chandrasiri, J.; Jayawardena, C.; Amarasekara, D.; Hettarachchi, R.; Premawansa, G.; Pathmeswaran, A.INTRODUCTION Stroke characteristics, subtypes, and risk factors in women may differ from men. Data on sex differences in stroke are scarce in developing countries, especially the South Asian region. We aimed to describe the sex differences in patients with stroke admitted to a tertiary care hospital in Sri Lanka. METHODS Consecutive patients with stroke enrolled in the Ragama Stroke Registry over 3 years (2020–2023) were studied. Sex differences in demographics, presentation delays, clinical characteristics, stroke subtypes, risk factors, stroke severity, and early functional outcomes were compared using χ2 test, independent sample t test and Wilcoxon rank-sum test. Associations of early functional dependence were studied using multiple logistic regression. RESULTS Of 949 patients with stroke, 387 (40.8%) were women, with a median age of 66 (interquartile range [IQR] 57–73) years compared to 63 (IQR 54–70) years in men (p < 0.001). Women had more ischaemic strokes (85.8% vs. 78.6% in men, p = 0.005). Swallowing difficulty (p = 0.039) and bladder involvement (p = 0.001) were more common in women, whereas dysarthria (p = 0.002) and cerebellar signs (p = 0.005) were more common in men. More women had hypertension (74.4% vs. 59.4%, p < 0.001) and diabetes (52.2% vs. 41.6%, p = 0.001), whereas smoking (0.3% vs. 35.1%, p < 0.001), alcohol use (0.3% vs. 55.0%, p < 0.001), and other substance abuse (0.8% vs. 5.2%, p < 0.001) were almost exclusively seen in men. No differences were noted in delays to hospital admission (delay ≥4.5 h: women 45.4% vs. men 41.3%, p = 0.222). There were no sex differences in the rates of CT scanning (women 100% vs. men 99.6%, p = 0.516) or thrombolysis for ischaemic stroke (women 7.8% vs. men 10.2%, p = 0.458), but more men received stroke unit care (women 37.2% vs. men 45.4%, p = 0.012). No differences were noted between sexes in the clinical (Oxfordshire classification, p = 0.671) or aetiological (TOAST criteria, p = 0.364) subtypes of stroke. Stroke severity on admission was similar between sexes (median NIHSS score; women 8.0 vs. men 8.0, p = 0.897). More women had a discharge Barthel index (BI) <60 than men (62.6% vs. 53.5%, p = 0.007), but female sex was not associated with BI <60 on multivariate logistic regression (p = 0.134). There was no difference in in-hospital mortality (women 5.9% vs. men 5.9%, p = 0.963). CONCLUSIONS Women with stroke in this Sri Lankan cohort were older, had different risk factor profiles and clinical stroke characteristics, and had more ischaemic strokes. Female sex was not independently associated with functional disability on discharge or in-hospital mortality.Item Causes, complications and short-term outcome of acute Kidney injury in a resource-limited setting(SAGE-Hindawi Access to Research, 2024-12) Herath, N.; De Silva, S.; Liyanage, P.; Kumara, S.; Devi, S.; Abeysekara, V.; Mallawarachi, R.; Perera, S.; Karunathilaka, I.; Samarasinghe, S.; Weerakoon, K.AIMS The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. METHODS Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. RESULTS Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p=0.017). More severe AKI was associated with type 2 diabetes (p=0.0042), hypertension (p < 0.0001) and multiple comorbidities (p=0.0014). Persons with no comorbidities had less severe AKI (p=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and p=0.047). CONCLUSIONS AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.Item Epidemiological patterns and trends of paediatric snakebites in Sri Lanka(Biomed Central, 2024-12) Dayasiri, K.; Caldera, D.; Suraweera, N.; Thadchanamoorthy, V.; Hettiarachchi , M.; Denipitiya, T.; Bandara, S.OBJECTIVES This study aimed to analyse the epidemiological patterns of paediatric snake bites in Sri Lanka over a 4-year period (2020-2024).METHODS A multi-centre, retrospective observational study was conducted from June 2020 to June 2024 across nine governmental hospitals in seven provinces of Sri Lanka. Data were collected based on 757 children presenting with snake bites. The snake bites were analysed based on age, gender, and seasonal variations. Data on the type of snake involved, geographic variations and the temporal trends in snake bite occurrences were also analysed.RESULTS The mean age of the 757 children recruited to the study was 10.3 