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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 How do we define normal bowel frequency from newborn to teens?:A Bayesian meta-analysis(Wiley, 2024-12) Munasinghe, S.; Manathunga, S.; Hathagoda, W.; Kuruppu, C.; Ranasinghe, P.; Devanarayana, N. M.; Baaleman, D. F.; Benninga, M. A.; Rajindrajith, S.OBJECTIVES Defecation disorders are a common pediatric problem and bowel frequency is crucial in identifying them. The aim of this analysis is to define normal bowel frequencies in healthy children ranging from newborns to adolescents. METHODS A literature search was conducted using MEDLINE, SCOPUS, EMBASE, Cochrane Library, and Web of Science from their inception to February 2024, aiming to identify studies reporting bowel habits of healthy children (0–18 years). A Bayesian distribution modeling approach was adopted to pool the mean frequency of bowel opening using inverse-variance weighing. A subgroup analysis and a meta-regression were performed with Bayesian generalized additive mixed distributional models. The methodological quality of the articles was evaluated using the Newcastle–Ottawa Scale modified for cross-sectional studies. RESULTS Seventeen studies were included in the analysis, including 22,698 children aged from 0 to 18 years. The subgroup meta-analysis showed mean bowel frequencies for newborns, 1–6 months, 6–12 months, 1–2 years, 2–5 years, and over 5 years are 3.24 (95% credible interval [CrI]: 2.83–3.63), 1.99 (95% CrI: 1.77-2.19), 1.66 (95% CrI: 1.45–1.88), 1.53 (95% CrI: 1.37–1.7), 1.15 (95% CrI: 0.99–1.31), and 1.02 (95% CrI 0.88–1.18), respectively. Between studies, heterogeneity demonstrated a near-normal distribution with a mean of 0.16 and a 95% CrI of 0.04–0.28. The variance of the distribution of mean bowel frequency reduced with age. DISCUSSION In this Bayesian meta-analysis, we found that younger children have a higher bowel frequency. The reported bowel frequencies for each age group could serve as normal values in clinical practice to differentiate health and disease.Item Sex differences in stroke in a Sri Lankan cohort(Karger, 2024-12) Ranawaka, U. K.; Mettananda, C. D.; Nugawela, M.; Pathirana, J.; Chandrasiri, J.; Jayawardena, C.; Amarasekara, D.; Hettarachchi, R.; Premawansa, G.; Pathmeswaran, A.INTRODUCTION Stroke characteristics, subtypes, and risk factors in women may differ from men. Data on sex differences in stroke are scarce in developing countries, especially the South Asian region. We aimed to describe the sex differences in patients with stroke admitted to a tertiary care hospital in Sri Lanka. METHODS Consecutive patients with stroke enrolled in the Ragama Stroke Registry over 3 years (2020–2023) were studied. Sex differences in demographics, presentation delays, clinical characteristics, stroke subtypes, risk factors, stroke severity, and early functional outcomes were compared using χ2 test, independent sample t test and Wilcoxon rank-sum test. Associations of early functional dependence were studied using multiple logistic regression. RESULTS Of 949 patients with stroke, 387 (40.8%) were women, with a median age of 66 (interquartile range [IQR] 57–73) years compared to 63 (IQR 54–70) years in men (p < 0.001). Women had more ischaemic strokes (85.8% vs. 78.6% in men, p = 0.005). Swallowing difficulty (p = 0.039) and bladder involvement (p = 0.001) were more common in women, whereas dysarthria (p = 0.002) and cerebellar signs (p = 0.005) were more common in men. More women had hypertension (74.4% vs. 59.4%, p < 0.001) and diabetes (52.2% vs. 41.6%, p = 0.001), whereas smoking (0.3% vs. 35.1%, p < 0.001), alcohol use (0.3% vs. 55.0%, p < 0.001), and other substance abuse (0.8% vs. 5.2%, p < 0.001) were almost exclusively seen in men. No differences were noted in delays to hospital admission (delay ≥4.5 h: women 45.4% vs. men 41.3%, p = 0.222). There were no sex differences in the rates of CT scanning (women 100% vs. men 99.6%, p = 0.516) or thrombolysis for ischaemic stroke (women 7.8% vs. men 10.2%, p = 0.458), but more men received stroke unit care (women 37.2% vs. men 45.4%, p = 0.012). No differences were noted between sexes in the clinical (Oxfordshire classification, p = 0.671) or aetiological (TOAST criteria, p = 0.364) subtypes of stroke. Stroke severity on admission was similar between sexes (median NIHSS score; women 8.0 vs. men 8.0, p = 0.897). More women had a discharge Barthel index (BI) <60 than men (62.6% vs. 53.5%, p = 0.007), but female sex was not associated with BI <60 on multivariate logistic regression (p = 0.134). There was no difference in in-hospital mortality (women 5.9% vs. men 5.9%, p = 0.963). CONCLUSIONS