Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
8 results
Search Results
Item A morphometric analysis of craniofacial features of the Coastal Indigenous people in Sri Lanka(Sociedad Chilena de Anatomia, 2024-12) Liyanage, S.; Devasingha, D. M. L. C. D.; Dissanayake, D. M. P. V.; Ranaweera, L.The existence of an indigenous community within a country is a source of pride and warrants significant attention. Sri Lanka is no exception, and, as a country with the fossil remains of anatomically modern Homo sapiens, it is hypothesized that Sri Lankan Indigenous people might harbor ancient genetic signatures. This study aims to establish baseline data of certain craniofacial anthropometric measurements in the Coastal Indigenous people and classify their head, face, and nose types. This study involved 126 (70 Male and 56 Female) unrelated individuals from six villages, representing the Coastal Indigenous population. Sixteen craniofacial measurements were obtained, providing calculations of three craniofacial indices: the Cephalic index, Facial index, and Nasal index. It was apparent that all craniofacial measurements, except nose protrusion of males, had significantly higher dimensions than those of the female participants. In addition to baseline quantitative raw data, the calculated indices are as follows: The mean cephalic, facial, and nasal indices of females were 78.50± 4.84, 88.37±13.06, and 93.93±12.23, respectively, whereas those of males were 78.85±5.76, 91.74±13.70, and 94.58±14.06, respectively. This is the first craniofacial study on Coastal Indigenous people in Sri Lanka. The most common head shape observed among both genders was mesocephalic. Males predominantly exhibited a hyperleptoprosopic facial type, while females mostly showed a leptoprosopic facial type. The most dominant nasal type recorded for both genders was the platyrrhine nasal phenotype. Interestingly, such platyrrhine nose is rarely present in other world populations, except in African populations.Item Identification of type 2 diabetes patients with non-alcoholic fatty liver disease who are at increased risk of significant hepatic fibrosis: a cross-sectional study(Sri Lanka Medical Association, 2023) Mettananda, K.C.D.; Egodage, T.; Dantanarayana, C.; Solangarachchi, M.B.; Fernando, R.; Ranaweera, L.; Siriwardhena, S.; Ranawaka, C.K.; Kottahachchi, D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Annual screening of patients with diabetes for fatty liver, and identifying those with significant hepatic fibrosis using the FIB-4 score and vibration-controlled transient elastography (VCTE) has been recommended to detect patients who may progress to advanced hepatic fibrosis/cirrhosis. However, VCTE is not freely available in resource-limited settings. OBJECTIVES: To identify clinical and biochemical predictors of significant liver fibrosis in diabetics with fatty liver. METHODS: We conducted a cross-sectional study among all consenting adults with T2DM and non-alcoholic fatty liver disease (NAFLD) attending the Colombo North Teaching Hospital, Ragama, Sri Lanka from November 2021 to November 2022. FIB-4 scores were calculated and patients with a score ≥1.3 underwent VCTE. Risk associations for liver fibrosis were identified by comparing patients with significant fibrosis (LSM ≥8 kPa) with those without significant fibrosis (FIB-4<1.3). RESULTS: A total of 363 persons were investigated. Of these, 243 had a score of FIB-4 <1.3. Of the 120 with a FIB-4 ≥1.3, 76 had LSM ≥8 kPa. Significant fibrosis was individually associated with age (OR 1.01, p<0.0001), duration of diabetes (OR 1.02, p=0.006), family history of liver disease (OR 1.42, p=0.035), waist (OR 1.04, p=0.035), and FIB-4 (OR 2.08, p<0.0001). However, on adjusted analysis, significant fibrosis was only associated with a family history of liver disease (OR 2.69, p=0.044) and FIB-4 (OR 1.43, p<0.001). CONCLUSION: In patients with T2DM and fatty liver, advancing age, increased duration of diabetes, a family history of liver disease, waist circumference and a high FIB-4 score increase the risk of significant hepatic fibrosis. Targeted interventions in this group may help prevent progression to advanced hepatic fibrosis/cirrhosis.Item Identification of patients with type 2 diabetes with non-alcoholic fatty liver disease who are at increased risk of progressing to advanced fibrosis: a cross-sectional study(BMJ Publishing Group Ltd, 2023) Mettananda, C.; Egodage, T.; Dantanarayana, C.; Fernando, R.; Ranaweera, L.; Luke, N.; Ranawaka, C.; Kottahachchi, D.; Pathmeswaran, A.; de Silva, H.J.; Dassanayake, A.S.INTRODUCTION: Identification of advanced hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD) is important as this may progress to cirrhosis and hepatocellular carcinoma. The risk of hepatic fibrosis is especially high among patients with diabetes with NAFLD. Annual screening of patients with diabetes for fatty liver and calculation of Fibrosis-4 (FIB-4) score and exclusion of significant fibrosis with vibration-controlled transient elastography (VCTE) have been recommended. However, VCTE is expensive and may not be freely