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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Pediatric emergencies(Samudra Medical Publications, 2022) Perera, P.; Rajindrajith, S.No abstract availableItem The establishment of a population-specific reference value for the ruler drop test for the clinical assessment of reaction time(Elsevier, 2023) Rajapaksha, S.; Kitulwatte, I.; Senarathne, U.; Edirisinghe, A.; Perera, P.BACKGROUND: Reaction time (RT) is the interval between a stimulus and an appropriate voluntary response in an individual. Alcohol is known to result in delayed RT. In Sri Lanka, an alleged drunken driver is legally subjected to a medico-legal examination to confirm or exclude impairment. The guideline for examining a drunk person in Sri Lanka includes the ruler drop test (RDT) as a test of RT. RDT is a simple test of visual reaction time in which the subject attempts to stop a falling ruler, and the height fallen is used to determine the time taken to react to the event. However, a formal study has yet to be carried out to establish population-specific reference values to interpret RDT results. METHODS: A cross-sectional descriptive study was conducted using 903 adults ≥18 years. A nonparametric approach was applied for deriving the reference values based on an inter-percentile interval. RESULTS: The study population consisted of 56.6% females, and the mean age of the participants was 41.6 years. Most (95%) of the study population could catch the ruler at or less than 40.0 cm of average height. The average height on RDT increased from younger to older age groups. However, subgrouping based on other variables, including sex, age, and alcohol consumption, did not show any statistically significant difference. CONCLUSIONS: The population-specific cut-off limit to identify alcohol intoxication by RDT in a Sri Lankan adult is 'average height' >40 cm.Item Efficacy of hydroxyurea in reducing the erythropoietic stress of ineffective erythropoiesis in transfusion dependent beta thalassaemia: A randomised, double-blind placebo-controlled clinical trial(Sri Lanka Association for the Advancement of Science, 2021) Yasara, N.; Premawardhena, A.; Perera, P.; Manamperi, A.; Mettananda, S.The unbalanced synthesis and accumulation of a-globin chains due to impaired synthesis of 0- globin results in the destruction of red blood cells (RBC) and erythroid precursors of patients with P-thalassaemia. This leads to an increased erythropoietic activity and ineffective erythropoiesis in the bone marrow of these patients. Hydroxyurea is a licenced medication that decreases the RBC destruction of patients with p-thalassaemia. However, its effect on erythropoietic stress is unclear. In this study, our objective was to evaluate the effect of hydroxyurea on erythropoietic stress of ineffective erythropoiesis in transfusion-dependent (TD) p-thalassaemia. This experimental study was carried out at the Thalassaemia Unit of Colombo North Teaching Hospital as part of a randomised, double-blind placebo-controlled clinical trial that evaluates the efficacy of hydroxyurea. We recruited 24 patients with TD p-thalassaemia who were taking hydroxyurea IQ- 20 mg/kg/day and 16 patients who were receiving a placebo. The erythropoietic stress of ineffective erythropoiesis was assessed by measuring serum soluble transferrin receptor (sTfR) levels before and six months after taking either hydroxyurea or placebo. Levels of sTfR were measured using a validated enzyme-linked immunosorbent assay. Paired t-test was used in the statistical analysis. Nineteen (79%) out of 24 patients who received hydroxyurea showed a reduction in sTfR level, of which 8 (33%) and 6 (25%) showed >25% and 10-25% reductions, respectively. A significant reduction in mean sTfR level was observed after hydroxyurea treatment (72.3±SD25.9) compared to pre-treatment levels (89.6士SD22.9), (pv0.01). Conversely, no difference in sTfR levels was seen in patients who received the placebo pre・(91.9土SD24.7) and post-treatment (96.4±SD19.4), (p=0.17). In conclusion, oral hydroxyurea significantly reduced the erythropoietic stress of ineffective erythropoiesis in patients with TD p-thalassaemia showing a promise as a treatment modality.Item Sequelae of BCG vaccination and effects of cleaning vaccine site with alcohol(Sri Lanka Medical Association, 2012) Perera, P.; Samaranayaka, G.; Samaranayaka, R.; Ranathunga, N.INTRODUCTION: In Sri Lanka, BCG vaccine is given during neonatai period. There are many myths regarding BCG vaccine among general public and sequelae of vaccination is not well documented in medical literature. AIMS: Objectives of this study were to describe the sequelae of BCG vaccination when given at neonatal period and to find out whether cleaning the vaccine site with 70% alcohol, affect its potency. METHODS: A prospective observational study was carried out at Ragama teaching hospital and 2 private hospitals in Gampaha district. 