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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Glycaemic control and avenues for improvement among people with type 2 diabetes mellitus from rural Sri Lanka – a retrospective cohort study(Elsevier, 2023) Mettananda, C.; Chathuranga, U.; Rathnayake, T.; Luke, N.; Meegodavidanage, N.BACKGROUND The majority of Sri Lankans and South Asians are rural dwellers but follow-up data on glycaemic control and its associations in rural communities are sparse. We followed up a cohort of hospital-based rural Sri Lankans with diabetes from diagnosis up to 24-months. METHODS We conducted a retrospective cohort study of people with type-2 diabetes (T2DM) diagnosed 24 months before enrolment who were being followed up at Medical/Endocrine clinics of five hospitals selected by stratified random sampling in Anuradhapura, a rural district of Sri Lanka from June 2018 to May 2019 and retrospectively followed them up to the diagnosis of the disease. Prescription practices, cardiovascular risk factor control and their correlates were studied using self-administered and interviewer-administered questionnaires and perusing medical records. Data were analysed using SPSS version-22. FINDINGS A total of 421 participants [mean age 58.3 ± 10.4 years, female 340 (80.8%)] were included in the study. Most participants were started on anti-diabetic medications in addition to lifestyle measures. Of them, 270 (64.1%) admitted poor dietary-control, 254 (60.3%) inadequate medication-compliance and 227 (53.9%) physical inactivity. Glycaemic control was assessed mainly on fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) data were available in only 44 (10.4%). Target achievements in FPG, blood pressure, body mass index and non-smoking at 24-months following initiation of treatment were 231/421 (54.9%), 262/365 (71.7%), 74/421 (17.6%) and 396/421 (94.1%) respectively. INTERPRETATION In this cohort of rural Sri Lankans with type-2 diabetes mellitus, all were started on anti-diabetic medications at the diagnosis, but glycaemic target achievement was inadequate at 24 months. We identified the major patient-related reasons for poor blood glucose control were poor compliance with diet/lifestyle and/or medications and misconceptions about antidiabetic medications.Item Pyrexia of unknown origin (PUO) and the cost of care in a tertiary care institute in Sri Lanka(BioMed Central, 2023) Premathilaka, R.; Darshana, T.; Ekanayake, C.; Chathurangani, K.C.; Mendis, I.; Perinparajah, S.; Shashiprabha, M.; Nishshanka, S.; Tilakaratna, Y.; Premawardhena, A.BACKGROUND: Despite advancements in diagnostic technology, pyrexia of unknown origin (PUO) remains a clinical concern. Insufficient information is available regarding the cost of care for the management of PUO in the South Asian Region. METHODS: We retrospectively analyzed data of patients with PUO from a tertiary care hospital in Sri Lanka to determine the clinical course of PUO and the burden of the cost incurred in the treatment of PUO patients. Non-parametric tests were used for statistical calculations. RESULTS: A total of 100 patients with PUO were selected for the present study. The majority were males (n = 55; 55.0%). The mean ages of male and female patients were 49.65 (SD: 15.55) and 46.87 (SD: 16.19) years, respectively. In the majority, a final diagnosis had been made (n = 65; 65%). The mean number of days of hospital stay was 15.16 (SD; 7.81). The mean of the total number of fever days among PUO patients was 44.47 (SD: 37.66). Out of 65 patients whose aetiology was determined, the majority were diagnosed with an infection (n = 47; 72.31%) followed by non-infectious inflammatory disease (n = 13; 20.0%) and malignancies (n = 5; 7.7%). Extrapulmonary tuberculosis was the most common infection detected (n = 15; 31.9%). Antibiotics had been prescribed for the majority of the PUO patients (n = 90; 90%). The mean direct cost of care per PUO patient was USD 467.79 (SD: 202.81). The mean costs of medications & equipment and, investigations per PUO patient were USD 45.33 (SD: 40.13) and USD 230.26 (SD: 114.68) respectively. The cost of investigations made up 49.31% of the direct cost of care per patient. CONCLUSION: Infections, mainly extrapulmonary tuberculosis was the most common cause of PUO while a third of patients remained undiagnosed despite a lengthy hospital stay. PUO leads to high antibiotic usage, indicating the need for proper guidelines for the management of PUO patients in Sri Lanka. The mean direct cost of care per PUO patient was USD 467.79. The cost of investigations contributed mostly to the direct cost of care for the management of PUO patients.Item Spatial epidemiologic trends and hotspots of leishmaniasis, Sri Lanka, 2001-2018(Centers for Disease Control and Prevention (CDC), 2020) Karunaweera, N.D.; Ginige, S.; Senanayake, S.; Silva, H.; Manamperi, N.; Samaranayake, N.; Siriwardana, Y.; Gamage, D.; Senerath, U.; Zhou, G.;ABSTRACT: