25th Anniversary International Scientific Conference-2016

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Plenaries, Symposia and free papers presented at the 25th Anniversary International Scientific Conference, held on 6-8th April 2016, Faculty of Medicine, University of Kelaniya to celebrate the Silver Jubilee Anniversary of Faculty of Medicine

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Ability to use computer software among new medical entrants to the Faculty of Medicine, University of Kelaniya
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Solangaarachchi, D.I.K.; Kumara, A.A.K.B.; Hettige, S.; Ediriweera, E.P.D.S.
BACKGROUND: Computer software is essential to enhance academic life of students. OBJECTIVES: To describe the level of confidence and ability on using computer software among new entrants to Faculty of Medicine, University of Kelaniya METHODS: Moodle based self-administered questionnaire was given to new entrants in 2015 and 2016 and their perception on the level of confidence, ability and usage were recorded. RESULTS: The results are described according to the 2015 (n=159) and 2016 (n=147) batches respectively. Proportion of males were 27% and 35%. Proportions who could install software in each batch was 20% (n=32 and 29) and could not were 15.7% (n=25) and 27.2% (n=40). Those who could and could not install a printer were 10.1% (n=16)/ 16.3% (n=24) and 30.8% (n=49)/ 34% (n=50) respectively. Proportions who could and could not install a pen drive were 28.9% (n=46)/ 40.1% (n=59) and 15.7% (n=25)/ 17% (n=25) respectively. Nine percent (n=14) and 13.6% (n=20) had used, 63.5% (n=101) and 50.3% (n=74)) were aware but had not used and 27.7% (n=44)) and 36.1% (n=53) were not aware of open source software. CONCLUSIONS: A majority of students had no awareness on software installation and pen drive scanning and have not used open source software at the point of entry to the Medical Faculty.
Advances in lipid-modification for the prevention of vascular disease
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Armitage, J.
OBJECTIVES : 1. To understand the importance of different lipids to vascular disease risk and how genetics have helped 2. To reiterate the value and safety of statins as a first line therapy for lipid modification 3. To explain the potential role of newer lipid-lowering agents: PCSK9 inhibitors, cholesterol ester transfer protein inhibitors and small interfering RNAs to block lipid-related protein synthesis Observational studies indicate a clear, positive and continuous relationship between coronary heart disease risk and blood LDL- cholesterol levels and inverse associations with HDL-cholesterol. Recent genetic evidence also supports a causal role for CETP, lipoprotein (a) [Lp(a)], apoC3, ANGPLT3 and PCSK9 in vascular risk. Large, well-designed randomized trials of statins and meta-analyses of trials show that reductions of 20-25% in the risk of vascular events are seen per 1 mmol/L reduction in LDL-cholesterol, with larger reductions producing greater benefits. Statins are safe and well tolerated although the risk factors for the rare side-effect of myopathy need to be understood to allow their use most safely and effectively. The results of trials of HDL-raising have so far been disappointing, both because older drugs were toxic (niacin) and other studies may have been underpowered to detect plausible effects. An alternative explanation is that HDL-cholesterol is not causally related to vascular disease but only associated and there is supportive genetic data for this view. Newer agents such as monoclonal antibodies against PCSK9 and CETP inhibitors are currently in Phase 3 trials and clearly reduce LDL levels substantially with CETP inhibitors also increasing HDL-cholesterol and show promise for vascular risk reduction but are likely to be very expensive and are not yet proven. Results will emerge in the next couple of years.
Anovulation as cause of infertility and novel methods of ovulation induction
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Palihawadana, T.S.
Infertility is known to affect one in six couples. Ovulatory dysfunction is a common underlying cause and is seen in approximately 38% of couples seeking infertility treatment. Polycystic ovary syndrome was the commonest underlying cause of anovulation and was seen in nearly 60% women. Hypogonadotropic hypogonadism and ovarian failure are uncommon causes of anovulation seen in only about 1-2% of women with anovulation. Clomifene citrate is the commonest medication used for induction of ovulation. It is successful in achieving ovulation in over three quarters of women with WHO group II anovulation. However, factors such as hirsutism, a high antral follicle count and a high LH:FSH ratio are associated with clomifene resistance. Aromatase inhibitor, letrozole, is a novel medication for induction of ovulation. It is successful in achieving ovulation in nearly 75% of women who respond to clomifene and 25% of women with clomifene resistance. Factors associated with resistance to letrozole included a high day2 LH level, hirsuitism and clomifene resistance had the highest association. The use of letrozole for augmentation of ovulation, in comparison to clomifene, resulted in a higher endometrial thickness and a trend towards monofollicle development. Gonadotropin (FSH) is used in induction of ovulation among women with resistance to oral medication. A low-dose step down regimen of rFSH, in comparison to a low-dose step-up regimen, showed a shorter duration of treatment, with no significant reduction in the total drug requirement. These findings have improved our understanding of different modes of induction of ovulation, which helps in further research and clinical practice.
