Browsing by Author "Pathmeswaran, A."

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Adjusting for spatial variation when assessing individual-level risk: A case-study in the epidemiology of snake-bite in Sri Lanka
(Public Library of Science, 2019) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Murray, K.; Iwamura, T.; Lalloo, D.G.; de Silva, H.J.; Diggle, P.J.
BACKGROUND:Health outcomes and causality are usually assessed with individual level sociodemographic variables. Studies that consider only individual-level variables can suffer from residual confounding. This can result in individual variables that are unrelated to risk behaving as proxies for uncaptured information. There is a scarcity of literature on risk factors for snakebite. In this study, we evaluate the individual-level risk factors of snakebite in Sri Lanka and highlight the impact of spatial confounding on determining the individual-level risk effects.METHODS:Data was obtained from the National Snakebite Survey of Sri Lanka. This was an Island-wide community-based survey. The survey sampled 165,665 individuals from all 25 districts of the country. We used generalized linear models to identify individual-level factors that contribute to an individual's risk of experiencing a snakebite event. We fitted separate models to assess risk factors with and without considering spatial variation in snakebite incidence in the country.RESULTS:Both spatially adjusted and non-adjusted models revealed that middle-aged people, males, field workers and individuals with low level of education have high risk of snakebites. The model without spatial adjustment showed an interaction between ethnicity and income levels. When the model included a spatial adjustment for the overall snakebite incidence, this interaction disappeared and income level appeared as an independent risk factor. Both models showed similar effect sizes for gender and age. HEmployment and education showed lower effect sizes in the spatially adjusted model.CONCLUSIONS:Both individual-level characteristics and local snakebite incidence are important to determine snakebite risk at a given location. Individual level variables could act as proxies for underling residual spatial variation when environmental information is not considered. This can lead to misinterpretation of risk factors and biased estimates of effect sizes. Both individual-level and environmental variables are important in assessing causality in epidemiological studies.
Admission to medical schools in Sri Lanka: predictive validity of selection criteria
(Sri Lanka Medical Association, 2006) de Silva, N.R.; Pathmeswaran, A.; de Silva, N.; Edirisinghe, J.S.; Kumarasiri, P.V.R.; Parameswaran, S.V.; Seneviratne, R.; Warnasuriya, N.; de Silva, H.J.
OBJECTIVE: To assess the extent to which current selection criteria predict success in Sri Lanka's medical schools. METHODS: The study sample consisted of all students selected to all six medical schools in two consecutive entry cohorts. The aggregate marks of these students at the General Certificate of Education (GCE) Advanced Level examination, the district of entry, admission category, candidate type (school/private) and gender, were identified as entry point variables. Success in medical school was measured in four ways: the ability to pass the first summative examination and the final examination at the first attempt, and obtaining honours in either examination. Multivariate analysis using logistic regression was used to assess the extent to which these entry point factors predict variability in outcome measures.RESULTS: Aggregate scores among the 1740 students in the study sample ranged from 212 to 356, with a median of 285. The male:female ratio was 1.4:1. Private candidates (taking the examination for the third time) accounted for 22% of students. Being a school candidate, female and having a higher aggregate score, were the only independent predictors of success for all four outcome measures. The aggregate score alone accounted for only 1-7% of the variation in performance in medical school. CONCLUSIONS: Marks obtained at the A Level examination (the only academic criterion currently used for selection of medical students in SriLanka) is a poor predictor of success in medical school.
Adolescent sexual practices and contraceptive usage
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Herath, H.M.R.P.; Dissanayake, D.M.A.B.; Hilmi, M.A.M.; Pathmeswaran, A.; Wijesinghe, P.S.
INTRODUCTION: Adolescence is a critical period of development, as adoption of unhealthy risk behaviours such as unprotected sex, smoking and drug abuse, avoiding contraceptive methods will lead to long standing health and socioeconomic consequences. Therefore information is needed about the sexual practices and contraceptive usage of adolescents and young adults to develop interventions in the community. This study was undertaken to describe and compare the sexual practices, knowledge and usage of contraceptives by adolescents and young adults in selected urban and rural settings.METHOD: This cross sectional descriptive study was conducted among young adults aged less than 21 years at the time of interview in three settings in both rural and urban areas. The study subjects were students from universities, technical colleges and garment factory workers representing both rural and urban areas. The data was collected using a pretested self administered questionnaire during June 2007 to August 2007. Information collected included marital status, gender and the level of education, first sexual relationship (age, partner, contraception used), current contraceptive practices and knowledge about contraceptive methods. The data was analysed using SPSS 10.1 statistical package. Informed consent was obtained from all participants. RESULTS : There were a total of 1258 subjects who had returned the completed questionnaires. Out of them there were 290 garment factory employees, 480 technical college students, and 488 university students. The percentage of females was 58.9%. The mean ages of the males and the females of the total population were 20.75(50 1.13) years and 20.55(SD 1.63) and it was similar in the three settings. The level of education was highest among the undergraduates lowest among garment factory workers. Out of the population 303 (24.1%) were sexually active. It was significantly higher among males {33.5%0 than females (17.0%). Both among male and females this trend was significantly more common among garment factory workers. Sexual activity of the unmarried and the premarital sexual practices of married subjects are shown in the table. 6. 17% of females and 33.5% of males were sexually active before marriage. 90% male garment factory workers were sexually active. In contrast the proportion
Age, sex and hyperlipidemia: Is it a simple association?
