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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Navigating the pandemic of a lifetime: COVID-19 morbidity, mortality, and vaccination through the eyes of a physician(Ceylon College of Physicians, 2023) de Silva, S.T.No Abstract AvailableItem Inhaled beclomethasone in the treatment of early COVID-19: a double-blind, placebo-controlled, randomised, hospital-based trial in Sri Lanka(BMJ Publishing Group Ltd, 2023) Mettananda, C.; Peiris, C.; Abeyrathna, D.; Gunasekara, A.; Egodage, T.; Dantanarayana, C.; Pathmeswaran, A.; Ranasinha, C.OBJECTIVES: To study if early initiation of inhaled beclomethasone 1200 mcg in patients with asymptomatic, mild or moderate COVID-19 reduces disease progression to severe COVID-19. DESIGN: Double-blinded, parallel-groups, randomised, placebo-controlled trial. SETTING: A hospital-based study in Sri Lanka. PARTICIPANTS: Adults with asymptomatic, mild or moderate COVID-19, presenting within the first 7 days of symptom onset or laboratory diagnosis of COVID-19, admitted to a COVID-19 intermediate treatment centre in Sri Lanka between July and November 2021. INTERVENTIONS: All participants received inhaled beclomethasone 600 mcg or placebo two times per day, for 10 days from onset of symptoms/COVID-19 test becoming positive if asymptomatic or until reaching primary endpoint, whichever is earlier. PRIMARY OUTCOME MEASURE: Progression of asymptomatic, mild or moderate COVID-19 to severe COVID-19. SECONDARY OUTCOME MEASURES: The number of days with a temperature of 38°C or more and the time to self-reported clinical recovery. RESULTS: A total of 385 participants were randomised to receive beclomethasone(n=193) or placebo(n=192) stratified by age (≤60 or >60 years) and sex. One participant from each arm withdrew from the study. All participants were included in final analysis. Primary outcome occurred in 24 participants in the beclomethasone group and 26 participants in the placebo group (RR 0.90 ; p=0.763). The median time for self-reported clinical recovery in all participants was 5 days (95% CI 3 to 7) in the beclomethasone group and 5 days (95% CI 3 to 8) in the placebo group (p=0.5). The median time for self-reported clinical recovery in patients with moderate COVID-19 was 5 days (95% CI 3 to 7) in the beclomethasone group and 6 days (95% CI 4 to 9) in the placebo group (p=0.05). There were no adverse events. CONCLUSIONS: Early initiation of inhaled beclomethasone in patients with asymptomatic, mild or moderate COVID-19 did not reduce disease progression to severe COVID-19. TRIAL REGISTRATION NUMBER: Sri Lanka Clinical Trials Registry; SLCTR/2021/017.Item Initial response to SARS-CoV-2 (COVID-19) outbreak in Sri Lanka; views of public health specialists through an International Health Regulations lens(Public Library of Science, 2023) Caldera, A.; Wickremasinghe, R.; Newby, G.; Perera, R.; Mendis, K.; Fernando, D.The COVID-19 pandemic affected Sri Lanka despite having developed an International Health Regulations (IHR) steering committee in 2016 and a national action plan for health security following the Joint External Evaluation in 2018. Many steps were taken to improve the disaster management skills of healthcare workers even before the COVID-19 outbreak. We interviewed seven public health specialists to obtain their views on the country's response to the pandemic. A thematic analysis was conducted, leading to the emergence of three major themes and seven subthemes. The major themes included health security preparedness; COVID-19 management; and effects of COVID-19. The subthemes were; preparedness prior to pandemic and gaps in the preparedness (under health security preparedness); dual burden for the curative sector, strategies to reduce transmission and barriers to managing COVID-19 (under COVID-19 management) and negative and positive effects of COVID-19 (under effects of COVID-19). When COVID-19 reached Sri Lanka, healthcare workers, border control authorities and those involved with infectious disease control were overwhelmed by the magnitude of the pandemic. Healthcare workers' hesitation to work amidst the pandemic due to fear of infection and possible transmission of infection to their families was a major issue; the demand for personal protective equipment by health workers when stocks were low was also a contributory factor. Lockdowns with curfew and quarantine at government regulated centers were implemented as necessary. Perceptions of the public including permitting healthcare workers to perform field public health services, logistical barriers and lack of human resources were a few of the barriers that were expressed. Some persons did not declare their symptoms, fearing that they would have to be quarantined. The pandemic severely affected the economy and Sri Lanka relied on donations and loans to overcome the situation. Pandemic also brought about innovative methods to maintain and upgrade health service provision. Individuals with non-communicable diseases received their regular medications through the post which reduced their risk of being infected by visiting hospitals. Improvement of laboratory services and quarantine services, a reduction of