Antibiotic sensitivity patterns of Extended-Spectrum β-Lactamase urinary tract infections in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sebastiampillai, B.S.; Premaratna, B.A.H.R.; Luke, W.A.N.V.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.; Miththinda, J.K.N.D.
BACKGROUND: Extended-spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections (UTI) are increasing in incidence and poses a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. The prevalence of ESBL producing organisms particularly in the Asian region remains unknown. OBJECTIVES: To identify common ESBL producing organisms and to evaluate the antibiotic sensitivity patterns of ESBL UTIs in Sri Lanka. METHODS: Patients admitted with ESBL-UTI to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama over a period of 6 months from January 2015 were recruited. Their Urine culture and ABST reports were analysed after obtaining informed written consent. RESULTS: Of the 52 patients who consented to be on the study, 30 (57.7%) were males. Mean age was 64.11 (SD=12.59) years. E. coli was the commonest organisms (84.6%; n=44), causing the ESBL-UTI followed by Klebsiella (15.4%; n=8). Fifty (96.2%) patients were sensitive to meropenem, 38 (73.1%) to imipenem, 30 (57.7%) to amikacin and 24 (46.2%) to nitrofurantoin. Meropenem resistance was found in 2 (3.8%) cases which were due to infection with E. coli.These two patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: While E. coli and Klebsiella are the commonest ESBL producing organisms causing UTI, carbapenems remain as the first line therapy. However 3.8% prevalence of meropenem resistance among the study population should draw attention of clinicians and needs implementation of measures to prevent emergence of carbapenum resistant ESBL organisms.
Antinociceptive activity of aqueous extract of Psychotriasarmentosa leaves
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Ratnayake, W.M.K.M.; Chandrika, U.G.; Suresh, T.M.; Abeysekera, A.M.; Salim, N.
BACKGROUND: Adverse side effects caused by NSAIDS and other existing allopathic analgesic agents have made these drugs unwelcoming to many. The search for alternative therapies has intensified over the years. Consequently, the investigations on the efficacy of plant based drugs used in traditional medicine has been seen as a fruitful research strategy in the search for new analgesic drugs due to possibly lesser side effects as well as the low cost. Indigenous healers in Sri Lanka prescribe an aqueous extract of leaves of Psychotriasarmentosa (named “Gonica” in Sinhala; Family: Rubiaceae) for individuals who have been physically assaulted, indicating that it may possess potent analgesic and/or anti-inflammatory activity. OBJECTIVES: Previous studies have shown that aqueous extract of P. sarmentosa has significant anti-inflammatory activity and the general objective of the present study was to determine the antinociceptive activity of this preparation. METHODS: Acetic acid induced writhing method was conducted to evaluate the analgesic activity on male Wistar rats. Data analysis was carried out using one-way analysis variance (ANOVA) and results with p <0.05 were considered as statistically significant. RESULTS: The results showed that the treatment with 100 mg/kg of freeze dried aqueous extract of P. sarmentosa leaves significantly reduced the abdominal contractions induced by the intra-peritoneal administration of acetic acid solution when compared to the control. The percentage inhibition of it was found to be 44.4 % whereas it was 50.8 % for acetyl salicylic acid. CONCLUSIONS: These preliminary observations provide evidence for the antinociceptive properties of leaves of P. sarmentosa as claimed in folk medicine.
Awareness on alternative medical systems among diabetes mellitus patients in Uva and North Central provinces; Mullaithivu, Mannar and Killinochchi districts in the Northern Province
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Nuwansiri, L.S.B.; Abeysooriya, S.R.; Thilakarathne, M.G.T.C.; Pathirana, G.K.M.; Peiris, L.D.C.; Mirfaha, M.A.F.