125 babies each from government and private sector were recruited for the study with the consent from parents. Vaccine was administered in the morning as well as evening, as required by the patient, by a consultant Paediatrician. Vaccine site was cleaned with 70 % alcohol and allowed to dry before vaccination. All babies were bathed on same day. Babies were followed up periodically until a scar was detected. RESULTS: 182 babies completed the follow up and all babies developed a scar. Time taken for a reaction varied but all babies had a reaction by 8 weeks and a scar by 14 weeks. 6 babies had fever within one week of vaccination but it was due to feeding failure or sepsis. None had adverse reactions attributable to the vaccine. CONCLUSIONS: Cleaning the vaccine site with alcohol does not affect the potency of BCG vaccine. Proper technique of administration is important for successful vaccination. Time of vaccination and bathing had no effect on efficacy or side effects.Item Knowledge of mothers regarding helminth infections and patterns of anthelminthic usage in children(Sri Lanka Medical Association, 2012) Perera, P.; Dissanayaka, D.; Fernando, M.; Ranathanga, N.INTRODUCTION: Intestinal helminth infections are a global problem. There are lot of misbelieves among people regarding helminth infections, which often leads to inappropriate use of anthelmintics. AIMS: To assess the knowledge of mothers regarding helminth infections and to describe the patterns of anthelmintic usage in children. METHODS: A descriptive cross sectional study was carried out at University Paediatric unit. Teaching hospital Ragama, during September 2011 to November 2011. Two Hundred children and their mothers admitted to the Paediatrics university unit with at least one child above 18 months were recruited with informed written consent. Socio-demographic data, availability of sanitary facilities and safe drinking water, knowledge on intestinal infections and practices related to anthelmintic treatment were collected using a pretested Interviewer administered questionnaire. RESULTS: Nearly all families had access to a safe toilet and 62% had safe drinking water. 84% of children had regular anthelmintic treatment and out of them 39.3% had 3 monthly, 55.3% six monthly and 5.3% annually. Out of them only 81.4% had risk factors to get helminth infections, while 36,9% had no evidence in the past of worm infection. There was no statistically significant association between regular anthelmintics usage and presence of risk factors (odds ratio 1.799, CI 0.849-3.815). Knowledge of mothers regarding transmission of worm infections and clinical features was poor. CONCLUSIONS: Considering the high literacy rate among Sri Lankan mothers knowledge about worm infections was surprisingly poor. A lot of children are receiving unnecessary anthelmintic treatment. Health education programs addressing these issues are indicated.Item Dental hygiene practices and the pattern of dental caries in preschool children in Ragama(Sri Lanka Medical Association, 2012) Perera, P.; Abeweera, N.; Fernanado, M.; warnakulasuria, T.W.; Ranathunga, N.INTRODUCTION: Dental caries is a common problem among preschool children, but often neglected as deciduas teeth are replaced later by permanent teeth. However, for many reasons, protecting deciduas teeth is very important. AIMS: The objectives of this study were to describe the prevalence of dental caries among preschool children and assess the utilization of dental care facilities. METHODS: A descriptive cross sectional study was done between August 2010 and October 2010 at child welfare clinics held in the Ragama MOH area. Consecutive children aged between 2 and 5 years attending the clinics were recruited with the consent of parents. An interviewer administered questionnaire was used to obtain data and the mouth was examined for caries. Total decayed-missing-filled (dmft) score and significant caries index (SIC) were calculated to describe the prevalence of dental caries. Care index was calculated to describe the use of dental services. RESULTS: Out of 410 children recruited, none had routine visits to a dentist. Though practices related to brushing teeth were satisfactory, 37.8% children in the study sample had caries. This increased to 68.8% by 5 years of age. Mean dmft score for the whole sample was 1.41 and SIC index was 4.09. The Care index was 4.72. The dmft score in girls was higher than boys. Incisors of the upper jaw were the mainly affected teeth. CONCLUSIONS: Prevalence of dental carries among this cohort of Sri Lankan preschool children is very high. The level of dental care for preschool children at present appears to be unsatisfactory.Item Pattern of physical growth during first six months of life among a cohort of babies living in Gampaha district, Sri Lanka(2013) Perera, P.; Fernando, M.; Mettananda, S.; Samaranayake, R.Introduction: Current WHO recommendation is to continue exclusive breast feeding (EBF) up to six months. Main concern regarding this recommendation is, whether EBF supports rapidly growing infant with adequate nutrition. Methods: A cohort of randomly selected new-borns was followed up at two, four and six months, to study feeding pattern and physical growth. Feeding practices and socio-demographic data were collected using an interviewer administered questionnaire. Weight & length were measured using standard techniques. Results: EBF rates were very high in this