available in resource-limited settings. We aim to identify predictors of significant liver fibrosis who are at increased risk of progression to advanced liver fibrosis and to develop a prediction model to prioritise referral of patients with diabetes and NAFLD for VCTE. METHODS AND ANALYSIS: This cross-sectional study is conducted among all consenting adults with type 2 diabetes mellitus with NAFLD at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All patients get the FIB-4 score calculated. Those with FIB-4 ≥1.3 undergo VCTE (with FibroScan by Echosens). Risk associations for progression to advanced liver fibrosis/cirrhosis will be identified by comparing patients with significant fibrosis (liver stiffness measure (LSM) ≥8 kPa) and without significant fibrosis (LSM <8 kPa). A model to predict significant liver fibrosis will be developed using logistic regression. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (P/66/07/2021). Results of the study will be disseminated as scientific publications in reputable journals.Item Immediate outcome of microwave ablation for liver tumours in a single cohort of patients in Sri Lanka.(The College of Surgeons of Sri Lanka, 2022) Appuhamy, C.; Ganewatte, E.; Ranaweera, L.; Dassanayake, A.S.; Gunetilleke, M.B.; Tillakaratne, S.; Gunawardena,H.P.; Niriella,M.A.; Siriwardana,R.C.Introduction and Objectives Microwave ablation (MWA) is an emerging treatment modality for hepatocellular carcinoma (HCC) and other liver tumours. We aimed to assess the immediate success and complications of MWA in a cohort of patients. Method Patients were assessed retrospectively, using an intervieweradministered questionnaire and a follow-up CECT/MRI at, 6-week.Result 55 patients underwent MWA from October 2021-May 2022, at Colombo-North Teaching Hospital, Ragama, Sri Lanka, and selected private hospitals( Durdans Hospital, Colombo, Nawaloka Hospital, Colombo, Lanka Hospital, Colombo).The median age was 64 (40-82) years, with a male preponderance (n=45, 81.1%). The indication was HCC in 54 (98.1%) and metastatic tumour in one (1.8%). The median tumour size was 28 (10-80) mm. Segment VII was the commonest site to be involved (n=18, 34.6%). The majority (n=40, 72.7%) was a single lesion. No participant underwent the procedure twice. The mean post-procedural hospital stay was 12 hours (95%CI=11.4-12.5, SD=2.0).In the 6-week follow-up, 2 recurrences (3.6%) and single death (1.8%) with no relation to the procedure, were reported. Another 2 (3.6%) denied the follow-up. Complete ablation was reported in 46 patients (83.7%), comparable to the rates in literature (95-97%), with only 7 patients (12.7%) having residual tumours. No major complications were reported. 9 patients (16.4%) developed 'Post ablation syndrome', not as common as in literature (34%). They presented with abdominal pain (7.3%), vomiting (7.3%), and fever (3.6%).Conclusion MWA is a successful and safe treatment option for primary liver tumours in Sri Lanka, with ablation rates comparable to the western world.Item Human skeletal remains analysis from Pallemalala shell midden in Southern Sri Lanka.(Chilean Society of Anatomy, Argentine Association of Anatomy and Panamerican Association of Anatomy., 2022) Ranaweera, L.; Adikari, G.Sri Lanka, an island off the tip of the Southeast of the Indian subcontinent processes the earliest skeletal evidence of anatomically modern Homo sapiens (37,000 B.P.) and the best human skeletal record sequence in the South Asian region. Adding another to the list, the skeletal remains, which belong to Mesolithic culture were found at Pallemalala shell midden in Southern Sri Lanka during scientific archaeological exploration by Postgraduate Institute of Archaeology, University of Kelaniya. Sri Lanka. The aim of the study was to determine the minimum number of human individuals, age, sex, and pathological conditions related to the ancient Pallemalala commiunity. For the primary analysis, 426 bone fragments were available. Out of those, 233 bones were identified as human bones which represent 7 minimum number of individuals. The rest of the collection comprises some animal bones and shell species. The community was predominated by the female population. The identified age categories were around 20 years, between 35-45 years, and over 45 years. The encountered pathological lesions were bone thickening, alveolar resorption, dental abscesses, dental caries, antemorterm tooth loss, calculus deposits and brown colour stains on teeth. Regarding the dietary pattern, it was evident that their diet may have consisted of coarse foodstuffs with an extremely basic dietary chemistry.Item Morphological variations of lumbrical muscles in Sri Lankan cadavers(IMED Research Publications, 2022) Ranaweera, L.; Wijesooriya, P.; Vithanage, S.; Cabral, E.Introduction: Lumbricals are the small, worm-like, intrinsic muscles responsible for performing the precision pinch movements of the hand. These are quite unique in their position owing to movable proximal and distal tendon attachments. Purpose of the study: The aim of the study was to identify anomalies of lumbrical muscle