BACKGROUND: Diabetes Mellitus is a metabolic disorder due to deficiency of insulin. According to Ayurveda concepts this is part of urinary disorders characterized by profuse urination with several abnormal qualities due to Dhosic imbalances. According to the Siddha concept Alaldhosha increase first, then Walidhosha increase, afterwards Wali and Aryamdhoshas is increased. Concurrently disturbance of seven Dhathus function occur and eliminate body energy through urine. The concept of Unani that mentioned Zinbatusshukkari (Diabetes Mellitus) develops due to weakness of the kidney as a result of strong exposures power, weakness of the retentive power and causative factors. Prevention is the best method to control this disease. Awareness among people should be increased to prevent this disease. All medical systems should combine efforts. Other than allopathic system Ayurveda, Siddha, and Unani are other alternative medical systems that can provide awareness. OBJECTIVE: To find out awareness of people about other alternative medical systems that can control Diabetes Mellitus and to find out method of continuing treatment at diabetes clinics in these medical systems. METHODS: An interviewer administered questionnaire was used to collect data visiting Sidda, Unani, Ayurveda District Hospitals, Central Dispensaries and free Ayurveda Dispensaries in Uva province, North central province, Killinochhi, Mannar,and Mullaithivu districts. RESULTS: There were few hospitals that provide Diabetic clinics (Uva-20%, North central -11%, Killinochchi, Mannar and Mullaithivu districts -25%). Of 40 patients identified from clinics only 50% of patients were aware of Ayurveda, Siddha, Unani treatments for Diabetes. CONCLUSIONS: Availability of alternative medical facilities for management of Diabetes Mellitus is limited in these districts. The awareness of people about these systems is not satisfactory.
Awareness on excessive noise exposure, hearing protection and perceived symptoms of noise exposure among grade 12 students of a selected government school in the Colombo District
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Dantanarayana, N.D.
Introduction: More studies have been conducted recently to address the growing concern of hearing loss among adolescents due to non-occupational noise exposure. Objective: To describe adolescents’ current awareness on excessive noise exposure, risky listening situations and perceived auditory symptoms in the Sri Lankan context. Methods: This was a school based descriptive cross sectional study. In a purposively selected school, study participants were selected using simple random sampling. Proportional probability sampling was used to select participants from each subject stream. Results were analyzed using descriptive statistics. Results: All participants considered excessive noise exposure as a cause of hearing loss. 71.4% comprehended that hearing loss due to excessive noise cannot be cured. Only 9.9% recognized that the usage of ear protectors was the most effective mode of hearing protection. Among different noisy situations, most frequently exposed situations included traffic noise exposure, usage of mobile phones and MP3 players. The most common exposure duration was less than one hour with 6-10 loudness range. Ear fullness and muffled speech were the most prominent auditory symptoms after being exposed to noise. Conclusion: Although all study participants were aware that hearing loss can occur due to excessive noise, their awareness on the usage of most effective hearing protection methods was considerably low. A hearing conservation programs for adolescents should be developed to address non-occupational noise effects on hearing and hearing protection. Schools seem to be the best place to begin the process of teaching hearing protection.
Bad cholesterol, vascular risk and dementia
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Armitage, J.
The prevalence of dementia and cognitive impairment is increasing globally as lifespan lengthens and presents major health care challenges as well as creating significant social burdens. Although Alzheimer disease is the most common type of dementia, autopsy and neuroimaging studies show that the majority of dementia cases also have cerebral vascular pathology (such as infarcts, white matter lesions and cerebral microbleeds). In keeping with this, many studies and systematic reviews have shown that higher levels of vascular risk factors and cardiovascular disease predict future risk of dementia and cognitive decline. The extent to which modifying vascular risk factors such as blood cholesterol and blood pressure might prevent dementia has become an important question. Using data from 3 large randomised trials of cholesterol modification we have estimated the impact of different types of incident vascular events on cognitive aging to help understand the potential power of randomised studies to detect such effects. These data provide quantitative estimates of the impact of LDL-lowering on cognitive aging and will be presented.
Blood alcohol concentration in motorcycle fatalities reported to a tertiary care hospital in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Senarathne, U.D.; Edirisinghe, P.A.S.; Kitulwatte, I.D.G.