(College of Community Physicians of Sri Lanka, 2009) Pathmeswaran, A.; Pinidiyapathirage, J.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION: Hyperlipidemia is a known cardiovascular disease risk factor. There are effective lifestyle, dietary and pharmacological interventions to treat hyperlipidemia. It is important to target testing for hyperlidemia for the most appropriate age sex groups to optimize resource utilization. Identifying such groups is not easy when there is an interaction between age and sex. OBJECTIVE: To describe the association between age, sex and hyperlipidemia among 35 to 64 year old residents of Ragama. METHODS: Residents aged 35-64 years in the Ragama MOH area were randomly sampled from the voters list after stratification into 10 year age groups. Blood for lipid profile was collected after a 14 hour overnight fast for analysis. Bivariate and multiple logistic regression were performed using Stata 8.2. Results are expressed as odds ratios and relevant 95% confidence intervals (OR; 95% Cl). RESULTS: Total sample analysed was 2987; 45% (n=1338) were males, 17% (n=515), 38% (n=1140) and 45% (n=1332) were in the age groups of 35-44, 45-54 and 55-64 years respectively. The prevalence of hyperlipidemia was 36%. In bivariate analysis, females (OR 1.3; 95% Cl 1.1-1.5) and the age groups of 45-54 (OR 1.7; 95% Cl 1.3-2.1) and 55-64 years (OR 1.5; 95% Cl 1.2-1.9) when compared to 35-44 years were at a higher risk of hyperl[pidaemia . In multiple logistic regression too females (OR 1.2; 95% Cl 1.1-1.4) and the same age groups ( 45-55 [OR 1.7; 95% Cl: 1.3-2.1] and 55 to 64 years OR 1.5; 95%CI: 1.2-1.9) respectively) had higher risk of hyperlipideamia. When an age sex interaction term was added to the above model, 35-44 year old females had the lowest risk. In comparison to the latter, the OR (95%CI) of females of 45-54 and 55-64 years were 2.4(1.8-3.4) and 2.8(2.1-3.9) respectively. The same for males of 35-44, 45-54, and 55-64 years were 2.0(1.3-2.9), 2.3(1.6-3.2) and 1.5(1.1-2.1) respectively. CONCLUSION: The risk of hyperlipidemia increased with increasing age among females but among males the lowest risk was in the 55-64 year age group. Attempts to portray a simple picture are likely to obscure important details and may even be misleading.
Alcohol use and alcoholic fatty liver disease: a prospective, communitybased study among adults in an urban community in Sri Lanka
(The Sri Lanka Medical Association, 2022) Niriella, M.A.; Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Dassanayake, A.S.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
Background: Data on alcoholic fatty liver (AFL) is limited. Therefore, we investigated alcohol use and AFL in a cohort of adults in an urban community in Sri Lanka. Methods: The study population (selected by age-stratified random sampling) was screened in 2007 (35-64 years) and re-evaluated in 2014. They were assessed by structured interviews, anthropometric measurements, liver-ultrasound, and biochemical and serological tests. AFL was diagnosed on ultrasound criteria, ‘unsafe’ alcohol consumption (Asian standards: males>14 units, females >7 units per week) and absence of hepatitis B/C markers. Controls were unsafe alcohol consumers who had no fatty liver on ultrasound. Results: 2985/3012 (99%) had complete data for analysis. 272/2985 (9.1%) were unsafe-drinkers in 2007 [males-270; mean-age-51.9, SD-8.0 years]. 86/272 (31.6%) had AFL [males-85; mean-age-50.2, SD-8.6 years]. Male gender [p<0.001], increased waist circumference (WC) [OR 4.9, p<0.01], BMI>23kg/m2 [OR 3.5, p<0.01] and raised alanine aminotransferase (ALT) [OR 2.8, p<0.01] were independently associated with AFL. 173/272 (63.6%) unsafe alcohol consumers from 2007 were re-evaluated in 2014. 134/173 had either had AFL or had changed to ‘safe’ or no alcohol consumption. 21/39 (53.8%) [males-21 (100%), meanage- 57.9, SD-7.9 years] who remained ‘unsafe’ alcohol users who had no fatty liver in 2007 developed AFL after 7-years (annual incidence 7.7%). On bivariate analysis, only male gender was associated with new-onset AFL. Of the 42 who had AFL at baseline but changed their drinking status from unsafe to safe or no alcohol, 6 had resolution of fatty liver in 2014. Conclusion: In this community-based study among adults from an urban community, unsafe alcohol use was found in 9.1%. Among unsafe alcohol users, the prevalence of AFL was 31.6% and the annual incidence of AFL was 7.7%. New-onset AFL was independently associated with male gender.