cohort of children. One main reason to stop EBF was growth faltering. Only some children showed a catch up growth by stopping EBF. At two, four and six months, weight faltering rates among EBF babies were, 11.1%, 20.1% and 13.2% respectively. Length faltering had a similar pattern, but with a higher rate at all ages. Conclusions: EBF up to six months did not cause growth faltering in the majority. In the majority, no identifiable cause for growth faltering was found. Possible genetic influence on growth faltering was not considered when stopping EBFItem Constipation and functional faecal retention in a group of school children in a district in Sri Lanka(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.; Mettananda, S.; Perera, P.; Jasmin, S.; Karunarathna, U. A.; Adihetti, D.; Goonewardena, R.OBJECTIVE: To assess the prevalence of constipation and functional faecal retention among a group of school children in Gampaha district of Sri Lanka. METHOD: This is a cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in a semi-urban school in Gampaha District of Sri Lanka. Constipation was defined using Rome III criteria and Paris Consensus on Childhood Constipation Terminology (PACCT). Functional faecal retention was diagnosed using Rome II criteria. RESULTS: A total of 441 questionnaires were distributed and 429 (97.3%) responded (53.1% males, mean age 12.4 years, SD 1.5 years). According to Rome III criteria and PACCT, 46 (10.7%) had constipation. Prevalence of constipation was higher in males (14.5%) compared to females (6.5%) [OR 2.45, 95% CI 1.19-5.1, p=0.012]. Twenty three (5.4%) had functional faecal retention. CONCLUSIONS: Chronic constipation is a significant problem, affecting approximately 10% of children in a semi-urban school in Gampaha district. It is commoner among males. Both Rome III criteria and PACCT are effective in diagnosing childhood constipation in epidemiological studiesItem A Pilot study on assessment of racial affinity of Sri Lankan population using discriminant function statistics and a few established morphological racial traits(Elsevier Science Ireland Ltd, 2009) Perera, P.; Pathmeswaran, A.Determination of racial affinity was not considered in investigations of unidentified bones in Sri Lanka until recently. Post-Tsunami exhumation of mass graves to identify Japanese and Europeans tourists highlighted the lack of anthropological data to separate them from Sri Lankans. OBJECTIVE: The objective of this study is to determine the racial affinity of the Sri Lankan population using few well documented anatomical traits and Giles and Elliot's discriminant function analysis. METHODOLOGY: Following measurements were obtained from 38 skulls. Basion-Prosthion length, Maximum length, Maximum breadth, Basion-Bregma height, Basion-Nasion height, Bizygomatic breadth, Prosthion-Nasion height and Nasal breadth. RESULTS: Giles and Elliot (1963)'s discriminant functions developed to determine ancestry were used. In addition, few well-established morphological racial traits were also observed. Separate discriminant functions developed by Giles and Elliot to differentiate American white skulls from black skulls and white skulls from native Indian skulls were used. Five skulls had the measurements of blacks and another five had the measurements of Native Americans. The rest had measurements of American whites. 24 skulls had 'medium' (intermediate triangle) nasal openings. Nasal root contour was low to moderate in height (tented) in 22 skulls. Nasal spine was small in 31 skulls and nasal sill was blurred in 27 skulls. CONCLUSION: Discriminant functions developed by Giles and Elliot identified the majority of skulls in this study as belong to Caucasians but only few skulls had obvious Caucasian morphological traits. However, there were few skulls showing clear Negroid and Mongoloid morphological features. Finally this study showed that the formulae developed by Giles and Elliot can be used to differentiate Sri Lankan skulls from those of American Indians and Blacks.Item Scars of torture: a Sri Lankan study(Elsevier, 2007) Perera, P.Interpretation of scars of torture is not an easy task as our understanding of evolution of scars of different methods of torture is still in its infancy. The objectives of this study were to produce the features of a typical scar of a few selected methods of torture and determine their characteristic distribution. To achieve this, 100 medico-legal records of victims of torture examined at the Judicial Medical Officer's Office, Colombo between 1998 and 2001 were perused. Scars caused by seven selected methods of torture were taken into consideration. They were, assault with both non-pliable and pliable blunt objects, cigarette burns, burns with heated solid objects and molten plastic, ligature application with different forms of suspension and cuts with sharp objects. Total number of scars analyzed in this study was 1846, which included 740 scars of non-pliable blunt weapons, 182 of pliable blunt weapons, 102 of ligature, 59 of molten polythene, 55 of heated objects and 82 of razor blades and knives. Typical scars of each method of torture and their characteristic distribution were determined.