BACKGROUND: Motorcycle, the common man’s vehicle in Sri Lanka when crashes is fatal due to its inherent instability and absence of an outside shield to absorb energy during a collision. Managing an unstable vehicle after consuming alcohol, a central nervous system depressant, increases the risk of a fatal collision. Research on motor-cycle fatalities and blood alcohol concentrations has not been reported from Sri Lanka earlier. OBJECTIVES: To describe the contribution of blood alcohol concentrations (BAC) to fatal motorcycle accidents. METHODS: A retrospective descriptive study based on post-mortems of motorcycle fatalities referred to a tertiary care hospital from 2010-2014 was done using a pro-forma. RESULTS: Out of 180 motorcycle accidents reviewed, 166(92%) were riders, 14(8%) were pillion riders. 171(95%) were males and majority (n=142, 79%) were between 20-60 years of age. BAC was requested for 88(49%) and reports were available only for 76(86%) victims. Out of them 34(45%) had BAC >80mg/100ml. The highest BAC reported was 428mg/100ml with the mean value being 104mg/100ml. Cause of death (COD) given for 78(43%) victims was head injury for 69(38%) multiple injuries. Presence of >25 injuries (p=0.028) and COD given as multiple injuries (p=0.029) were significantly associated with BAC >80mg/100ml. CONCLUSIONS: Having BAC >80mg/100ml significantly contributes to the motorcycle rider being subjected to more injuries in a collision. Since less than half the cases were subjected to BAC analysis, actual magnitude of the problem could be greater than illustrated by the study.
Cancer antigen 15-3 and the grade of the breast carcinoma in newly diagnosed patients
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Akalanka, H.M.K.; Ekanayake, S.; Samarasinghe, K.
BACKGROUND: Cancer antigen 15-3 (CA15-3) is a breast tumor marker of clinical utility. However, the utility of measuring CA15-3 in patients with breast cancer (BC) remains controversial. OBJECTIVES: To assess CA15-3 concentrations of newly diagnosed BC patients and to compare those with concentrations of apparently healthy females and within the different the grades of the carcinoma. METHODS: CA15-3 concentration of newly diagnosed BC patients (n=155) and apparently healthy age matched females (n=35) was assessed using enzyme immunoassay sandwich method with a final fluorescent detection using mini vidas immuno analyser. Nottingham grade of the carcinoma of each BC patient was recorded from the histopathology records. RESULTS: The median levels of CA15-3 of the BC patients and apparently healthy women in the study sample was 14.45 (IQR: 10.17) U/mL and 14.19 (IQR: 7.09) U/mL respectively. CA15-3 concentrations were not significantly different among BC and healthy women (p>0.05). Only 11% of women with BC had elevated CA15-3 concentrations above the reference range (30 U/mL). The BC patients were classified as Nottingham grade I (13.4%), II (47.8%) and III (38%). CA15-3. Concentrations (median and IQR) within each grade were 15.24 (6.62), 13.06 (11.56) and 17.52 (13.69) respectively. CA15-3 concentrations were not significantly different according to the grade (p>0.05). CONCLUSIONS: CA 15-3 concentrations of newly diagnosed breast cancer patients were not significantly different when compared with apparently healthy women and according to the Nottingham grading.
Characteristics of patients admitted to an emergency treatment unit of a private sector hospital
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Senanayake, M.G.B.; Wickremasinghe, A.R.
BACKGROUND: Studies have highlighted that the private sector contributes a major share in outpatient healthcare and a small proportion in in-patient care in Sri Lanka. There is little or no information on private health sector emergency care. OBJECTIVES: To determine the socio-economic characteristics of patients admitted to an emergency treatment unit (ETU) in a private hospital in Colombo. METHODS: A descriptive cross sectional study was carried out on patients admitted to the ETU of a private hospital in Colombo from October 16th to December 15th 2015. Data were abstracted from medical records, verbal interviews, and the computerized data base maintained by the hospital. RESULTS: 2395 patients (1426 men; 59.2%) were admitted during the study period. The majority of patients were 61 to 70 years (30.4%). 80.3% were employed. 61.6% of patients had an insurance policy of which, 41.5% were private insurance policies. The monthly income ranged between Rs.15, 000 and Rs.150, 000 (mean Rs.43, 700±19,020). The commonest admissions were due to diseases of the digestive system (27.4%). Persons with an educational level of
Chronic liver disease in Sri Lanka: cirrhosis and its complications
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Niriella, M.A.