Women with stroke in this Sri Lankan cohort were older, had different risk factor profiles and clinical stroke characteristics, and had more ischaemic strokes. Female sex was not independently associated with functional disability on discharge or in-hospital mortality.Item Colonic diverticular disease revisited(Taylor & Francis, 2024-12) De Silva, A. P.; Nuwanshika, N.; Dassanayake, U.; Niriella , M. A.; Ranasinghe, P.; De Silva, H. J.INTRODUCTION Diverticular disease, including diverticulosis and diverticulitis, presents a significant health concern globally, with increasing prevalence in Western societies and emerging trends in Asia. The incidence of diverticulitis, is on the rise, leading to significant morbidity and healthcare costs. AREAS COVERED A literature search was conducted using the PubMed database, and studies published between 1995 and 2024 were selected based on their relevance to the overall understanding of disease. This review investigates the clinical spectrum, classification, and management strategies of diverticular disease, focusing particularly on evolving trends in diagnosis and treatment. Discussions regarding the prevalence of diverticulosis, the identification of risk factors associated with disease progression, recent advancements in research, and the utilization of biomarkers in disease monitoring and treatment decision-making are considered in detail. EXPERT OPINION The discourse on diverticular disease underscores the pressing need for tailored management strategies and innovative treatments. Understanding the intricacies of the disease’s pathophysiology is paramount for effective intervention. Recent advances in diagnostic imaging and biomarker identification are promising, yet more research is imperative to further refine patient care. Advances in these areas hold the potential for significantly improving outcomes in disease management.Item Screening for prednisolone in anti-asthmatic herbal remedies using lc-ms/ms in sri lanka.(Postgraduate Institute of Science (PGIS), University of Peradeniya, 2024-11) Fernando, S. S. D.; Fernando, P. N. J.; Rashani, S. A. N.; Cooray, A.; De Silva, A. P.Prednisolone, a corticosteroid used to treat asthma, poses significant concerns when adulterated in herbal remedies, particularly for athletes subjected to anti-doping regulations. Despite their widespread use, comprehensive studies to determine the extent of prednisolone adulteration in herbal products are lacking in Sri Lanka. This study aimed to fill this research gap by screening commonly used herbal remedies for asthma in Sri Lanka to identify the presence of Prednisolone. A tailored LC-MS/MS method was developed and validated for this purpose. An optimized ultrasound-assisted extraction procedure was established using a reference standard, achieving a recovery rate of 100.45% by adjusting the extraction solvent and sonication time. The LC-MS/MS method utilised a biphenyl column (100 mm × 2.1 mm, 2.7 μm) with a mobile phase of acetonitrile and water acidified with 0.1% formic acid. Chromatographic conditions were optimized for a column; oven temperature of 50 °C, an initial acetonitrile concentration of 5%, a dwell time of 0.200 secs, and a run time of 10 min. Validation of the method followed EuraChem guidelines and was done using a Prednisolone reference standard, demonstrating high precision, accuracy, sensitivity, and specificity. Extraction recoveries showed relative standard deviation (%RSD) ≤ 10% and calibration linearities had R2 ≥ 0.988. The detection limits were 0.03 μg/g for powdered and 0.003 μg/mL for liquid herbal matrices. The study screened 27 different over-the-counter brands and prescription anti-asthmatic herbal products collected randomly from suburban areas of Colombo. The validated LC-MS/MS method identified that 25 products were below the detection limit, while two prescribed products were flagged as doubtful. In conclusion, the developed LC-MS/MS method successfully detected prednisolone in complex herbal matrices with high specificity and precision, providing valuable insights into the prevalence and extent of prednisolone adulteration in herbal remedies.Item Development of an lc-ms/ms method for the detection of prednisolone doping using human fingernails(Postgraduate Institute of Science (PGIS) , University of Peradeniya, 2024-11) Kanishka, W. A. S.; Fernando, P. N. J.; Rashani, S. A. N.; Jayakody, R. S.; Cooray, A.; De Silva, A. P.Sports doping detection mainly relies on urine and blood samples. Nails are less commonly used, even though they can provide long-term drug use, due to challenges in preparation and pulverization. This study developed a Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) method to detect prednisolone in human fingernails. Nails from volunteers not administered with prednisolone were ethically collected, cleaned, dried, and pulverized for analysis. The extraction of prednisolone was optimized for solvent type, extraction frequency, and shaking rate. The optimized sample preparation was followed by cleaning of Nail clippings by vortexing at 2200 rpm using ultrapure water at 50 °C for 75 secs, drying at 50 °C for 80 mins, cutting into small pieces, and subjected to methanol extraction by shaking for 18 hrs at 300 rpm. LC-MS/MS analysis used a biphenyl column (100 mm × 2.1 mm, 2.7 μm) with a binary gradient of acidified (0.1% formic acid) acetonitrile and an aqueous phase to identify prednisolone. The run time for the LC-MS/MS method was 7.50 minutes. The retention time of prednisolone was 2.18 minutes. The method was validated according to International Council for Harmonization (ICH) guidelines, showing strong linearity (R² > 0.99) and high specificity with no carryover. Within-run accuracy and precision were ± 3.24% and 3.76% coefficient of variation (CV), respectively, while between-run accuracy and precision were ± 4.18% and 3.5% CV, respectively. LOD and LOQ were 0.0003 mg/L and 0.00154 mg/L, respectively. Using a cost-effective pulverization setup, the validated The LC-MS/MS method effectively detected prednisolone in fingernails. Further studies with prednisolone-doped nails are needed to advance nail-based doping detection in sports and forensics.Item Carbohydrate intakes and cardiovascular disease risk factors in South Asians: Results from 56,024 participants in Bangladesh, India, Pakistan and Sri Lanka.(American Heart Association, 2024-11) Lahiri, A.; Imamura, F.; Kasturiratne, A.; Jha, V.; Katulanda, P.; Khawaja, K.; Mridha, M.; Anjana, R. M.; Chambers, J.; Forouhi, N.BACKGROUND Evidence on effects of carbohydrate intake with cardiovascular disease risk factors is inconsistent and has limited generalizability to diverse populations such as South Asians, whose carbohydrate intakes are typically high. AIMS We examined the association of the quantity and types of carbohydrate intake with two risk factors for major cardiovascular events– hypertension (HT) and hypercholesterolemia (HC). METHODS We analyzed cross-sectional data from participants aged ≥18 years in the South Asia Biobank in Bangladesh, India, Pakistan, and Sri Lanka. Using dietary data assessed with interviewer-led 24h diet recalls, we calculated intakes of total and subtypes of carbohydrates and several indices of carbohydrate quality. Primary outcomes were HT and HC, defined by medication use, doctor diagnosis, blood pressure and blood lipid levels. With mixed effects Poisson regression, HT and HC was regressed on quantiles of carbohydrate intakes by country to estimate prevalence ratios (PR) and 95% confidence intervals (CI), followed by meta-analysis pooling country-specific estimates. We examined interactions by diabetes status and adiposity. RESULTS Of 56,024 adults, 36.6% had HT, 16.1% had HC. In pooled multivariable analyses comparing extreme quantiles, total carbohydrate intake was not associated with HT or HC prevalence. Fructose, free sugar and free sugar-to-fiber ratio were associated with higher prevalence of HT (PRsQ5vsQ1: 1.03-1.15). Higher intakes of cereal fiber (PRQ4vsQ1: 0.96, 95% CI: 0.95-0.98) and legume fiber (PRQ4vsQ1: 0.98, 95% CI: 0.97-0.98) were associated with lower prevalence of HT and higher cereal fiber intake with lower HC prevalence (PRQ5vsQ1: 0.80, 95% CI: 0.75-0.85). Diabetes and adiposity were observed as effect-modifiers (p<0.001). There were null associations in adults with diabetes but in non-diabetic adults, free sugar intake was related positively with HT (PRQ5vsQ1: 1.07, 95% CI: 1.05-1.09) while fiber intake was inversely related (PRQ5vsQ1: 0.98, 0.95-0.97). Starch, sugar and free sugar intake were associated positively with HT prevalence in adults with high body fat (≥20% for men; ≥30% for women) and visceral fat (≥10%) levels (PRsQ5vsQ1: 1.03-1.20); associations were null for low body and visceral fat levels. Associations varied by country (between-country heterogeneity I2>60%).CONCLUSION Associations of dietary carbohydrates with HT and HC depended on the quality and type of intake in South Asians.Item Causes, complications and short-term outcome of acute Kidney injury in a resource-limited setting(SAGE-Hindawi Access to Research, 2024-12) Herath, N.; De Silva, S.; Liyanage, P.; Kumara, S.; Devi, S.; Abeysekara, V.; Mallawarachi, R.; Perera, S.; Karunathilaka, I.; Samarasinghe, S.; Weerakoon, K.AIMS