Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Impact of acalypha indica (Kuppamenia) phytochemicals on glucose-6-phosphate dehydrogenase deficiency: two clinical case studies(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, K.; Fernando, N.; Dayanath, B.K.T.P.; Williams, S.; Premawardhena, A.INTRODUCTION Acalypha indica, known as “kuppamenia” in Sinhala, plays a significant role in ayurvedic medicine in Sri Lanka. Despite its medicinal use, certain phytochemicals within the plant have been linked to oxidative stress-induced haemolysis in individuals deficient in glucose-6-phosphate dehydrogenase (G6PD) enzyme activity. However, we know very little regarding those chemicals due to a dearth of literature. Here, we present two cases highlighting the impact of Acalypha indica ingestion on individuals with G6PD deficiency.CASE PRESENTATION Case 1: A 65-year-old man presented with jaundice, pallor, and haematuria after consuming “Kuppamenia mallum”. His peripheral blood picture showed bite cells and Heinz bodies. Positive Brewer’s test raised the clinical suspicion of G6PD deficiency. He received blood transfusions during the acute phase and was discharged upon improvement of symptoms. Low levels of G6PD enzyme at the follow-up visit confirmed the diagnosis. Case 2: A 61-year-old male presented with respiratory distress, jaundice and haematuria, accompanied by peripheral cyanosis and hypotension. He was admitted following four days of continuous ingestion of Acalypha indica. Peripheral oxygen saturation was low, and Heinz bodies were evident in the peripheral blood film. Blotting paper methaemoglobinaemia assessment revealed a level of 70%. Despite optimal medical management, he succumbed to a cardiac arrest on the fourth day of admission.DISCUSSION AND CONCLUSIONS Despite its antioxidant properties, Acalypha indica can precipitate acute haemolysis in G6PD-deficient individuals. Symptomatology and outcomes vary with the amount ingested, underscoring the necessity for research into identifying potentially toxic phytochemicals and their concentrations.Item Do doctors really know about “hs-cTnI”? A comprehensive evaluation of knowledge regarding high-sensitivity cardiac troponin I (hs-cTnI) assay among medical officers in Gampaha district(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, N.; Fernando, K.; Gallage, T.; Dayanath, B.K.T.P.; De Silva, S.INTRODUCTION AND OBJECTIVES The high-sensitivity cardiac troponin I (hs-cTnI) assay is a crucial diagnostic marker in the triage of patients presenting with chest pain. Notably, errors in interpreting the testing method have been identified among medical officers, leading to an increased likelihood of inaccuracies in testing and interpretation. This study aims to evaluate the level of understanding among medical officers regarding the hs-cTnI assay in relation to the most recent European Society of Cardiology (ESC) guideline released in 2020. METHODS A cross sectional questionnaire-based study was conducted at two government hospitals in Gampaha District during June 2022. A self-administered e-questionnaire was used to assess knowledge regarding hs-cTnI. Knowledge was measured through cumulative scoring of questionnaire responses, subsequently categorized as either good or poor knowledge. Scores below 60% were designated as poor, and vice versa. Descriptive statistics were employed for data summarization. RESULTS Out of 300 participants, 76% (227) responded. Only 14.5% (33/227) exhibited proficient knowledge of the analytical component, while 41.9% (95/227) demonstrated good knowledge of the clinical component. A score ≥60% on the analytical component knowledge correlated significantly with factors such as designation being a senior registrar or consultant (p<0.001), postgraduate enrolment (p<0.001), participation in continuous professional development programmes (p<0.001), and employment in a teaching hospital (p=0.025). Conversely, no significant associations were observed with age (p=0.066) or private practice (p=0.118). Clinical component knowledge scores ≥60% were significantly associated with age between 25 and 35 years (p=0.006), postgraduate enrolment (p<0.001), participation in continuous professional development programs (p<0.001), and employment in a teaching hospital (p=0.001) but not with doing private practice (p=0.170). CONCLUSIONS In Sri