The predominant cause of chronic liver disease in Sri Lanka is alcoholic cirrhosis (AC) and cryptogenic cirrhosis (CC). The latter is probably due to non-alcoholic steatohepatitis (NASH). With increasing incidence and prevalence of non-alcoholic fatty liver disease (NAFLD), NASH related cirrhosis will likely become the leading cause of chronic liver disease in Sri Lanka. The prevalence of chronic hepatitis B and hepatitis C is very low in the community, as well as among ‘high risk’ populations such as prisoners and those with transfusion dependent anaemia. This has led to a unique population of non-viral chronic liver disease patient population predominating in our country, which is a contrast to the rest of the South Asian region. In fact NAFLD is the leading cause for listing for liver transplantation and is the leading liver disease among potential liver donors for living donor liver transplantation. The long term transplant free survival of AC and CC patients is similar and death in both groups is predominantly liver related. We have also studied and published on hepatocellular carcinoma and chronic kidney disease in cirrhosis, minimal hepatic encephalopathy and road traffic collisions and the quality of life in cirrhosis.
Clinical and molecular heterogeneity of β thalassaemia intermedia in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Perera, S.
A third of all patients attending thalassaemia centres in Sri Lanka have non-transfusion dependent thalassaemia (NTDT). The majority of these have Hb E β-thalassaemia. The genetic basis of non-E β-thalassaemia intermedia (TI) was studied in an attempt to correlate their genotype with the phenotype. Fifty unrelated TI patients were identified from the main thalassaemia centres, assessed clinically and categorized into ‘mild’, ‘moderate’ and ‘severe’ groups. DNA analyses were performed using standard techniques. Seventeen patients were homozygous or compound heterozygous for β mutations. Five of the homozygotes who carried two mild β alleles had mild disease. Nine inherited two severe β alleles with either one or two α gene deletions; despite the α deletions, they had severe disease. Thirty three patients were heterozygous for a β mutation: IVSI-5 G>C was the commonest. Twenty eight of the heterozygotes carried excess α genes and had a mild-moderate phenotype. The clinical outcomes of this TI population were mostly explained by the genotypes linked to the α and β gene cluster. However, in a minority, the existence of other causative genetic determinants remains to be defined.
Clinical management of agrochemical poisoning – promising outcome with evidence based practice
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Jayamanne, S.F.
Pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. It is a major problem in countries like ours where highly toxic organophosphate pesticides and paraquat are available. Medical management is difficult, with case fatality more than 15%. In the early part of this century, little clinical research and evidence existed with which to determine best therapy. Research conducted in Sri Lanka over the last fifteen years has changed the overall management and outcomes. Our main concern is still organophosphates and carbamates. We still do not know how the core treatments—atropine, oximes, should best be given. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids, improve oxygen delivery to tissues, and therefore the final outcome. The role of oximes is not completely clear. Small studies suggest benefit from new treatments such as clonidine, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Some pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality and we have successfully achieved this.
Clinico-pathological and radiological profile of peripheral lymphadenopathy in patients with systemic diseases
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sood, R.; Philip, N.M.; Madhusudhan, K.S.; Sharma, M.C.; Mathur, S.; Wig, N.; Biswas, A.
BACKGROUND: Peripheral lymphadenopathy is a physical sign observed in many patients with systemic diseases. In the evaluation of peripheral lymphadenopathy, ultrasonography of the nodes may be used as an adjunct to clinical examination. OBJECTIVE: To evaluate and correlate the clinical and ultra-sonographic profile of peripheral lymphadenopathy in patients with systemic illness with pathological diagnosis. METHODS: Sixty patients (male=30, female=30; mean age=33.38 (SD=14.6) years presenting with systemic illnesses and peripheral lymphadenopathy were included in the study after obtaining approval from Institutional Ethics Committee. A detailed clinical examination of lymph nodes was done, followed by ultrasonography and then sampling of the nodes. On ultrasonography, the nodes were categorized as pathological or reactive and if pathological, an attempt was made to subcategorize into tuberculosis, malignancy and non-specific. The clinical and sonographic features were correlated with pathological diagnosis. Patients with inconclusive pathological diagnosis were followed up for 3 months. RESULTS: Hard consistency and presence of matting were significantly associated with tubercular and malignant pathologies respectively. The sensitivity, specificity and overall accuracy of ultrasonography in diagnosing pathological lymph nodes were 97.3%, 62.5% and 86.8% respectively. Long axis to short axis ratio of <2, abnormal fatty hilum and abnormal vascularity were associated with pathological nodes. CONCLUSIONs: Clinical and sonographic examination of peripheral lymph nodes correlate well with final pathological diagnosis and may guide in deciding the lymph nodes to be sampled.