Anal incontinence during postpartum period: a community based cross sectional study
(College of Community Physicians of Sri Lanka, 2009) Rajeshkannnan, N.; Pathmeswaran, A.
INTRODUCTION: Anal incontinence is regarded as the "unvoiced symptom". It has a negative impact on the quality of life of the sufferer. The commonest cause in women in the reproductive age group is child birth and it is important to determine the burden of anal incontinence and identify possible risk factors in order to improve the quality of intra partum and postpartum care. OBJECTIVE: To determine the frequency and severity of anal incontinence among post partum mothers in Vavuniya district and to identify factors associated with it. METHODS: A community based cross sectional study was conducted. Sample included all mothers (hospital and home deliveries) who had completed postpartum period between 1st August and 30th September 2007. They were identified from the "expected date of delivery" registers maintained by Public Health Midwives (PHMs). Data were collected by trained PHMs at the respondents' houses using an interviewer administered questionnaire. RESULTS: The mean age of the 540 postpartum mothers interviewed was 28 (range: 16 - 44) years. Majority 78 % (n=423) were Sri Lankan Tamils, 13 %(n=68) Sinhalese and remaining 9%(n=49) Moors. Thirty nine percent (n=209) of them were primi parous. Eighty one percent (n=435) had a normal vaginal delivery and 79% (n=344) of them had an episiotomy. Eighty nine mothers complained of anal incontinence giving a prevalence of 16.5% (95% Cl: 13.4 - 19.6). Among them 94.4% (n=84) considered it as a minor problem and only 39.3% (n=35) had consulted a health worker for the symptom. Risk factors for anal incontinence according to descending order of risk included, having an episiotomy (OR= 5.06; 95%CI: 2.60-9.86), vaginal delivery (OR=4.58; 95% Ci: 1.63-12.84), primi parity (OR= 3.45; 95% Cl: 2.25 -5.21), family income above Rs5000/- per month (OR-1.92; 95% Cl: 1.21 - 3.04) and duration of labour (OR= 1.81; 95% Cl : 1.15-2.87) CONCLUSION: Anal incontinence is not an uncommon symptom in postpartum mothers and majority of affected individuals avoid seeking medical attention. Factors associated with increased risk of anal sphincter damage should be considered during delivery and an attempt should be taken to reduce it.
Anatomical variations of lumbar arteries and their clinical implications: a cadaveric study
(Hindawi Publishing Corporation, 2013) Karunanayake, A.L.; Pathmeswaran, A.
Lumbar arteries arise from the abdominal aorta. Some abdominal and spinal surgeries can damage these arteries, and that can lead to serious consequences. This study aimed at studying the types and frequencies of variations of lumbar vasculature. We dissected both sides of 109 adult human cadavers and studied the variations of lumbar vasculature. Age range was 43-90 years. Fifty-seven percent were males and 43% were females. The number of lumbar arteries arising from either side of the abdominal aorta varied between 3 and 5 pairs. The lumbar arteries arose from a common single stem in 12% of the cadavers. The third and fourth pairs of lumbar arteries arose from a common single stem in 3% and 11% of cadavers, respectively, and the first and second pairs of lumbar arteries arose from a common single stem in 1% and 2% of cadavers, respectively. The first and second lumbar arteries on the right side traveled anterior to the right crus of the diaphragm in 7% and 8% of cadavers, respectively. There were several variations with regard to the number, origin from the abdominal aorta, and pathway of lumbar arteries from what is described in the literature.
Antenatal oral glucose tolerance test abnormalities in the prediction of future risk of postpartum diabetes in women with gestational diabetes: Results from the living study
(Blackwell Publishing Asia, 2024) Gupta, Y.; Kapoor, D.; Lakshmi, J.K.; Praveen, D.; Santos, J.A.; Billot, L.; Naheed, A.; De Silva, H.A.; Gupta, I.; Farzana, N.; John, R.; Ajanthan, S.; Bhatla, N.; Desai, A.; Pathmeswaran, A.; Prabhakaran, D.; Teede, H.; Zoungas, S.; Patel, A.; Tandon, N.