Lanka, medical officers’ analytical knowledge on the hs-cTnI assay seems lacking. Ongoing training programmes are essential to enhance their knowledge and proficiency in hs-cTnI testing.Item Knowledge of the high-sensitivity cardiac troponin assay among medical officers in Gampaha District, Sri Lanka(The Kandy Society of Medicine, 2023) Fernando, N.; Fernando, K.; Gallage, T.; Dayanath, B.K.T.P.; de Silva, S.T.INTRODUCTION: The high-sensitivity cardiac troponin (hs-cTn) assay is a crucial diagnostic test that is obligatory in the triage of patients presenting with chest pain. It is essential for medical officers to have adequate knowledge regarding the procedures for testing and the interpretation of test outcomes to deliver optimal healthcare for patients. It has been observed that medical officers are lacking in awareness regarding this testing method, resulting in a greater likelihood of errors in testing and interpretation. This study aims to evaluate the level of understanding among medical officers regarding the hs-cTn assay in relation to the most recent European Society of Cardiology guideline released in 2020. METHODOLOGY: We conducted a cross-sectional study at two government hospitals in Gampaha District in June 2022. A self-administered e-questionnaire was used to assess knowledge regarding hs-cTn. Knowledge was measured by calculating a cumulative score for the answers to a questionnaire and categorised into good or poor knowledge. A score less than 60% was categorized as poor and vice versa. Descriptive statistics were used to summarize the data. RESULTS: Of the 227 medical officers, only 14.5% (n=33) had good knowledge of the analytical component while 41.9% (n=95) had good knowledge on the clinical component. A score ≥60% on the analytical component knowledge was significantly associated with designation being a senior registrar or consultant (p<0.001), postgraduate enrolment (p<0.001), participation in continuous professional development programmes (p<0.001), and employment in a teaching hospital (p=0.025), but not with age (p=0.066) or private practice (p=0.118). Clinical component knowledge score ≥60% was significantly associated with age between 25 and 35 years (p=0.006), designation being a consultant (p<0.001), postgraduate enrolment (p<0.001), participation in continuous professional development programs (p<0.001), and employment in a teaching hospital(p=0.001) but not with doing private practice (p=0.170). CONCLUSIONS: In Sri Lanka, medical officers’ general knowledge on the hs-cTn assay seems lacking. There is a need for continuous training to improve knowledge on hs-cTn testing among medical officers.Item Azygous anterior cerebral artery infarction(Oxford, 2024) Fernando, N.; Ranawaka, U.No abstract availableItem Cross-cultural adaptation and validation of the Sinhala version of the hospital anxiety and depression scale (HADS) for patients diagnosed with ischemic heart disease (IHD) in Sri Lanka(College of Community Physicians of Sri Lanka, 2023) Gamage, C.K.W.; de Zoysa, P.; Balasuriya, A.; Fernando, N.; Jayamanne, D.INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is a frequently used instrument to measure depression and anxiety symptoms among patients diagnosed with ischaemic heart disease (IHD). However, a Sinhala version of HADS for Sri Lankan IHD patients has not been validated in Sri Lanka. OBJECTIVES: To translate, cross-culturally adapt and validate the HADS in a Sinhala-speaking Sri Lankan population with IHD METHODS: The Sinhala translation of HADS was conducted in four phases: forward translation, backward translation, patient testing and proofreading with the Mapi Research Trust guidelines. Content and consensual validation of the translated scale was conducted with the Delphi method, and the ratings were evaluated for consensus. The validated scale was administered to a sample selected using systematic sampling of 140 IHD patients attending medical clinics at a base hospital in Sri Lanka. Factor structure was verified with Confirmatory Factor Analysis (CFA) and reliability with internal consistency by Cronbach's alpha. RESULTS: The HADS Sinhala version showed good content and consensual validity. CFA proved that the uncorrelated two-factor structure was compatible with the original instrument (x2=156.98; df=76; p<0.001). The Confirmatory Fit Index (CFI) was 