Communication interventions that influence the employment of persons with disabilities
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Perera, K.N.
INTRODUCTION: Persons with disabilities (PwD) lack basic support such as access to social safety nets, education, health services, and gainful employment. Sri Lanka allocates 3% of job opportunities for PWD within the public and corporate sectors. A significant proportion of PwD are affected with a communication impairment. There is minimal evidence pertaining to the employability of these persons. OBJECTIVE: To describe the perspectives of employers pertaining to communication needs required for the employment of PwD and to describe the need for communication interventions for PwD METHODS: This descriptive cross sectional study included 15 companies in the private sector which are employing PwD for a minimum period of one year. Data was collected by a pre-tested self-administrated questionnaire. A descriptive analysis was done using SPSS software. RESULTS: The predominant disabilities present were physical disability (57%) and Speech and Hearing disability (57%). 93% of the companies used formal interviews to recruit PwD, in which majority of the companies (53%) considered communication skills as an important factor in their recruitment. With 53% of the companies stating that the communication skills of the PwD remain significantly below the expected level, 67% perceived that intervention given in communication will increase their productivity and result in increased delivery of outcomes (100%), better quality of work (92%), better peer relationships (83%), high employee satisfaction (75%), and financial increments (67%). CONCLUSION: Speech and language therapy is identified as an integral requirement for the employability of PWD. Communication interventions will better enable PwD to participate and contribute productively to the country’s workforce and economy.
Community incidence of snake bite in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Pathmeswaran, A.
There are few studies on community incidence of snake bite. There are no national level data. We undertook a community-based country-wide survey on snake bite in Sri Lanka. The survey was designed to sample 1% of the population of Sri Lanka. A Grama Niladhari (GN) division was defined as a cluster for data collection. 125 clusters were allocated to each province. The clusters were selected using simple random sampling and in each cluster, 40 households were sampled consecutively from a random starting point. Population based incidence rates of snake bite were then constructed. 1,125 GN divisions with 43,827 households and a population of 164,746 (0.81% of country’s population) were surveyed. 694 snakebites and 317 significant envenoming (local tissue necrosis and systemic envenoming) were reported within the past 12 months. The crude overall community incidence of snake bites and significant envenoming were 421 and 192 per 100,000 population, respectively. There was wide variation within districts, the worst affected being Mullaitivu, Anuradhapura, Batticaloa and Polonnaruwa, all mainly agricultural areas in the Dry Zone of the country. It is concluded that Sri Lanka has a high community incidence of snake bite and envenoming, with marked geographical variation within the country.
Computer literacy among new medical entrants to the Faculty of Medicine, University of Kelaniya
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Hettige, S.; Gunarathne, M.G.S.S.; Ediriweera, E.P.D.S.
BACKGROUND: Computer literacy is essential for students. OBJECTIVES: To assess the level of computer literacy among new entrants to the Faculty of Medicine, University of Kelaniya. METHODS: Moodle based self-administered questionnaire was given new entrants (159 in 2015 and 147 in 2016). RESULTS: The results are described according to the 2015 (n=159) and 2016 (n=147) batches respectively. Proportions who had used computers were 99% (n=157) and 98% (n=144). Those who had formal training in computer literacy were 68% (n=108) and 65% (n=96) and 46% (n=73) and 45% (n=66) were in possession of paper qualifications related to the training undergone. Proportions who used computers daily were 19% (n=31) and 31% (n=46) and 9% (n=14) and 13% (n=19) used it ≤once/month. Students’ perceptions on their ability to use computers were as follows: 1) Competent - 14%(n=23) and 17% (n=25), 2) Average - 75%(n=119) and 78%(n=114) and 3) Poor - 11%(n=17) and 5%(n=8). Relevance of computer literacy for medical students was as follows: 1) Essential - 48%(n=77) and 56%(n=82), 2) Very important - 42%(n=66) and 36%(n=53) and 3) Reasonably important - 9%(n=15) and 8%(n=12). Only two (1%) students from 2015 batch stated that computer literacy is of very little important to function as a doctor. CONCLUSIONS: Majority had used computers before entering the Medical Faculty and almost two thirds has had formal training and less than one half had paper qualifications on computer literacy. Majority believed computer literacy is important for them as medical students as well as doctors.