years (SD-5.00, range-0.1-17 years). Males (57.7%) were significantly more affected than females (42.3%) (p < 0.05). Visual identification confirmed the snake species in 58.4% of cases. The hump-nosed viper (16.7%), Russell's viper (14.7%), and common krait (12.9%) were the most common medically important snakes identified in the study. Seasonal peaks in snake bites occurred in May-July and November-December. An increasing trend in snake bite incidence was noted over the first three years, with a slight decline in the final year.CONCLUSION Paediatric snake bites in Sri Lanka show significant age, gender, and seasonal patterns. Targeted public health interventions are needed to mitigate the impact on children.Item Silver Russell syndrome: A suspected syndromic child in Sri Lanka presenting with recurrent head-banging associated with force-feeding(Sri Lanka College of Psychiatrists, 2024-10) Vidyatilake, P.; Kodikaraarachchi, D.; Chandradasa, M.; Wijetunge, S.No abstract availableItem Auditory and visual hallucinations in an adolescent following orthotopic liver transplantation(Sri Lanka College of Psychiatrists, 2024-10) Chandradasa, M.; Abeyrathne, M.; Sithara, P.; Kodithuwakku, K.; Fernando, M.No abstract availableItem Undetected falls among older adults attending medical clinics in four tertiary care centres in Sri Lanka; the need of a comprehensive geriatric assessment(BioMed Central, 2024-10) De Zoysa, W.; Rathnayake, N.; Palangasinghe, D.; Silva, S.; Jayasekera, P.; Mettananda, C.; Abeygunasekara, T.; Lekamwasam. S.OBJECTIVE Falls take a high priority among the prevalent medical conditions in old age. Despite this, a history of falls or the risk of future falls is not routinely assessed or properly managed in medical clinics in Sri Lanka. This study was done to evaluate the prevalence and factors associated with falls and recurrent falls among older adults attending medical clinics in four selected tertiary care centres in the country.METHODS A cross-sectional study was carried out at four centres (Teaching Hospital Karapitiya, Colombo South Teaching Hospital, Colombo North Teaching Hospital and University Hospital-Kotelawala Defence University) with 704 older adults, aged 65 years and above, attending medical clinics for more than six consecutive months. Information related to falls and possible associated factors (socio-demographic, behavioural, environmental and biological) were collected using an interviewer-administered questionnaire.Results: The Mean (SD) age of the participants was 72.5(5.5) years and 58.7% were females. Of the 704 total sample, 220 (31.3%, 95% CI 28-35%) participants experienced at least one fall after the age of 65, and 12.8% (95% CI 10-15%) (n = 90) experienced recurrent falls (two or more falls within the last 12 months). Falls were associated with gender, level of education, marital status, and physical dependence (p < 0.01). For those who had at least one fall, multiple logistic regression (MLR) revealed being single (p = 0.03, OR = 2.12, 95% CI; 1.052-4.304), being widowed/divorced/separated (p = 0.03, OR = 1.47, 95% CI; 1.039-2.093) compared to living with a spouse, presence of moderate (p = 0.007, OR = 1.72, 95% CI; 1.160-2.577) and severe (p = 0.001, OR = 2.98, 95% CI; 1.563-5.688) physical dependency compared to mild physical dependency as risk factors for falls. Having secondary education (p = 0.01, OR = 0.55, 0.350-0.876) was a protective factor for falls. For those with recurrent falls, MLR showed moderate physical dependency (p = 0.001, OR = 2.34, 95% CI; 1.442-3.821) compared to slight physical dependency as a risk factor.CONCLUSIONS Approximately one-third of the older adults attending medical clinics had experienced at least a single fall, and one-eighth have had recurrent falls, which were mostly unrecorded and not clinically assessed. Physical dependency was the major contributing factor to falls and recurrent falls. Falls assessment should be included in the routine clinical assessment of older adults attending outdoor medical clinics. Health professionals should be educated to detect and assess those at risk of falling and take appropriate measures to prevent or minimize falls.Item Sri Lanka’s journey through antimicrobial resistance – gaps and gains(Sri Lanka Medical Association, 2024) Chandrasiri, N.S.; Vidanagama, D.S.; Gunaratna, G.P.S.; Elwitigala, J.P.; Patabendige, C.G.U.A.; Jayatilleke, S.K.No abstract available