OBJECTIVES To explore associations between type and number of abnormal glucose values on antenatal oral glucose tolerance test (OGTT) with postpartum diabetes in South Asian women diagnosed with gestational diabetes (GDM) using International Association of the Diabetes and Pregnancy Study Groups criteria.METHODS This post-hoc evaluation of the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, a randomized controlled trial, was conducted among women with GDM in the index pregnancy, across 19 centers in Bangladesh, India, and Sri Lanka. Postpartum diabetes (outcome) was defined on OGTT, using American Diabetes Association (ADA) criteria.RESULTS We report data on 1468 women with GDM, aged 30.9 (5.0) years, and with median (interquartile range) follow-up period of 1.8 (1.4-2.4) years after childbirth following the index pregnancy. We found diabetes in 213 (14.5%) women with an incidence of 8.7 (7.6-10.0)/100 women-years. The lowest incidence rate was 3.8/100 women years, in those with an isolated fasting plasma glucose (FPG) abnormality, and highest was 19.0/100 women years in participants with three abnormal values. The adjusted hazard ratios for two and three abnormal values compared to one abnormal value were 1.73 (95% confidence interval [CI], 1.18-2.54; p = .005) and 3.56 (95% CI, 2.46-5.16; p < .001) respectively. The adjusted hazard ratio for the combined (combination of fasting and postglucose load) abnormalities was 2.61 (95% CI, 1.70-4.00; p < .001), compared to isolated abnormal FPG.CONCLUSIONS Risk of diabetes varied significantly depending upon the type and number of abnormal values on antenatal OGTT. These data may inform future precision medicine approaches such as risk prediction models in identifying women at higher risk and may guide future targeted interventions.
Anthropometric correlates of total body fat, visceral adiposity and cardio-metabolic health risk: a community cohort study of urban, adult Sri Lankans
(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranawaka, U.K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Anthropometric measurements (AM) are used as proxies for more direct measurements of body fat (BF) and its distribution. Several studies have examined the association between AM, BF and health outcomes such as cardiovascular risk (CVR). However, correlation of such simple AM and advanced measures of BF and the ability of these to predict CVR has not been studied in community follow up studies. OBJECTIVES: To examine the relationship between simple and advanced anthropometric measurements and their ability to predict cardiovascular risk factors in an urban adult Sri Lankan population. METHOD: The data was collected from a community cohort of adults (aged 42-71 years) selected by age-stratified random sampling from electoral lists of the Medical Officer of Health area, Ragama. Individual simple measurements [body weight, height, waist circumference (WC), hip circumference (HC)], advanced measurements [total body fat (TBF), visceral fat percentage (VFP) by Omron® body fat monitor] and cardiovascular risk factors [blood pressure, HbA1c, triglycerides, low-density (LDL-C), high-density-lipoprotein cholesterol (HDL-C) level, cardio-metabloic risk (CMR) (2 or more risk factors)] were assessed and their relationships were examined. RESULTS: 2155 individuals [1244 (57.7%) women, mean age 59.2 years (SD, 7.7)] participated. Complete data were available for 2000 (92.8%) [1147 (57.4%) women, mean age 59.2 years (SD, 7.7)]. Mean (SD) for anthropometric measurements were: males WC-85.9 (10.8) cm, HC-93.4 (8.0) cm, WHpR (waist-to-hip ratio) -0.92 (0.06), WhtR (waist-to-height ratio) -0.52 (0.06), BMI (body mass index) -23.5 (3.8) kg/m2, TBF -27.0 (5.7)%, VFP -10.7 (5.2)%; females WC -84.8 (10.7) cm, HC-97.2 (9.5) cm, WHpR-0.87(0.08), WhtR-0.52 (0.07), BMI -25.4 (4.4) kg/m2, TBF -38.2 (4.2)%, VFP-9.6 (4.9)%. BMI and WC correlated well with VFP (Pearson’s r for males: 0.94 and 0.85, females: 0.96 and 0.78, respectively). In both sexes, increasing BMI, WC, WHtR, TBF and VFP, were significantly associated with higher risks of hypertension, diabetes, dyslipidemia and combined CMR (ROC area under the curve>0.6). CONCLUSIONS: In this cohort of urban, adult Sri Lanka, simple anthropometric measurements correlated strongly with VFP, and were equally good in predicting cardiovascular risk factors.
Antimicrobial susceptibility and empirical prescribing practices in treating urinary tract infections
(Sri Lanka Medical Association, 2012) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Pathmeswaran, A.