Developing a research agenda in a less-than-research-friendly environment: the Ragama story
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, J.
Universities should be engines for knowledge generation. Although there are signs of change, a research culture is not widespread in Sri Lankan universities. It was in this environment that the Faculty of Medicine was established at the University of Kelaniya, in 1991. The private North Colombo Medical College, that was its physical forerunner, had virtually no recognized research output. The major strength of the new faculty was the quality of its academic staff. It soon had a critical mass of restless high-achievers with excellent postgraduate training. As with most institutions with a short history, making a mark nationally and internationally depended on drive, commitment, pragmatism and, most importantly, innovation - adapting to research in a resource poor setting. The strategy had to be simple and feasible: not to compete internationally in laboratory-based basic sciences, but to focus on diseases that were relevant locally but rare in the West, and on diseases of affluence that were emerging in the developing world, concentrating on their epidemiology and clinical aspects, and seeking foreign collaboration for their detailed study. Research was undertaken while developing new study programmes, curricula and timetables for the newly established faculty, and servicing one of the busiest teaching hospital in the country. There was a freedom to follow individual research interests, and as each department initially had few staff, inter-departmental, multi-disciplinary research was not just a philosophy, but a necessity. Though there were a few skeptics, research was encouraged at every level, including in the undergraduate curriculum, and achievements publicly acknowledged. International collaborations with leading researchers and institutions followed. Faculty members were recognized for their research and many were soon in influential academic, editorial and administrative positions nationally and internationally. Research infrastructure was built gradually: a molecular medicine unit, a clinical trials unit participating in ground-breaking international trials, a national reference laboratory for thalassaemia, a community cohort for the longitudinal study of non-communicable diseases, and one of the only four WHO-recognized ethics committees in the country, to name a few. At 25 years, and starting from zero, our measureable institutional research output stands at about 1,000 Google Scholar and 500 PubMed publications, with over 10,500 citations and an h-index of 46. Compared to the first five years (1991-1996), publications and citations have increased nearly 10-fold during the last four (2012-2015). Work in some areas has led to implementation or changes in clinical practice and health policy internationally. The output is one of the best in this country, but challenges remain and the impetus needs to be sustained, and the research agenda more ambitious.
Developing and validating a language assessment tool to diagnose aphasia in a Sri Lankan Sinhala speaking context
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Rathnayake, S.
Aphasia is an acquired communication disorder commonly present in stoke survivors. No standardized tests are currently available to identify aphasia in the Sri Lankan context. The objectives of this study were to identify language functions in Sinhala to be used as tasks in the tool; to identify the reliability of the developed tool and to identify the validity of the developed tool. Face validity and construct validity were achieved based on the Delphi-method. External validity was identified with concurrent and criterion validity. Data from 200 participants without aphasia (age ranges of 20-40, 41-60, 61-80, 80+ years) and 251 participants with strokes (PWS) were analyzed in the validation process. The reliability was achieved by reliability measures of internal reliability (IR) as Cronbach alpha (CA), split half reliability(SHR), test-retest (TR) and inter-examiner reliability (IER) using a sample of 30 participants with aphasia (PWA) and 60 PWS. No correlation was observed among total scores with age, educational or economy for participants without aphasia, but significant correlation was observed for PWA for age (-758) and education (0.490). The Delphi method resulted with 12 tasks and 69 items for the tool. IR for each task was calculated and CA was within the expected range (0.70-0.90) for 8 tasks and (04) four tasks needed revision. IER reliability was 0.99. TR reliability was 0.90. Two tests correlation was 0.86. ROC curve for 60 SWS was analyzed and that score (140) was used among another 251 PWS to diagnose aphasia and the results indicated sensitivity as 01 and specificity as 0.91 with gold-standard comparisons. In conclusion, the developed tool could be used as a clinically valid and reliable tool to diagnose aphasia in the Sri Lankan context.