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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Effects of Cinnamomum zeylanicum (Ceylon cinnamon) extract on lipid profile, glucose levels and its safety in adults: A randomized, double-blind, controlled trial(Public Library of Science, 2025-01) Muthukuda, D.; De Silva, C. K.; Ajanthan, S.; Wijesinghe, N.; Dahanayaka, A.; Pathmeswaran, A.BACKGROUND Cinnamon has been studied as a possible way to control blood glucose and serum cholesterol levels. However, there are no well-conducted randomized controlled trials that can accurately measure the lipid and glucose-lowering effects of Cinnamomum zeylanicum (C. zeylanicum) extract. This study primarily aimed to evaluate the effect of a standardized C. zeylanicum extract on serum low-density lipoprotein cholesterol (LDL-C) levels and secondarily on other lipid parameters (high-density lipoprotein cholesterol (HDL-C), total cholesterol and triglycerides), glucose levels, anthropometric measures, blood pressure, and safety outcomes in individuals with an LDL level between 100-190mg/dL.MATERIALS AND METHODS This was a randomized, double-blinded, placebo-controlled clinical trial. Participants were allocated to either C. zeylanicum extract or placebo group (1:1 allocation ratio). They were advised to take two capsules per day (1000 mg/day, a dose based on prior clinical studies suggesting potential efficacy and safety). Reduction in LDL-C at 12 weeks (from the baseline value) was compared between the two groups using ANCOVA. A complete-case analysis was adhered to in analyzing the outcome data.RESULTS The mean age (SD) of the 150 participants was 50.4 (10.52) years, and 66% were females. Among the 127 participants assessed at 12 weeks, those in the C. zeylanicum extract arm had a lower LDL-C value than the placebo arm but the difference was not significant (the baseline adjusted mean difference was 6.05mg/dL; 95% CI: -2.43 to 14.52; p = 0.161). However, participants in the C. zeylanicum extract group showed significantly greater reductions in fasting blood sugar (FBS) levels (the baseline adjusted mean difference was 8.59mg/dL; 95% CI: 0.59 to 16.59; p = 0.036). There was a significant interaction effect between the supplement and participants' glycemic status, with individuals with type 2 diabetes mellitus (T2DM) who received C. zeylanicum extract experiencing a notable reduction in FBS levels (standardized coefficient: -63, 95% CI: -102 to -25; p = 0.002).CONCLUSIONS C. zeylanicum extract did not have significantly reduce LDL-C but demonstrated a significant FBS-lowering effect, particularly in individuals with T2DM, with a favorable safety profile.Item Risk factors for low resilience among Grade 10 adolescents in the Gampaha district, Sri Lanka: a case-control study(BMJ Publishing Group, 2025-01) Manori, S.; Jayawardana, P. L.; Godamunne, P.OBJECTIVE Resilience means the ability to deal successfully with difficult situations, and hence low resilience will lead to many negative outcomes. The aim of this study was to explore risk factors for low resilience among Grade 10 adolescents in Gampaha district, Sri Lanka.METHODS Resilience levels and data related to putative risk factors were obtained by using a validated 14-Item Sinhala Resilience Scale and a questionnaire on putative risk factors (both of which were self-administered) from Grade 10 adolescents by conducting a descriptive cross-sectional study. There were 464 (33.6%) cases with low resilience (score=14-73) and 916 (66.4%) controls with high resilience (score=74-98). For the case-control study, the computed sample size for each case and control group was 128, who were selected by applying simple random sampling. Risk factors for low resilience were determined using bivariate and multivariable analyses by applying χ2 test and multivariable logistic regression. Results were expressed as ORs with respective 95% CIs.RESULTS Among the 33 putative risk factors analysed, 13 were found to be significant in bivariate analysis. In multivariable logistic regression analysis, out of 24 independent variables entered initially into the model, only 9 were retained in the final model. These comprised (1) one or both parents dead (AOR=2.5, 95% CI [1.2, 14.5]; p=0.032), (2) mother's low educational level (AOR=1.9, 95% CI [1.6, 3.8]; p=0.021), (3) sleep <8 hours (AOR=1.6, 95% CI [1.1, 3.8]; p=0.002), (4) having less than six close classmates (AOR=1.5, 95% CI [1.1, 4.3]; p=0.021), (5) not attending Sunday school (AOR=1.8, 95% CI [1.1, 10.6]; p=0.001), (6) being short-tempered (AOR=2.2, 95% CI [1.5, 3.6]; p=0.003), (7) having conflicts with friends (AOR=1.4, 95% CI [1.2, 7.5]; p=0.043), (8) not seeking help when confronted/facing with difficulties (AOR=1.6, 95% CI [1.2, 6.9]; p=0.032) and (9) lack of support from home when in need (AOR=1.6, 95% CI [1.2, 5.8]; p=0.001).CONCLUSION AND RECOMMENDATION Altogether nine risk factors were identified. Interventions focusing on risk factors ascertained should be developed and conducted regularly by the schools, targeting all adolescents of Grade 10 to boost their status of resiliencyItem Waiting times in the colorectal cancer treatment pathway in a Sri Lankan cohort: data from a specialised tertiary care setting(The College of Surgeons of Sri Lanka, 2025-01) Priyadarshanie, W. P. C. D.; Smaranayake, U. M. J. E.; Hansanie, S. M. N.; Geekiyanage, U.; Kumarage, S. K.; Chandrasinghe, P. C.INTRODUCTION Colorectal cancer (CRC) is the third most prevalent cancer in Sri Lanka, with rising incidence rates over the past decade. Timely intervention is essential for favourable outcomes, but prolonged waiting times remain a significant healthcare challenge globally. This study examines the time intervals between key steps in the CRC diagnostic and treatment pathway to identify potential areas for reducing delays. METHODS A cohort of 108 patients with suspected CRC symptoms, presenting to the University Surgical Unit at North Colombo Teaching Hospital from 2017 to 2024, was analysed. Data were collected on time intervals between: [1] symptom onset to primary care visit, [2] General Practitioner (GP) referral to specialist consultation, [3] specialist consultation to colonoscopy, [4] colonoscopy to imaging or neoadjuvant chemo-radiotherapy (NCRT), and [5] colonoscopy to surgery. Median times for each interval were calculated. RESULTS Of the 108 patients (36.1% male, median age 63), the median time from symptom onset to GPvisit was 11 weeks. Patients referred by GPs waited a median of 3 weeks for specialist consultation. Two-thirds underwent colonoscopy within 2 weeks of specialist consultation, with 78% completing it within 4 weeks. For patients not requiring NCRT, the median time from colonoscopy to surgery was 3.86 weeks; for those requiring NCRT, it was 12.86 weeks. CONCLUSIONS Waiting times for colonoscopy and curative surgery are within the accepted universal standards for colorectal cancer management, in this cohort. The delay in patient presentation to primary care was notably longer than physician-related delays. Early specialist referral for bowel symptoms may reduce time to diagnosis and treatment, aligning colonoscopy-to-treatment intervals with international standards.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 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.