INTRODUCTION: Empiric antimicrobials are recommended for urinary tract infection (UTI). Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy. Aims: To describe antimicrobial susceptibility patterns and empirical prescribing practices in adult in¬ward patients with UTI. METHODS: Data for this descriptive study was collected prospectively from consecutive adult patients with positive urine culture admitted to Colombo North Teaching Hospital. Sensitivity testing was done using Joan Stokes method. RESULTS: Among 745 patients, 441 (59.2%] were females. Mean (SD) age of the study population was 48.2 (19) years. Coliforms were the commonest (85.6%) isolates followed by Streptococcus spp., Candida spp., Staphylococcus spp., and Pseudomonas spp.. Susceptibility of bacteria to antimicrobials was as follows; nitrofurantoin- 76.8%, gentamicin- 62.7%, cefuroxime- 46.3%, co-trimoxazole- 44.1%, norfloxacin-43.6%, cefalexin- 37.6%, ciprofloxacin- 37.3%, co-amoxiclav- 20.7%, ampiciUin- 17.6%. 381(51.1%) received empirical antimicrobial therapy. 75 received more than one antimicrobial. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Nitrofurantoin was prescribed in only 9.2%. Concordance between the empirical antimicrobial prescribed and the sensitivity of the isolated organism was seen only in 25.7%. In 29.6%, urinary isolate was resistant to the empirical antimicrobial and in 44.7% the prescribed empirical antimicrobial was not included in sensitivity testing. CONCLUSIONS: Susceptibility was low (<50%) to the first line antimicrobials other than nitrofurantoin and gentamicin. Ciprofloxacin was the most frequently prescribed empiric therapy even though susceptibility to it was low. Despite high susceptibility nitrofurantoin was underutilized. There was obvious discrepancy between empirical prescribing practices and susceptibility pattern of isolates.
Antimicrobial susceptibility of urinary isolates and prescribing practices of empirical antimicrobials in patients with urinary tract infection in a tertiary care hospital
(Sri Lanka College of Microbiologists, 2009) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Perera, W.P.M.H.; Pathmeswaran, A.
OBJECTIVE: Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy of urinary tract infection (DTI). We sought to describe antimicrobial susceptibility patterns in in-ward patients with UTI and compare it with prescribing practices. METHODS: A descriptive study was conducted at the Colombo North Teaching Hospital in consecutive patients with a positive urine culture between January 2007 and July 2008. Sensitivity testing was done using Joan Stokes method. RESULTS: Coliforms were the commonest (89.6%) isolates in 1206 specimens. The susceptibility was as follows; nitrofurantoin - 83.9% jgentamicin - 74.3%, coamoxiclav - 69.7%, cefalexin - 57.8%, norfloxacin - 57.7%, ciprofloxacin - 50%, cotrimoxazole-37.5%, ampicillin -23.3%. Clinical data analysed for 259 (females -67,95%,^12 years - 95.2%). 25.1% didn't receive empirical antimicrobials. Among the 194 who received an antimicrobial 52.1% received ciprofloxacin and 11.3% received nitrofurantoin. Concordance between the empirical antibiotic prescribed and the sensitivity of the isolated organism was seen only in 21.7%. In 16.5% urinary isolate was resistant to the empirical antibiotic and in 61.8% empirical antibiotic was not included in sensitivity testing. Overall, sensitivity of ciprofloxacin and nitrofurantoin was tested in 6.7% (susceptibility rate - 50%) and 94.3% (susceptibility rate - 83.9%), respectively. CONCLUSIONS: Coliforms were the commonest isolate irrespective of the origin, site and type of DTI. Resistance was high (£50%) to ampicillin, cotrimoxazole and ciprofloxacin. Ciprofloxacin was the most frequently prescribed empiric therapy but its sensitivity was tested in less than 10%. Despite high susceptibility rate nitrofurantoin was underutilised. There was obvious discrepancy between empirical prescribing practices and both the susceptibility pattern of isolates and sensitivity testing practices.
Antimicrobial susceptibility patterns and empirical prescribing practices in adult in patients with urinary tract infection: is there a need for changing clinical practices?
(Sri Lankan Society for Microbiology, 2014) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Pathmeswaran, A.