acute respiratory infections and diarrhoeal diseases, improved intersectoral coordination and public philanthropic response were other positive effects.Item Neurological disorders associated with COVID-19 in Sri Lanka(BioMed Central,, 2023) Chang, T.; Wijeyekoon, R.; Keshavaraj, A.; Ranawaka, U.; Senanayake, S.; Ratnayake, P.; Senanayake, B.; Caldera, M.C.; Pathirana, G.; Sirisena, D.; Wanigasinghe, J.; Gunatilake, S.; ASN COVID-19 Study GroupBACKGROUND: Neurological manifestations of SARS-CoV-2 infection have been reported from many countries around the world, including the South Asian region. This surveillance study aimed to describe the spectrum of neurological disorders associated with COVID-19 in Sri Lanka. METHODS: COVID-19 patients manifesting neurological disorders one week prior and up to six weeks after infection were recruited from all the neurology centres of the government hospitals in Sri Lanka from May 2021 – May 2022. Data was collected using a structured data form that was electronically transmitted to a central repository. All patients were evaluated and managed by a neurologist. Data were analysed using simple descriptive analysis to characterise demographic and disease related variables, and simple comparisons and logistic regression were performed to analyse outcomes and their associations. RESULTS: One hundred and eighty-four patients with neurological manifestations associated with COVID-19 were recruited from all nine provinces in Sri Lanka. Ischaemic stroke (31%) was the commonest neurological manifestation followed by encephalopathy (13.6%), Guillain–Barre syndrome (GBS) (9.2%) and encephalitis (7.6%). Ischaemic stroke, encephalitis and encephalopathy presented within 6 days of onset of COVID-19 symptoms, whereas GBS and myelitis presented up to 10 days post onset while epilepsy and Bell palsy presented up to 20 – 40 days post onset. Haemorrhagic stroke presented either just prior to or at onset, or 10 – 25 days post onset of COVID-19 symptomatic infection. An increased frequency of children presenting with encephalitis and encephalopathy was observed during the Omicron variant predominant period. A poor outcome (no recovery or death) was associated with supplemental oxygen requirement during admission (Odds Ratio: 12.94; p=0.046). CONCLUSIONS: The spectrum and frequencies of COVID-19 associated neurological disorders in Sri Lanka were similar to that reported from other countries, with strokes and encephalopathy being the commonest. Requiring supplemental oxygen during hospitalisation was associated with a poor outcome.Item Teaching medical students basic communication skills online during the COVID-19 pandemic(College of General Practitioners of Sri Lanka, 2021) Perera, D.P.; Ramanayake, R.P.J.C.; Mendis, K.; Withana, S.S.No Abstract availableItem Chronic musculoskeletal symptoms following COVID-19 in a cohort of Sri Lankan patients(Ceylon College of Physicians, 2022) Kurukulasuriya, S.A.; Karunanayake, A.L.INTRODUCTION AND OBJECTIVES: Musculoskeletal symptoms of myalgia and arthralgia after recovery of COVID-19 is a pressing issue. Objective of this study was to assess the prevalence of persistent myalgia and arthralgia and likelihood of developing rheumatoid arthritis (RA), six weeks following COVID-19. METHODS: A descriptive longitudinal study was conducted in selected private sector hospitals in Colombo, Sri Lanka. PCR positive COVID-19 patients were recruited by consecutive sampling until required sample size of 333 was fulfilled. They were contacted over the phone six weeks after the discharge. Interviewer administered questionnaire was used to evaluate the presence of symptoms of myalgia and arthralgia. Those with positive symptoms were invited for a consultation to conduct further investigations. RESULTS: Of the 333 patients, 96 (28.8%) had persistent arthralgia, myalgia or both, six weeks after recovery from COVID-19. Among them, 56.3% had only arthralgia, 10% had only myalgia and 33% had both myalgia and arthralgia. Two patients (4.8%; 95% CI: 0.6-16.2%) were confirmed of having RA. CONCLUTIONS: More than one fourth of patients, suffered with persistent symptoms of myalgia and arthralgia six weeks following COVID-19 and 2 patients (4.8%) were confirmed to have rheumatoid arthritis..Item An evaluation of tele therapy services during the COVID-19 pandemic at a university-clinic in Sri Lanka; a preliminary study(University of Kelaniya, Sri Lanka, 2022) Parththeepan, V.; Bakmeewewa, D.A.Background: Tele therapy is really the delivery of a large variety of therapeutic interventions through the use of telecommunications technology to connect clinicians and clients. Tele therapy typically employs webcams, audio headsets, and videoconferencing software to enable synchronous interaction among clinicians and clients. The primary outcome of this study was describing a tele therapy program at a university clinic and an evaluation of patient satisfaction of speech and language therapy services. The study also aimed to document challenges faced by patients and their families in accessing SLT tele services at Ayati. Methods: The study methodology employed both quantitative and qualitative methods. Due to health-related