Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Multimorbidity, medications, and their association with falls, physical activity, and cognitive functions in older adults: multicenter study in Sri Lanka(Nature Publishing Group, 2025-02) Zoysa, W.D.; Mendis, S. A.; Rathnayake, N.; Liyanage, A.; Palangasinghe, D.; Silva, S.; Jayasekera, P.; Mettananda, C.; Lekamwasam, S.This study was aimed to examine the prevalence and associations between multimorbidity, polypharmacy, Falls Risk Increasing Drugs use (FRIDs), Anti Cholinergic Burden (ACB), and adverse health outcomes in older adults attending medical clinics. A cross-sectional study was conducted among 704 older adults attending medical clinics in four tertiary care hospitals. The mean (SD) age of study participants was 73 (5.5) years, and the majority were females (58.7%). Patients 305 (43.5%) reported at least one fall after age of 65 while 220 (31.3%) reported falls in the previous 12 months and 90 (12.8%) reported recurrent falls. The prevalence of multimorbidity was 77.4% while polypharmacy was seen in 51.2%. The use of at least one FRID was seen in 70.5% patients while higher ACB was seen in 5.4%. Multimorbidity, polypharmacy, use of FRIDs and ACB were not associated with negative health outcome (p > 0.05). Polypharmacy, however, was associated with high ACB (p < 0.001). This study highlights a high prevalence of multimorbidity and polypharmacy among older people in clinical settings. However, negative associations between drugs and multimorbidity with adverse health outcomes indicate that these relationships are complex, potentially influenced by other factors such as poor drug compliance, which can lead to falls.Item Composition, determinants, and risk factors of low birth weight in Sri Lanka(Public Library of Science, 2025-02) Mettananda, S.; Herath, H.; Thewage, A.; Nanayakkara, K.; Liyanage, I.; Udani, K. S.; Savanadasa, R.; Goonewardena, S.; Gamhewage, N.; Hewamalage, A.; Rowel, D.; Daniel, A. E.; De Silva, C.; Perera, S.INTRODUCTION Low birth weight continues to pose significant challenges to healthcare systems worldwide. Despite substantial improvement in various public health indicators, many developing countries have failed to achieve a significant reduction in low birth weight rates. One major obstacle is the sparsity of data on the determinants of low birth weight. Here, we aim to determine the composition and risk factors for low birth weight in Sri Lanka, a prototype developing nation. METHODOLOGY We conducted a countrywide multicentre cross-sectional study in August and September 2023 in 13 purposively selected hospitals representing all nine provinces and different tiers of specialist hospitals in Sri Lanka. All live-born neonates were recruited prospectively, and their mothers were interviewed by trained data collectors to gather information on socio-demographic background, medical and obstetric history, and delivery details. Birth weight was measured immediately after the birth by trained healthcare personnel attending the delivery. RESULTS A total of 9130 live-born neonates were recruited, of which 52% were males. The mean birth weight was 2827g (95%CI 2817-2838g), and 1865 (20.4%) newborns were low birth weight. The prevalence of prematurity was 10.9% (n = 998), and 1819 (20.0%) neonates were born small for gestational age. Of the low birth weight neonates, 64% were small for gestational age, and 37% were preterm; 11% were both small for gestational age and preterm. Teenage pregnancy (p = 0.022), low maternal pre-pregnancy body mass index (p<0.001), inadequate weight gain during pregnancy (p<0.001), maternal anaemia at delivery (p = 0.020), chronic lung disease (p = 0.019), and pregnancy induced hypertension (p = 0.019) were significant modifiable risk factors for small for gestational age. CONCLUSION This study presents the results of one of the most extensive country-wide studies evaluating the composition and determinants of low birth weight. The study highlights the importance of considering small for gestational age and prematurity as separate categories of low birth weight. Small for gestational age contributes to approximately two-thirds of the low birth weight burden. Therefore, targeting modifiable risk factors for small for gestational age while mitigating the burden of prematurity is the most feasible approach to reduce the prevalence of low birth weight in developing countries, including Sri Lanka.Item Hepatic and renal functions of paediatric patients with thalassaemia: a cross-sectional study from two large thalassaemia centres in Sri Lanka(BMJ Publishing Group Ltd, 2025-02) Wijenayake, W.; Thennakoon, R.; Pathiraja, H.; Bandara, D.; De Silva, R.; Premawardhena, A.; Fernando, M.; Mettananda, S.OBJECTIVES Thalassaemia is a genetic disorder of haemoglobin synthesis characterised by life-long chronic anaemia. Although the endocrine and cardiac complications of thalassaemia are well-studied, hepatic and renal complications are understudied. This study aims to describe the hepatic and renal functions and to understand their determinants among paediatric patients with β-thalassaemia.DESIGN Cross-sectional study.SETTING Two largest thalassaemia centres in Sri Lanka.PARTICIPANTS All haematologically confirmed patients with β-thalassaemia aged 1-16 years attending the study sites were recruited between 1 January and 31 March 2023. Data were collected by interviewing parents and patients, performing physical examinations and perusing clinical records.RESULTS 72 children (girls 52.8%) were recruited. The mean age was 7.3 years (SD 3.8). A majority (44 (61.1%)) had β-thalassaemia major, while 22 (30.6%) had haemoglobin E β-thalassaemia. 