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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service(Wiley, 2024) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Uragoda, B.; Welikala, N.; Ranaweera, L.; Ganewatte, E.; Dissanayake, J.; Mudalige, A.; Siriwardana, R.ABSTRACT: BACKGROUND: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.Item Anthropometric knee profile measurements on articulator surface of femur among Sri Lankan population.(Sri Lanka Medical Association, 2023) Fernando, G.K.S.; Ranaweera, L.; Cabral, L.L.E.; Dissanayaka, P.; Bandara, I.D.M.R.N.; Sovis, W.F.U.N.INTRODUCTION: In Sri Lankan context there are no published data for articulator surface measurements for knee joints. Forensic, Anatomical, Archaeological, Bio-medical engineering, development of knee S145 prosthesis beneficial with anthropometrics. Digital Vernier Caliper (measuring range 0-140mm, resolution 0.02mm, accuracy ±0.01mm) used to obtain measurements. OBJECTIVES: The aim of this study, was to provide standard anthropometrics for the distal femur in Sri Lankan context. METHODS: Dried adult Femurs (42 male and 28 female) were analysed for the measurements of Medial condyle Antero-Postero Length (MAP), Anteroposterior length of intercondylar area (AP), Medial-Lateral Length (ML), Aspect Ratio (ML/AP) and Epi Condylar breadth (EB). Sex Dimorphism Ratio (SDR) were calculated for dry femurs. RESULTS: The mean values for male; MAP 24.95(±2.22), AP 25.47(±2.27), ML 20.82(±2.56), Aspect Ratio 0.82(±0.11) and EB 7.68(±0.43). The mean values for female; MAP 24.95(±3.08), AP 25.47(±3.16), ML 20.82(±2.28), Aspect Ratio 0.82(±0.18) and EB 7.68(±0.37). SDR values are MAP 107.74, AP 107.12, ML 99.04, and EB 106.55. CONCLUSIONS: The majority of SDR values lie above 100. Therefore, a difference between male and female values can be observed. Findings offer assistance to develop knee joint prostheses with culture-particular values, fitting for the Sri Lankan setting and pave the pathway to the studies on the above-mentioned fields in the local and international context. Sex determination is a crucial element in the creation of a biological profile since it offers information for identities.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 A study of morphological and morphometric variations in Sri Lankan diaphyseal nutrient foramina of humerus(WHO Office in Azerbaijan., 2022) Ranaweera, L.; Sulani, W.N.; Uggalla, T.Predominantly, the nutrient artery gives the blood supply to the long bones through the nutrient foramen. The present study analyzed the morphometric and morphological variations of Sri Lankan diaphyseal nutrient foramen of the humerus concerning the number, size, location, and direction along the shaft. A sample of 50 dry adult humeri was analyzed. The mean length of the bones was 29.53cm. The mean foramen index was 55.59. The current study encountered single, double, and triple nutrient foramina as well as the absence of such foramina. Five main locations of nutrient foramina were observed along the shaft of the humerus: anteromedial surface, medial border, lateral border, anterior border, and posterior surface. The nutrient foramen directions were towards the distal end or proximal end of the humerus. Most Sri Lankan humeri had single nutrient foramen. Most humeri had nutrient foramina on the anteromedial surface on the middle third of the shaft which is directed distally. The information regarding the nutrient foramina is important for the procedures such as bone graft, bone repair, and microsurgical bone transplantation.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 Virtual anatomy learning through the eye of ayurveda medical students in Sri Lanka during COVID 19 pandemic.(WHO Office in Azerbaijan., 2022) Ranaweera, L.; Samaranayake, G.V.P.; Cabral, E.Anatomy is the foundation stone of medical education. The COVID 19 pandemic imposed unexpected disruption to Anatomy education with most universities moving regular onsite classes to the online session. The purpose of this study was to identify the perceptions of Ayurveda medical students regarding virtual or online Anatomy learning. The study was conducted on 69 second-year Ayurveda medical students using a self-administrated questionnaire. The majority of the students (92.8%) did not have prior experience in online learning (OL) before the COVID 19 pandemic. Regarding the learning activities preferred by students prior to the COVID 19, 73.9% of students preferred the live lectures from the academic staff. It was evident that 92.8% of students believed that zoom cloud meeting is the most effective method of Anatomy in the OL platform. In order to improve their Anatomy dissection knowledge, 50.7% of students were suggested to show live Gross Anatomy dissection. The OL is more successful than onsite learning for the theory of Anatomy. Access to online materials (86.9%), learning from their own places (92.7%), the ability to stay at home (95.6%), interactivity of the class (56.5%), and the ability to record a meeting (88.4%) are the key advantages of OL. Reduced Interaction with the teacher (78.2%), technical issues (92.7%), lack of interactions with their colleagues (82.6%), poor learning conditions at home (71%), and social isolation (81.1%) are the main disadvantages that they must face in their online learning process. In the era of smartphones and the internet, it was indicated that the Ayurveda medical students prefer to be engaged in the hybrid system which includes online Anatomy lectures with onsite Anatomy practicals.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.