Leishmaniasis, a neglected tropical disease, is on the decline in South Asia. However, cases of cutaneous leishmaniasis have risen in Sri Lanka since 2001, and the lack of in-depth research on its epidemiologic characteristics hampers control efforts. We analyzed data collected from patients with cutaneous leishmaniasis in Sri Lanka during 2001-2018 to study temporal and geographic trends and identify and monitor disease hotspots. We noted a progression in case rates, including a sharp rise in 2018, showing temporal expansion of disease-prevalent areas and 2 persistent hotspots. The northern hotspot shifted and shrank over time, but the southern hotspot progressively expanded and remained spatially static. In addition, we noted regional incidence differences for age and sex. We provide evidence of temporally progressive and spatially expanding incidence of leishmaniasis in Sri Lanka with distinct geographic patterns and disease hotspots, signaling an urgent need for effective disease control interventions. KEYWORDS: Asia; Indian subcontinent; Leishmania donovani; Sri Lanka; cutaneous leishmaniasis; dermatological pathologies; epidemiology; infectious diseases; leishmaniasis; parasites; protozoa; skin lesions; vector-borne infections.Item The Impact of empirical hydrocortisone therapy on clinical outcomes in dengue fever: A retrospective chart review(Oxford University Press, 2020) de Mel, S.; Thilakawardana, B.U.; de Mel, P.; de Silva, A.P.; de Mel, C.; Chandrasena, L.; Seneviratne, S.L.; Abeysuriya, V.BACKGROUND: The role of steroids in dengue infection (DI) remains uncertain. METHODS: A retrospective chart review was conducted on patients ≥18 y of age diagnosed with DI based on positivity for dengue non-structural antigen 1 or immunoglobulin M between October 2017 and November 2018. RESULTS: Hydrocortisone was administered to 106 of 406 patients. DI with warning signs occurred in nine patients (9.5%) in the steroid cohort and eight patients (2.5%) in the non-steroid group. The incidence of severe DI, bleeding and admission duration were similar between the groups. CONCLUSIONS: Our study shows no significant benefit of empirical steroids in DI. KEYWORDS: clinical outcomes; corticosteroids; dengue.Item A Retrospective analysis of facial injuries in victims of road traffic fatalities.(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2018) Paranitharan, P.; Perera, W.N.S.; Perera, A.A.B.S.; Paranavithana, S.S.; Samanpura, L.ABSTRACT: Facial injuries play a significant role when it comes to medico-legal interpretation, category of hurt, cause of death and for compensation purposes. Road traffic accidents had been identified as a major contributor towards facial injuries. The main objectives were to identify the different facial injuries such as abrasions, contusions, lacerations and fractures, injury pattern, the distribution and to correlate the facial injuries with vulnerable road users. A pre-prepared questionnaire was used to extract information from the autopsy reports of road traffic accidents involving 59 victims covering a period from 2005 to 2014. Majority of the victims were males (79.7%) and belonging to the age group of 21-30 (22%) and 41-50 (22%). The vulnerable road users were mostly pedestrians (39%), followed by motorcycle riders (28.8%). Only few (6.8%) of the victims had teeth injuries. Most of the victims had injuries on the right forehead (44%) and right peri-orbital area (37.3%). The commonest type of facial injuries were abrasions which were 44 (grazed abrasions 30.5% and other types of abrasions 44.1%) followed by lacerations 38 (64.4%). The most common injuries on the right forehead were abrasions (20.3%) and lacerations (16.9%) while on the right peri-orbital area it was contusions (18.6 %). Majority of the victims were pedestrians and motor cycle riders. Most of the injuries were observed on the right forehead and right peri-orbital region and the commonest facial injury type was abrasions. A specific type of injury pattern was not identified to retrospectively suggest the involvement of a pedestrian or others.Item Elderly victims dying of unnatural causes: a retrospective descriptive study from Ragama, Sri Lanka(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2018) Kitulwatte, I.D.G.; Paranavithana, S.S.; Perera, A.A.B.S.; Edirisinghe, P.A.S.Even though life expectancy among the elderly has been improving health hazards due to unnatural causes are a significant medical and social issue among this group. The objective was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. A retrospective descriptive study conducted for a period of 3 years, at a tertiary care hospital of Sri Lanka where information was collected from hospital records and post mortem reports of persons above 60 years of age, who died due to unnatural causes revealed that a