restrictions in face-to-face direct meetings because of government regulations related to Covid 19, data were collected through self-administered online questionnaires and translated to Tamil and Sinhala. A purposive sampling technique was used to select participants. The data were collected in three languages (English, Sinhala, Tamil). The study included 100 participants who had registered for continuous paediatric or adult SLT services via tele therapy at the Ayati centre or had participated in at least one session of tele therapy and could complete a questionnaire with or without the assistance of a proxy. The quantitative data were analyzed with the Statistical Package for Social Science (SPSS) software, while the qualitative data were analyzed with the Ritchie Spencer (1994) framework analysis. Results: During the COVID -19 outbreak in Sri Lanka, the major purpose of this study was to assess the quality of teletherapy services and patient satisfaction at a university-based clinic. The overall satisfaction with teletherapy was positive, with a high level of satisfaction in using telehealth to get speech and language teletherapy services, a majority (n=82) noting to use telehealth services for SLT in the future. However, teletherapy patients confront difficulties such as insufficient internet connectivity, which was reported. Conclusion: Future research may focus on the specific issues described here in order to truly comprehend how to solve them. Future research could include physician experiences to better understand the current state of telehealth services for Speech and Language Therapy.Item Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol(BMJ Publishing Group Ltd, 2022) Rajapaksha, R.M.N.U.; Khatri, R.B.; Abeysena, C.; Wijesinghe, M.S.D.; Endalamaw, A.; Thomas, T.K.; Perera, N.; Rambukwella, R.; de Silva, G.; Fernando, M.; Alemu, Y.A.Introduction: Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic. Methods: The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar ETHICS AND DISSEMINATION: Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review's findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.Item Psychological impact of COVID-19 among a cohort of Sri Lankan medical students: Preliminary results(Sri Lanka College of Psychiatrists, 2022) Abayabandara-Herath, T.; Premaratne, I.; Ediriweera, D.; Chandratilake, M.; Hapangama, A.Previous studies report that the COVID-19 pandemic has a negative effect on the psychological wellbeing of medical students. We aimed to determine the psychological impact of COVID-19 and its associated factors among a cohort of Sri Lankan medical students, using online versions of a demographic questionnaire and the validated Sinhala and Tamil versions of the DASS-21. Of the 418 students, majority were females, aged between 20-25 years. In the study group, 40 (9.6%), 105 (25.1%) and 7 (1.6%) of participants scored above the cut-offs for the depression, anxiety and stress subscales of the DASS-21 respectively. The COVID-19 pandemic appears to be associated with a negative impact as measured by the DASS-21 scale among this group of medical students.Item A Study on victims of intimate partner violence reported to Colombo North Teaching Hospital, Sri Lanka during 2019-2021(Academic Forensic Pathology International, La Jolla, CA, 2022) Muthulingam, T.; Edirisinghe, P.A.S.; Wijewardhane, H.P.; Thivaharan, Y.; Jayasundara, M.M.S.; Borukgama, N.; Kulathunga, D.L.; Alwis, D.N.; Govinnage, P.S.; Kitulwatte, I.D.G.Introduction: Intimate partner violence (IPV) is a common issue in any society and the reported cases are just the tip of an iceberg as most of the victims are reluctant to come to the criminal justice system. Forensic experts are often encountering the victims who chose to seek justice. Evaluation of the nature, consequences, and underlying factors are needed in planning preventive measures. Objectives: To describe the patterns and associated factors of IPV among victims who reported to Office of the Judicial Medical Officer of Colombo North Teaching Hospital and to specifically describe the patterns prior and during the COVID-19 pandemic. Methods: A retrospective descriptive study based on 471 medicolegal records of the victims who had undergone medicolegal examination following IPV during last two years (March 2019 to February 2021). Results: Out of 471, 206 cases were reported prepandemic and 265 reported postpandemic periods. Even though majority were females there were 21 males. Types of abuse were complex and often interrelated. There were 463 who had experienced physical injuries while there were 20 who had been subjected to sexual violence. Face was the commonest target of assault (63%). Substance abuse was identified as the commonest predisposing factor (56%). Even though repeated abuse was common, 42.5% of the victims had never made any complaints to the police. Despite multiple complains, 39.7% had experienced repeated violence. Conclusion: Victims of IPV are silently suffering for many long years. Failure in the response from authorities was identified. COVID-19 pandemic has become an additional risk factor for IPV. Strengthening of legal and social responses is the need of the hour.