55 children (76.4%) were transfusion dependent. Hepatomegaly was found in 47 (65.3%), while 28 (38.9%) had elevations of both alanine and aspartate transaminases. Haemoglobin E β-thalassaemia type (OR 13.6, 95% CI 2.0 to 92, p=0.008) and high ferritin above 1000 ng/mL (OR 6.2, 95% CI 1.0 to 38, p=0.047) were independent factors associated with high transaminases. 11 (15.5%) patients had an estimated glomerular filtration rate (eGFR) below 90 mL/min. The proportion of children with low eGFR was higher in β-thalassaemia major (23.3%), transfusion-dependent (18.5%) and deferasirox treatment (18.5%) groups.CONCLUSIONS Elevation of hepatic transaminases is common among children with thalassaemia, especially among the subset of patients with haemoglobin E β-thalassaemia and those with high ferritin. Milder reductions in eGFR are noted in some patients with transfusion-dependent β-thalassaemia major.Item Effectiveness of a Calgary-Cambridge model-based communication skills training for paediatric trainees in Sri Lanka: A nationwide pre-post intervention study using observed practices(Elsevier, 2025-01) Dayasiri, K.; Krishnapradeep, S.; Caldera, D.; Wijayasinghe, H.; Mudiyanse, R.OBJECTIVE To evaluate the effectiveness of a Calgary-Cambridge model-based communication skills training program for postgraduate paediatric trainees in Sri Lanka.METHODS A pre-post intervention study was conducted among 133 paediatric trainees across Sri Lanka. The training program focused on relationship-building, information gathering, and information giving. Communication skills were assessed using an OSCE with simulated patients and a 12-item checklist. Paired t-tests were used to analyze score differences.RESULTS Significant improvements were observed across all domains. Relationship-building scores increased from 13.5 to 23, information gathering from 12.6 to 20.2, and information giving from 13.3 to 24.8 (p < 0.01 for all). Relationship-building correlated positively with information gathering (r = 0.626) and giving (r = 0.600, p < 0.01). Trainees with prior communication training scored higher post-intervention (mean difference = 10.5, p = 0.019). No gender differences were observed. CONCLUSION The Calgary-Cambridge model-based training program effectively enhanced communication skills among Sri Lankan paediatric trainees. PRACTICE IMPLICATIONS Incorporating structured communication skills training into postgraduate curricula is essential, particularly in culturally diverse medical settings.Item The impact of mummies on modern psychiatry(Elsevier, 2025-01) Khaled Elbarbary, K.; Shoib , S.; Chandradasa , M.; Saeed, F.No abstract availableItem Congenital titinopathy: comprehensive characterization of the most severe end of the disease spectrum(Wiley-Liss, 2025-01) Coppens, S.; Deconinck, N.; Sullivan, P.; Smolnikov, A.; Clayton, J. S.; Griffin, K. R.; Jones, K. J.; Vilain, C. N.; Kadhim, H.; Bryen, S. J.; Faiz, F.; Waddell, L. B.; Evesson, F. J.; Bakshi, M.; Pinner, J. R.; Charlton, A.; Brammah, S.; Graf, N. S.; Krivanek, M.; Tay, C. G.; Foulds, N.C.; Illingworth, M.A.; Thomas, N.H.; Ellard , S.; Mazanti , I.; Park , S.M.; French, C.E.; Brewster , J.; Belteki , G.; Hoodbhoy, S.; Allinson , K.; Krishnakumar , D.; Baynam , G.; Wood , B.M.; Ward, M.; Vijayakumar , K.; Syed, A.; Murugan , A.; Majumdar , A.; Scurr , I.J.; Splitt , M.P.; Moldovan , C.; De Silva, D.C.; Senanayake, K.; Gardeitchik, T.; Arens, Y.; Cooper, S.T.; Laing, N.G.; Raymond , F.L.; Jungbluth , H.; Kamsteeg , E.J.; Manzur , A.; Corley , S.M.; Ravenscroft , G.; Wilkins , M.R.; Cowley, M.J.; Pinese , M.; Consortium, T.R.; Phadke , R.; Davis, M.R.; Muntoni , F.; Oates, E.C.Congenital titinopathy has recently emerged as one of the most common congenital muscle disorders. OBJECTIVE To better understand the presentation and clinical needs of the under-characterized extreme end of the congenital titinopathy severity spectrum.METHODS We comprehensively analyzed the clinical, imaging, pathology, autopsy, and genetic findings in 15 severely affected individuals from 11 families.RESULTS Prenatal features included hypokinesia or akinesia and growth restriction. Six pregnancies were terminated. Nine infants were born at or near term with severe-to-profound weakness and required resuscitation. Seven died following withdrawal of life support. Two surviving children require ongoing respiratory support. Most cohort members had at least 1 disease-causing variant predicted to result in some near-normal-length titin expression. The exceptions, from 2 unrelated families, had homozygous truncating variants predicted to induce complete nonsense mediated decay. However, subsequent analyses suggested that the causative variant in each family had an additional previously unrecognized impact on splicing likely to result in some near-normal-length titin expression. This impact was confirmed by minigene assay for 1 variant.INTERPRETATION This study confirms the clinical variability of congenital titinopathy. Severely affected individuals succumb prenatally/during infancy, whereas others survive into adulthood. It is likely that this variability is because of differences in the amount and/or length of expressed titin. If confirmed, analysis of titin expression could facilitate clinical prediction and increasing expression might be an effective treatment strategy. Our findings also further-support the hypothesis that some near-normal-length titin expression is essential to early prenatal survival. Sometimes expression of normal/near-normal-length titin is due to disease-causing variants having an additional impact on splicing.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.