Introduction: Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy for urinary tract infection (UTI).The aim of this study was to describe antimicrobial susceptibility patterns and empirical prescribing practices in adult in patients with UTI. Methods: The study was carried out at a tertiary care hospital in Sri Lanka. Data was collected prospectively from consecutive adult in patients with positive urine culture and clinical features compatible with UTI. Sensitivity testing was done using Joan Stokes method. The etiological uropathogens, antibiotic susceptibility rates, association between antimicrobial susceptibility rates and background variables and empirical prescribing practices were analyzed. Results: 745 subjects were studied. Mean (SD) age was 48.2 (19) years and 441(59.2%) were females. Coliforms were the commonest isolates (85.6%). Overall, 76.8% of the isolates were susceptible to nitrofurantoin. (coliforms-74.9%; Streptococcus spp.-100%; Staphylococcus spp.-95.6%). Overall susceptibility was < 50%, to many antimicrobials. Among coliforms and pseudomonas isolates susceptibility to ciprofloxacin was 37.7% and 29.4% respectively. The susceptibility rates of coliforms varied according to age, gender, origin of UTI and presence of co-morbidities. 381(51.1%) subjects received empirical antimicrobials. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Despite high susceptibility nitrofurantoin was prescribed in 9.2% only. Conclusions: Susceptibility was low to many first line and second line antimicrobials used to treat UTI in adults. There was obvious discrepancy between empirical prescribing practices and the susceptibility pattern of isolates. Incorporation of local surveillance data in to clinical practice will be useful to optimize the use of empirical antimicrobial therapy. DOI: http://dx.doi.org/10.4038/sljid.v4i1.6229 Keywords: Urinary tract infection, Antimicrobial susceptibility, Resistance, Empirical DOI: 10.4038/sljid.v4i1.6229
Assessment of teamwork skills of medical students using absolute and relative criteria
(Sri Lanka Medical Association, 2014) Chandratilake, M.; Kasturiratne, A.; Pathmeswaran, A.
INTRODUCTION AND OBJECTIVES: Teamwork is an essential professional attribute of medical professionals which has demonstrated to be directly contributing to improve patient care and safety. The assessment of teamwork ability of medical undergraduates is vital to foster this skill. Peers appear to be an effective source for the assessment. METHODS: This study attempted to develop a peer assessment for assessing teamwork ability of students validly and reliably using the team-based research projects adopted by the Faculty of Medicine, University of Kelaniya. In complying with the literature, the assessment focused on communication, participation, involvement, support, commitment and leadership. Each student scored self and peers (5 or 6) in their group on two scoring systems; absolute (allocation of absolute mark for each peer in the group), and relative (marking the peers relative to self). RESULTS: Out of 164 recruits, 128 completed the assessment accurately. The following observations were statistically significant: poor correlation (Pearson < 0.4) between self and peer scores for both domain and overall assessment levels with either absolute or relative marking; and high correlation (Pearson > 0.6) between absolute and relative scores given by peers. The variability of relative scores, however, was higher than the absolute scores. CONCLUSIONS: A peer assessment tool with a limited number of items and assessment of peers relative to oneself produced credible and discriminatory information about the teamwork skills of medical students. Its use for summative purposes is yet to be determined.
Association between changes of lumbar spine and age, physical activity and body mass index in a sample of Sri Lankan population: A descriptive study
(University of Kelaniya, 2006) Karunanayake, A.L.; Pathmeswaran, A.
Introduction: Disc space narrowing, vertebral osteophytes, spondylolisthesis are features of degeneration of the spine and are recognized causes of low back pain and sciatica. However on some occasions they can be present in the spine without causing problems such as low back pain and sciatica. Objective: To describe the association between disc space narrowing, vertebral osteophytes and spondylolisthesis with body mass index (BMI), posture, physical exercise and age. Method: Descriptive cross sectional study was done with people who had antero posterior and lateral radiographs of the lumbar spine ordered due to problems such as abdominal pain. These people had no problems of backache. Structured interviewer administered questionnaire was used to assess their leisure time activities and other physical activities done at office and home. Their weight and heights were measured and BMI was calculated. Results were analysed using EPI6 statistical package. This study was done in North Colombo Teaching hospital Ragama. Results: Sample size 133. Age range 18-79yrs. Mean (SD) age 51.4 (16.3). There were 82 (62%) females. Age had a significant positive association with vertebral osteophytes (P<0.0001). Regular exercise had a significant positive association with spondylolisthesis (P=0.03). BMI had a significant positive association with vertebral osteophytes (P< 0.001). Posture did not have a significant association with disc space narrowing, vertebral osteophytes and spondylolisthesis. Conclusions: Ageing and high BMI are associated with vertebral osteophytes. Regular exercise is associated with spondylolisthesis.
The association between negative experiences during childhood and social anxiety disorder: A cross-sectional study among Sri Lankan university students
(Sri Lanka Medical Association, 2023) de Silva, B.G.R.; De Zoysa, P.T.; Pathmeswaran, A.; Williams, S.S.
