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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item Unveiling the intricacies: Insight into gastroesophageal reflux disease(Baishideng Publishing Group, 2025-01) Wickramasinghe, N.; Devanarayana, N. M.Gastroesophageal reflux disease (GERD) poses a substantial global health challenge, with prevalence rates exhibiting geographical variation. Despite its widespread recognition, the exact prevalence and associated risk factors remain elusive. This article comprehensively analyzed the global burden of GERD, shedding light on its risk factors, underlying pathophysiological mechanisms, current diagnostic modalities, evolving management strategies tailored to diverse patient profiles, and complex determinants contributing to treatment failures. A deeper comprehension of GERD is achieved by dissecting these intricate facets, paving the way for enhanced clinical management and improved patient outcomes.Item Presentation of disseminated neuroblastoma mimicking Bell’s palsy: a case report(BioMed Central, 2025-01) Gunawardana, S.; Jogaprajahpan, G.; Dayasiri, K.BACKGROUND Neuroblastoma is an embryological malignancy of neural crest cells that may have diverse presentations owing to direct effects, metastases, or paraneoplastic syndromes. Facial nerve palsy is an extremely rare presentation of neuroblastoma.CASE PRESENTATION A previously healthy 1-year-and-10-month-old Sinhalese girl presented with difficulty in closing her left eye for 2 weeks, preceded by deviation of her mouth to opposite side. Initial physical examination was normal, apart from left lower-motor-type facial nerve palsy. Initial laboratory investigations were also normal. A tentative diagnosis of Bell's palsy was made. However, magnetic resonance imaging of the brain was performed owing to the incidental detection of a painless bulge in the left zygomatic region with overlying skin bruising, in the absence of any preceding trauma. Magnetic resonance imaging of the brain revealed a soft-tissue mass in the left lateral orbital wall, extending to the body of the sphenoid and bulging into the left anterior fossa. Contrast-enhanced computed tomography of the abdomen, performed subsequently, showed an intra-abdominal large paravertebral soft-tissue mass. Histology of the abdominal mass confirmed poorly differentiated neuroblastoma.CONCLUSION Facial nerve palsy is well recognized to have a myriad of underlying etiologies, including hematological malignancies, solid tumors, and paraneoplastic syndromes. However, its timely diagnosis is often challenging in the absence of other supportive clinical features. These children need careful and thorough evaluation for malignancies before commencing steroids, especially when underlying malignancy is likely.Item Development of a TaqMan-based dosage analysis PCR assay for the molecular diagnosis of 22q11.2 deletion syndrome(Genetics Society of Japan, 2025-01) Ranaweera , D.M.; De Silva , D.C.; Samarasinghe, D.; Perera , S.; Kugalingam, N.; Samarasinghe , S.R.; Madushani , W.Y.; Jayaweera , H.H.E.; Gunewardene , S.; Muneeswaran, K.; Gnanam , V.S.; Chandrasekharan, N.V.A hemizygous 1.5-3.0-Mb microdeletion of human chromosome 22q11.2 with the loss of multiple genes including histone cell cycle regulator (HIRA) causes 22q11.2 deletion syndrome (22q11.2 DS), a common disorder with variable manifestations including congenital malformations affecting the heart, palate and kidneys in association with neurodevelopmental, psychiatric, endocrine and autoimmune abnormalities. The aim of this study was to develop a TaqMan-based dosage analysis PCR (TaqMan qPCR) for use as a rapid, cost-effective test for clinically suspected patients fulfilling previously described criteria for molecular diagnosis of 22q11.2 DS in a lower middle-income country where the cost of testing limits its use in routine clinical practice. Nineteen patients were recruited with informed consent following ethical approval from the Ethics Review Committee, Lady Ridgeway Hospital for Children, Colombo. Dosage analysis of extracted DNA was performed using a TaqMan qPCR assay by amplifying regions within the target (HIRA) and control (testin LIM domain protein (TES)) genes of suspected patient (P) and unaffected person (N) samples. For detection of a deletion, the normalized value (HIRA/TES dosage) of a P sample was compared with that of an N sample. A ratio of P:N of 0.5 confirmed the presence of a deletion while a ratio of 1.0 refuted this. Seven of the 19 patients were found to have a HIRA deletion, confirming the diagnosis of 22q11.2 DS, with these results being in complete agreement with those of fluorescence in situ hybridization (FISH) (performed in nine of the 19 cases) and whole-exome sequencing (all 19 samples tested). This TaqMan qPCR assay was able to reliably distinguish HIRA-deleted cases from non-deleted ones. The assay was both cheaper and faster compared to commercially available alternatives in our setting, including FISH and multiple ligation-dependent probe amplification.Item Nature, prevalence and determinants of mental health problems experienced by adolescents in south Asia: a systematic review(Elsevier Ltd, 2025-01) Mudunna, C.; Weerasinghe, M.; Tran, T.; Antoniades, J.; Romero, L.; Chandradasa, M.; Fisher, J.BACKGROUND Adolescence is a sensitive phase of human development where individuals, aged 10-19 years, are particularly vulnerable to developing mental health problems (MHPs). South Asia, home to 24% of the world's population, is mostly comprised of low- and middle-income countries (LMIC). Most of the world's young people live in LMICs. This systematic review aims to assess the available evidence on the nature, prevalence and determinants of MHPs experienced by adolescents in south Asia. METHODS Following PRISMA guidelines, searches were conducted in four online databases (Ovid Medline, Ovid EMBASE, Ovid Global Health, Ovid PsycInfo), titles, abstracts, and full-texts were screened, data extracted and quality assessed. Extracted data were categorised into school-based studies (SBS) and non-school-based studies (NSBS). Data were further stratified according to country, MHPs and narratively synthesised. FINDINGS Of the 5847 records identified in the searches, 117 met inclusion criteria. Most (n = 87) were SBS. Key MHPs reported across countries include anxiety disorders and depression. Wide ranges of prevalence rates were reported for anxiety in Indian SBS (1.5-81.6%) and NSBS (1.8-88.1%), and for depression, Pakistani SBS (21-79%) and Indian NSBS (0.4-98.5%). Determinants include individual characteristics; violent victimisation; poor family/home/school environment/peer relationships; already experiencing MHPs and substance use/abuse. Increased physical activity, adequate nutrition, safe/positive homes/family environment, being unmarried females, higher maternal education, peer support/friendship, higher education level and engaging in extra-curricular activities were protective of mental well-being. INTERPRETATION Prevalence of MHPs among south Asian adolescents appears high. Determinants include social, cultural, environmental and socioeconomic factors often beyond individual control. Mental health policies and programs and research appropriate to the cultural context, that address social determinants of MHPs and evidence gaps, are needed to tackle the significant mental health burden among south Asian adolescents. FUNDING Authors CM and MW are supported by a Monash University Research Training Program Scholarship. JF is supported by the Finkel Professorial Fellowship funded by the Finkel Family Foundation.