majority of deaths were due to road traffic accidents of pedestrians.Item Splenic Syndrome in a young man at high altitude with undetected Sickle Cell Trait(Sage, 2018) Fernando, C.H.K.A.; Mendis, S.; Upasena, A.P.; Costa, Y.J.; Williams, H.S.A.; Moratuwagama, D.INTRODUCTION: Splenic syndrome is a rare presentation of sickle cell disease. It is important to rule out this possibility when an ethnically vulnerable patient presents with an acute abdominal symptoms in a background of precipitating events. CASE REPORT: A 26-year-old man who developed a severe abdominal pain at high altitude, found to have a tender splenomegaly. However, further inquiry revealed he is from an area where sickle cell disease is prevalent. Screening for sickle cell disease was positive. Radiological investigations confirmed a massive splenic infarction keeping with a diagnosis of splenic syndrome. Patient was managed conservatively. CONCLUSION: Sickle cell trait is considered a benign carrier state. However, rarely they can present with life-threatening conditions. Therefore, a high degree of clinical suspicion is required for early diagnosis of these specific entities to avoid increased morbidity and mortality of these patients.Item Clinical presentation and comorbidities of obsessive compulsive disorders in children and adolescents presenting to a tertiary care hospital in Sri Lanka(Sri Lanka College of Psychiatrists, 2016) Rohanachandra, Y.M.; Chandradasa, W.M.M.L.; Hettiarachchi, D.B.; Fernando, W.K.T.R.; Gunathilake, I.A.G.M.P.; Wijetunge, G.S.BAKGROUND: Obsessive compulsive disorder (OCD) in children differs from adults in that children do not show ego dystonicity, rarely have pure obsessions and commonly have pure compulsions with hidden obsessions. Comorbid psychiatric diagnoses are seen in more than 50% of children with OCD. AIMS: To describe the socio-demographic factors, clinical presentations and psychiatric comorbidities of children with OCD in a Sri Lanka setting, and to determine the factors associated with comorbidities. METHODS: A retrospective descriptive study design was used. Data was collected from clinic records of all patients diagnosed to have OCD at the child guidance clinic of Lady Ridgeway Hospital for Children, Colombo during the 3-year period from 2013-2016. RESULTS: Fifty two children were included in the study. The mean age of the children was 9.2 years. Males accounted for 71.2%. The majority (55.8%) had both obsessions and compulsions. Multiple obsessions were seen in 15.4% and multiple rituals in 26.9%. The most common theme was contamination (61.5%). Washing was the most common ritual (50%). Comorbidities were present in 55.7%, with attention deficit hyperactivity disorder (ADHD) (17.3%) being the most common. Of the participants, 90.4% had impairments related to OCD. There was a significant association between the gender and the age of the child (p=0.029) in the 5-10 year age group, boys were 5 times more common than girls, while the proportion of boys and girls were equal in children aged more than 10 years. Conclusion: Comorbidities are common in childhood OCD, and all children with OCD should be screened for comorbidities.Item Study on unnatural childhood deaths presented to North Colombo Teaching Hospital, Sri Lanka(Sage Publishing, 2014) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.INTRODUCTION: Unnatural childhood deaths are not only associated with intense trauma and separation distress, but also relate to a sense of neglect to protect children from harm. Accurate information on causes and circumstances of such deaths through a process of medico-legal investigations is essential in creating an awareness among the policy makers and educators/caregivers, to prevent these tragic deaths. OBJECTIVE: The aim of the study was to determine the causes and the circumstances of unnatural deaths of children among the medico-legal autopsy population presented to North Colombo Teaching Hospital, Sri Lanka. STUDY DESIGN: A retrospective descriptive study was carried out based on Reports of Postmortem Examination performed in a Tertiary Care Hospital, on children who died of unnatural causes during the period from 2009 to 2011.RESULTS: Out of 48 unnatural childhood deaths, 24 (50%) children were older than 10 years of age. The most frequent circumstance of death was accidental 39 (81%), while the most frequent cause of death was drowning 16 (33%). Fifteen died due to accidental drowning while one was a homicidal drowning. Suicidal deaths were found only among the children older than 16 years of age. Fifty-four percent of the accidental deaths had taken place at or around the home. CONCLUSION: Accidents accounted for the majority (or greatest number) of tragic childhood deaths. The presence of drowning as the most common cause of death indicates that an immense responsibility lies with the parents and caregivers to prevent such deaths