INTRODUCTION: Social Anxiety Disorder (SAD) demonstrates early-onset, chronic course, and impairment in all social spheres. OBJECTIVES: The study objective was to explore the association between negative childhood experiences among a university student sample that indicated a high prevalence of SAD. METHODS: A cross-sectional study was conducted among 1137 students from five state universities. The Liebowitz Social Anxiety Scale – Sinhala version, and a correlates questionnaire including a culturally adapted Adverse Childhood Events Questionnaire and contextually appropriate parenting-related questions, were used as instruments. The analysis included chi-square tests for independence, spearman’s r correlations, and binary logistic regressions. RESULTS: Within the sample, 52.2% were female, and 66% were between 21-23 years. All faculties were represented with 27.5% from engineering. 32.2% of participants were first years. Bivariate analyses identified that being an eyewitness towards violence towards mother, feeling unsafe, feeling mistreated by family, experiencing physical abuse, experiencing sexual abuse, experiencing emotional abuse, experiencing parental dissatisfaction, and parental overcontrol to be significantly (p<0.05) associated with SAD. Continuous variables of Parent dissatisfaction (AOR=1.07, 95% CI 1.01-1.13, p<0.05), parent overcontrol (AOR=1.08, 95% CI 1.02-1.15, p<0.01) and experiences of emotional abuse (AOR=1.31, 95%CI 1.11-1.54, p=0.001) remained independently associated with SAD on regression analysis. CONCLUSIONS: Findings from this study corroborate the literature on the association between childhood experiences and parenting-related factors and SAD. The findings also highlight for the first time that Sri Lankan university students are no exception. An urgent need for awareness and prevention of adverse experiences within the family context, and early intervention to prevent the development of SAD are crucial.
Association between the intima media thickness of lumbar arteries and the cell density of lumbar intervertebral discs: a postmortem study among Sri Lankan adults
(Sri Lanka Medical Association, 2005) Karunanayake, A.L.; Pathmeswaran, A.; Fonseka, M.M.D.; Wijayaratne, L.S.
BACKGROUND: Disc degeneration is an important cause of low backache. Cartilage cells help to maintain the structure of the disc. The lumbar arteries provide blood supply to the lumbar discs. The tunica media affects the mechanical properties of the vessel wall and thereby control the blood supply to the tissues. OBJECTIVES: To describe the association between the intima media thickness (expressed as a percentage of total thickness) of 4th lumbar artery and the mean cell density of the 4th lumbar disc. METHODS: Descriptive cross sectional study was done on 4th lumbar discs and 4th lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs and lumbar arteries. By using a graticule number of cells per 4mm2 were counted in each disc specimen in ten low power fields and the mean cell density was calculated. With a graticule measurement of intima media thickness (IMT) and total thickness of lumbar arteries were taken on each artery specimen in ten low power fields. Mean of IMT expressed as a percentage of TT was calculated. Correlation coefficient was calculated to find out the association between the IMT and the mean cell density. RESULTS: Postmortem specimens of 31 subjects aged between 21-96 years (mean age 46 years. SD 19 years) were examined. 24 were males. There was a significant association between the IMT and the cell density (r = 0-37, P< 0.05). CONCLUSIONS: IMT of lumbar arteries had a significant positive association with the cell density.
Awareness and usage patterns of substances among pre-clinical phase students at a Medical Faculty in Sri Lanka
(Sri Lanka Medical Association., 2019) Hapangama, A.; Fernando, R.; Pathmeswaran, A.; Kuruppuarachchi, K.A.L.A.
INTRODUCTION AND OBJECTIVES: Availability and usage patterns of psychoactive substances have changed worldwide. Knowledge about new trends of substance use is important for future generation of medical professionals to deliver appropriate treatment. Objective of the study was to determine the awareness and prevalence of substance use among pre- clinical phase medical students in a university in the Western Province, Sri Lanka. METHODS: A cross-sectional descriptive study was carried out using a self-administered questionnaire. RESULTS: Out of 162 students, 61.7% were female, 97.5% were between 20-25 years. 99% were aware of alcohol being a substance of abuse. 34% and 30% were not aware that heroin and cannabis were substances of abuse. Less than half of participants were aware of corex-D (44.4%), volatile substances (39.5%), and methamphetamines (32.7%). Figures for awareness about Psilocybin (9.9%), MDMA (8.6%), LSD (8%), GHB (4.3%), DXM (2.5%). Main sources of information regarding substances were peers and internet. 21% and 18 % of participants had used alcohol and betel respectively at least once while tobacco and corex-D was used among 7.4% and 6.2% respectively. 69% of substance users were male. Use of substances was significantly associated with male gender. CONCLUSION: Alarmingly majority of the participating pre-clinical phase students were not aware of the abuse potential of heroin and cannabis as well as of newer generation recreational drugs. Awareness regarding current trends and misuse potential of psychoactive substances and their consequences should be enhanced among medical students.
Baseline characteristics of patients with knee osteoarthritis pain flares in a Sri Lankan cohort
(Sri Lanka Medical Association, 2017) Rathnasiri, K.A.D.V.; Athukorala, I.; Pathmeswaran, A.; Chang, T.; Hunter, D.J.