present in the Sri Lankan people. Materials and Methods: A sample of 39 formalin preserved cadaveric human hands were subjected to the gross morphological study. Results: It was encountered that 59% of the lumbricals were normal in proximal and distal attachments whereas the rest of the lumbicals (41%) indicated the morphological variations. Among the hands, unipennate third lumbrical was seen in 7.7% (Left-15.7%: Right 0%) and unipennate fourth lumbrical was seen in 5.1% (Left-10.5%: Right 0%). The bipennate second lumbrical was seen in 5.1% (Left 5.3%: Right 5.1%). The 10.3% of split insertion was encountered in third lumbricals (Left 10.5%: Right 10%) as well as in fourth lumbricals (Left 5.3%: Right 15%). The third lumbrical insertion on the medial side of the middle finger was seen in 2.5% (Left 5.3%: Right 0%). Conclusion: The left hand is having more lumbrical variations than the right hand of the subjected human cadavers. The most common variation site is the insertion site. The variants are numerous in third and fourth lumbricals. The most common type of variation is the split insertion.Item Morphological variations of human pulmonary fissures: An anatomical cadaveric study in Sri Lanka(Firenze University Press, 2022) Ranaweera, L.; Sulani, W.N.; Nanayakkara, W.L.R.L.The aim of this study was to identify morphological and morphometric variations of pulmonary fissures. A sample of 50 adult formalin fixed Sri Lankan cadaveric lungs (24 left and 26 right lungs) were observed with the help of magnifying glass and length measurements of the lung fissures were taken using a measuring tape. Complete oblique fissure was seen in 16 (66.67%) left lungs and 11 (42.3%) right lungs. Incomplete oblique fissure was seen in 8 (33.33%) left lungs and 15 (57.69%) right lungs. There was complete absent of horizontal fissure in 4 (15.38%) right lungs whereas rest of the 22 right lungs indicated incomplete horizontal fissure (84.61%). The mean lengths of the left oblique fissure, right oblique fissure and horizontal fissure were 26.88±5.88cm, 27.31±6.04 cm and 8.31±3.61 cm, respectively. Incomplete fissure was the most common variant of the fissures in the analyzed sample. There was a high prevalence of incomplete horizontal fissure of right lung followed by incomplete right and left oblique fissures. Absence of oblique fissure was not found in either left or right lungs. The mean length of right oblique fissure was slightly greater than the mean length of left oblique fissure. The knowledge lung fissures, indeed help clinicians and radiologists to identify alterations of the disease distribution and to reduce the misinterpretation of radiological modalities as well as to arrive at an accurate diagnosis with plan of management of a patient.Item Estimation of sex from the osteometric measurements of the femur in a contemporary Sri Lankan population(Chilean Society of Anatomy, Argentine Association of Anatomy and Panamerican Association of Anatomy., 2022) Ranaweera, L.; Cabral, E.; Dissanayake, D.M.P.V.; Lakshan, W.S.V.SUMMARY: Sex estimation from human skeletal remains is of vital importance in the buildup of a biological profile of an individual in medico-legal and bioarchaeological studies. The present study is focused on the estimation of sex from osteometric measurements of the complete femur and its fragmentary parts, and the development of a web based application related to this. Fifteen osteometric measurements were taken from 78 dry cadaveric femurs from the Faculty of Medicine, University of Kelaniya. Using R software, linear discriminant analysis and logistic regression methods were applied to build classification models with the help of the application of a stepwise procedure, to identify the best combination of measurements to estimate the sex of the femur. A cross-validation method was applied to estimate the predictive accuracy of each model. Since the linear discriminant analysis model gave more predictive accuracy than the regression model, we suggest using linear discriminant analysis to estimate the sex using osteometric measurements of the femur. From the whole femur measurements, a formula to determine sex was developed with highest total accuracy of 83 % using four parameters; epicondylar breadth, anteroposterior mid-shaft diameter, bi-trochanter length, and maximum shaft diameter. Similarly, measurements of transverse head diameter and bi-trochanter length with a total accuracy of 76 % for the proximal part of the femur, measurements of anteroposterior mid-shaft diameter with a total accuracy of 77 % for the mid-shaft, and measurements of epicondylar breadth and maximum length of the lateral condyle with a total accuracy of 70 % for the distal part of the femur were identified as significant discriminants to determine sex, and formulae were written accordingly. Average accuracy ranged from 83 % to 70 %, with male accuracy slightly higher than that of females. A web application to estimate the sex of femur using these formulae was developed and this will be of great importance for forensic medicine and bio-archaeological research in Sri Lanka