The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. METHODS Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. RESULTS Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p=0.017). More severe AKI was associated with type 2 diabetes (p=0.0042), hypertension (p < 0.0001) and multiple comorbidities (p=0.0014). Persons with no comorbidities had less severe AKI (p=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and p=0.047). CONCLUSIONS AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.Item Implementation of a goal-directed Care Bundle for intracerebral hemorrhage: Results of embedded process evaluation in the INTERACT3 trial(Public Library of Science, 2024-12) Ouyang, M.; Anjum, A.; Cawley, F. G. M.; Wasay, M.; Ma, L.; Hu , X.; Chen, X.; Malavera, A.; Li, X.; Venturelli, P. M.; De Silva, H. A.; Thang, N. H.; Wahab, W. K.; Pandian, J. D.; Pontes-Neto, O. M.; Abanto , C.; Nigenda, V. C.; Arauz , A.; You , C.; Jan, S.; Song, L.; Anderson, C. S.; Liu, H.; INTERACT3 InvestigatorsThe third, stepped-wedge, cluster-randomized, Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3), has shown that a goal-directed multi-faceted Care Bundle incorporating protocols for the management of physiological variables was safe and effective for improving functional recovery in a broad range of patients with acute intracerebral hemorrhage (ICH). The INTERACT3 Care Bundle included time- and target-based protocols for the management of early intensive lowering of systolic blood pressure (SBP, target <140mmHg), glucose control (target 6.1-7.8 mmol/L in those without diabetes and 7.8-10.0 mmol/L in those with diabetes), anti-pyrexia treatment (target body temperature ≤37.5°C), and the rapid reversal of warfarin-related anticoagulation (target international normalized ratio <1.5). An embedded process evaluation was conducted to allow a better understanding of how the Care Bundle was implemented in different countries to enhance the transferability of this evidence in the international context. This study used a mixed-methods approach involving interviews, focus group discussions, and surveys to evaluate the implementation outcomes included fidelity, dose, reach, acceptability, appropriateness, adoption, and sustainability. Interviews (n = 27), focus group discussions (n = 3), and quantitative surveys (n = 48) were conducted in 7 low- and middle-income countries (LMICs) and 1 high-income country during 2019-2022. The Care Bundle was generally delivered as planned and well accepted by stakeholders, although some difficulties were reported in reaching the SBP and glycemic targets. Contextual factors including staff shortage, limited availability of antihypertensive drugs, and delayed systems of care processes, were common barriers to implementing the Care Bundle. Facilitating factors included good communication and collaboration with staff in emergency departments, the development of pathways within available resources, and regular training and monitoring. Our process evaluation provides useful insights into the contextual barriers which need to be addressed for effective scale up of the Care Bundle implementation in a global context.Item Epidemiological patterns and trends of paediatric snakebites in Sri Lanka(Biomed Central, 2024-12) Dayasiri, K.; Caldera, D.; Suraweera, N.; Thadchanamoorthy, V.; Hettiarachchi , M.; Denipitiya, T.; Bandara, S.OBJECTIVES This study aimed to analyse the epidemiological patterns of paediatric snake bites in Sri Lanka over a 4-year period (2020-2024).METHODS A multi-centre, retrospective observational study was conducted from June 2020 to June 2024 across nine governmental hospitals in seven provinces of Sri Lanka. Data were collected based on 757 children presenting with snake bites. The snake bites were analysed based on age, gender, and seasonal variations. Data on the type of snake involved, geographic variations and the temporal trends in snake bite occurrences were also analysed.RESULTS The mean age of the 757 children recruited to the study was 10.3 years (SD-5.00, range-0.1-17 years). Males (57.7%) were significantly more affected than females (42.3%) (p < 0.05). Visual identification confirmed the snake species in 58.4% of cases. The hump-nosed viper (16.7%), Russell's viper (14.7%), and common krait (12.9%) were the most common medically important snakes identified in the study. Seasonal peaks in snake bites occurred in May-July and November-December. An increasing trend in snake bite incidence was noted over the first three years, with a slight decline in the final year.CONCLUSION Paediatric snake bites in Sri Lanka show significant age, gender, and seasonal patterns. Targeted public health interventions are needed to mitigate the impact on children.