INTRODUCTION & OBJECTIVES: Patients with knee osteoarthritis (KOA) typically experience two broad types of pain – episodic and/or constant pain. This study explores the relationship between KOA pain episodes/flares, demographic haracteristics and putative triggers of pain reported at baseline. METHODS: Consecutive patients with KOA were recruited from rheumatology clinics at the National Hospital of Sri Lanka. KOA pain flares were defined as a >2 points increase on a 0-10 point numeric rating score (NRS) from lowest knee pain intensity at baseline. Patients were assessed for demographic and pain characteristics, potential risk factors for pain flares, the Knee Osteoarthritis Flare Ups Score (KOFUS) and knee effusion at baseline. RESULTS: A total of 100 patients (93% females) with a mean age of 59.8 years (SD 7.5) were recruited. Participants had mean height, weight and body mass index of 149.7 (SD 6.8) cm, 64.1 (SD 7.1) kg, 28.7 (SD 4.9) kg/m2 respectively. Mean (SD) score for usual pain and worst level of pain were 3.7 (1.8) and 7.5 (1.6). An average of 3.6 (SD 2) flares per month was reported. 9% reported a previous knee injury and 49% reported a previous episode of knee buckling. KOFUS score was >7 in 49%, and 44% had a knee effusion at baseline. There was no significant association between patient reported knee flares in the preceding month with previous knee injury, previous knee buckling or KOFUS score (p>0.05). CONCLUSION: This study did not demonstrate any association between previously identified KOA pain flare risk factors and KOA pain flares.
Beliefs and knowledge regarding snakebite in rural Sri Lanka: a qualitative survey
(Sri Lanka Medical Association, 2003) Makita, L.S.; Nandasena, S.; Costa, M.R.A.; Kasturiratne, A.; Pathmeswaran, A.; Lalloo, D.G.; de Silva, H.J.
OBJECTIVES: To identify common beliefs and assess knowledge regarding snakebite in rural Sri Lanka, and their influence on health-seeking behaviour. METHODS: Qualitative methods (focus group discussions and key informant interviews) were used to obtain data in five rural locations in wet, intermediate and dry zones. Data was subjected to "framework analysis" involving familiarisation, identification of thematic frame, indexing and coding, charting, mapping, and interpretation. RESULTS: People are aware of risk-behaviour associated with snakebite, and have reasonable knowledge regarding venomous and non-venomous snakes. However, differences in nomenclature sometimes lead to confusion in identifying species. Beliefs and legends, which are linked to religion, have lead people to respect the cobra. Traditional healers claim they can determine the snake species, clinical manifestations that may occur, and prognosis, based on phenomena, such as, day of the week and phase of the moon when the bite took place. They still employ treatment methods, such as wound incision with broken glass and scalp incision for applying potions. Although there is respect for traditional healing, there is acceptance of the efficacy of western medicine. Beliefs, such as, anti-venom though effective is toxic, long-term effects of snake venom can be completely neutralised only by traditional medicine, and producing the dead snake is essential for treatment in hospitals, lead people to seek treatment by traditional healers rather than in hospitals. CONCLUSIONS: Beliefs and misconceptions influence health-seeking behaviour following snakebite. There seems to be a growing acceptance of western medicine. However, traditional healing methods are still popular, but include harmful^rjractices. This information could form a basis for. educational intervention.
Betel-quid use and its effects on symptoms of schizophrenia and extrapyramidal symptoms among a group of patients in a tertiary care hospital in Sri Lanka.
(Sri Lanka College of Psychiatrists, 2020) Isuru, A.; Ediriweera, D.; Pathmeswaran, A.; Embuldeniya, A.; Narammalage, H.; Warnakulasuriya, S.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.
BACKGROUND: There is limited research regarding the prevalence of betel quid use and its effects on symptoms of patients with schizophrenia. Available studies suggest an association between betel chewing and positive symptoms among males with schizophrenia. AIMS: This study aimed to compare the prevalence of betel quid chewing between patients with and without mental illness, and to explore the association between betel quid use, symptoms of schizophrenia and side effects of psychotropic medication. METHODS: A cross sectional descriptive study was carried atoutpatient clinics at a tertiary care hospital in Sri Lanka. A structured interview schedule was administered to all participants. RESULTS: Out of 1000 participants, 20.9% chewed betel quid (95%CI: 18.4% - 23.4%). The rate of betel chewing among patients with and without a mental illness was 20.7% (95% CI: 17.0% - 24.4%) and 21.0% (95% CI: 17.6% - 24.5%) respectively and there was no significant difference between the two groups. There was no statistically significant difference between the occurrence of positive or negative symptoms and extra pyramidal side effects in patients with schizophrenia who did and did not chew betel. Female gender (p=0.004) and betel quid chewing (0.002) were associated with more anticholinergic side effects. CONCLUSIONS: There was no association between betel quid usage and the occurrence of positive or negative symptoms of schizophrenia or extra pyramidal side effects. KEYWORDS: Schizophrenia, Betel quid, Positive symptoms, Negative symptoms, Extra pyramidal side effects