0.89, and the Root Mean Square Error of Approximation (RMSEA) was 0.09. The reliability analysis indicated Cronbach's alpha for depression and anxiety as 0.86 and 0.83, respectively. CONCLUSIONS & RECOMMENDATIONS: The cross-culturally adapted HADS Sinhala version shows similar psychometric properties as the original instrument and can be used in future studies with confidence.Item Impact of COVID-19 outbreak on the number of invasive procedures in Institute of Cardiology, National Hospital of Sri Lanka -A descriptive longitudinal study(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Kuruppu, C.; Gunawardena, R.; Dunuwille, A.; Ranasinghe, G.; Fernando, N.; Mendis, S.; Fernando, M.; Wijewardena, A.; Prabath, I.H.D.S.Introduction: Covid-19 pandemic has significantly affected healthcare services worldwide with a similar impact on invasive procedures, in Institute of Cardiology, National Hospital of Sri Lanka (NHSL). Objectives: To analyse the impact of Covid-19 outbreak on therapeutic cardiology interventions, both elective and emergency, by comparing frequencies of procedures done during the initial affected year and immediate previous year. Methods: A Retrospective longitudinal descriptive study was carried out on frequencies of invasive therapeutic cardiology procedures during the period of 2019 March to 2021 February, at Cardiology Unit, NHSL. Pre-formed data collection sheets were filled using hospital registries. Final analysis was done by Microsoft-Excel 365. Results: Total number of procedures done in affected year was 4690 compared to 6096 in previous year. In April 2020, which was the most affected month, 52 cumulative procedures have been done in comparison to 427 procedures in April 2019. By August 2020 number of procedures has increased to 668 in compared to 486 in August 2019. Total of elective procedures were 3751 and 5061 in affected and non-affected years respectively. Similarly, the number of emergency procedures was 1035 in immediate previous year and 939 during Covid pandemic. Conclusions: Study has highlighted a significant impact on invasive therapeutic cardiology procedures, especially on electives, by the onset of the Covid-19 pandemic, especially during the period of lockdown. However, there has been a compensatory increase in procedures once lockdown was over, partially compensating for the numbers. There has been less impact on emergency procedures, the numbers of which have remained relatively constant.Item Cross-cultural adaptation of the type D personality scale for use with patients diagnosed with Ischemic heart disease in Sri Lanka(The Sri Lanka Medical Association, 2021) Walpita Gamage, C.K.; de Zoysa, P.; Balasuriya, A.; Fernando, N.; Jayamanne, B.D.W.INTRODUCTION: Ischemic Heart Disease (IHD), a major cardiovascular disease globally, has become the primary cause of death in Sri Lanka. Negative affectivity (NA) and social inhibition (SI) are two personality traits which increase the risk of IHD. The Type D Scale (DS-14) evaluates a person’s general level of distress on NA and SI. However, DS-14 has not been translated and validated into Sinhala in Sri Lanka. OBJECTIVES: The study aimed to cross-culturally adapt and validate the DS-14 for use with Sinhala speaking patients diagnosed with IHD. METHODS: Translation, back translation and pre-test were conducted before a two-rounds of a Delphi process which assessed content and consensual validity of the instrument. The validated questionnaires were administered to 140 patients diagnosed with IHD at a Base Hospital. Factor structure was confirmed through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) and reliability, by internal consistency with Cronbach’s alpha. RESULTS: The questionnaire was administered among 140 participants (85 females), aged 18-60 years. The DS-14 Sinhala version showed good content and consensual validity. Factor analysis proved two factors compatible with the original instrument, which explained the variance of 62.9%. CFA confirmed the two-factor model. The reliability analysis indicated Cronbach’s alpha for NA and SI as 0.93 and 0.88, respectively. CONCLUSION: The cross-culturally adapted DS-14 Sinhala version indicated the same psychometric properties as the original instrument, in the local context with IHD patients. It can be confidently applied in the investigation of Type D personality in IHD prevention and treatment, as well as in research. KEYWORDS: Ischemic Heart Disease, Type D Personality, DS-14Item Effect of antimicrobial agents on inflammatory cytokines in acute Leptospirosis(American Society for Microbiology, 2018) Fernando, N.; de Silva, R.; Hadunnetti, S.M.; Karunanayake, L.; de Silva, N.L.; de Silva, H.J.; Rajapakse, S.; Premawansa, S.The aim of this study was to assess the inflammatory cytokine response and possible association with antimicrobial treatment with penicillin, ceftriaxone, and doxycycline in acute leptospirosis. In the early acute stage, interleukin-10 (IL-10) levels were higher in mild cases than in severe cases (P = 0.01). IL-6 and IL-8 levels were low in patients who received >5 antimicrobial doses (P < 0.01). IL-8 levels were negatively correlated with the number of ceftriaxone doses administered (r = -0.315; P = 0.031). Further studies are needed to evaluate the possible downregulation of proinflammatory cytokines by ceftriaxone in leptospirosis.Item Leptospirosis: challenges in diagnosis, and predictors of severity(Ceylon College of Physicians, 2016) Rajapakse, S.; Fernando, N.; Niloofa, M.J.R.; de Silva, H.J.; Karunanayake, L.; Premawansa, S.; Handunnetti, S.M.No Abstract availableItem A Diagnostic scoring model for Leptospirosis in resource limited settings(Public Library of Science, 2016) Rajapakse, S.; Weeratunga, P.; Niloofa, R.; Fernando, N.; de Silva, N.L.; Rodrigo, C.; Maduranga, S.; Nandasiri, N.; Premawansa, S.; Karunanayake, L.; de Silva, H.J.; Handunnetti, S.Leptospirosis is a zoonotic infection with significant morbidity and mortality. The clinical presentation of leptospirosis is known to mimic the clinical profile of other prevalent tropical fevers. Laboratory confirmation of leptospirosis is based on the reference standard microscopic agglutination test (MAT), direct demonstration of the organism, and isolation by culture and DNA detection by polymerase chain reaction (PCR) amplification. However these methods of confirmation are not widely available in resource limited settings where the infection is prevalent, and reliance is placed on clinical features for provisional diagnosis. In this prospective study, we attempted to develop a model for diagnosis of leptospirosis, based on clinical features and standard laboratory test results. METHODS: The diagnostic score was developed based on data from a prospective multicentre study in two hospitals in the Western Province of Sri Lanka. All patients presenting to these hospitals with a suspected diagnosis of leptospirosis, based on the WHO surveillance criteria, were recruited. Confirmed disease was defined as positive genus specific MAT (Leptospira biflexa). A derivation cohort and a validation cohort were randomly selected from available data. Clinical and laboratory manifestations associated with confirmed leptospirosis in the derivation cohort were selected for construction of a multivariate regression model with correlation matrices, and adjusted odds ratios were extracted for significant variables. The odds ratios thus derived were subsequently utilized in the criteria model, and sensitivity and specificity examined with ROC curves. RESULTS: A total of 592 patients were included in the final analysis with 450 (180 confirmed leptospirosis) in the derivation cohort and 142 (52 confirmed leptospirosis) in the validation cohort. The variables in the final model were: history of exposure to a possible source of leptospirosis(adjusted OR = 2.827; 95% CI = 1.517-5.435; p = 0.001) serum creatinine > 150 micromol/l (adjusted OR = 2.735; 95% CI = 1.374-4.901; p = 0.001), neutrophil differential percentage > 80.0% of total white blood cell count (adjusted OR 2.163; 95% CI = 1.309-3.847; p = 0.032), serum bilirubin > 30 micromol/l (adjusted OR = 1.717; 95% CI 0.938-3.456; p = 0.049) and platelet count < 85,000/mm3 (adjusted OR = 2.350; 95% CI = 1.481-4.513; p = 0.006). Hosmer-Lemeshow test for goodness of fit was 0.931. The Nagelkerke R2 was 0.622. The area under the curve (AUC) was noted as 0.762. A score value of 14 reflected a sensitivity of 0.803, specificity of 0.602, a PPV of 0.54, NPV of 0.84, a positive LR of 2.01 and a negative LR of 0.32. CONCLUSIONS: The above diagnostic model for diagnosis of leptospirosis is suggested for use in clinical settings. It should be further validated in clinical practice.