COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern... more COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern medical officer working in a tertiary care hospital during the first wave of the pandemic in Sri Lanka. Her narrative describes how the stress of the pandemic brought into sharp focus the strengths and weaknesses in the health system. We suggest some strategies to improve our health services as the world faces the second wave and an uncertain future. These include structural changes in healthcare services at institutional and national levels, focused educational programmes for healthcare professionals to impart generic skills of disaster management, and the development of telehealth services and computerisation of health systems. We believe that we must maintain this focus to ensure that our patients can be guaranteed quality healthcare in the future.
This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Br... more This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting. Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited. A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury. One hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivo...
Oral Presentation Abstract (OP07), 120th Annual Scientific Sessions, Sri Lanka Medical Associatio... more Oral Presentation Abstract (OP07), 120th Annual Scientific Sessions, Sri Lanka Medical Association, 2014 Colombo, Sri Lanka
Introduction Quick Sequential Organ Failure Assessment (qSOFA) is potentially feasible tool to id... more Introduction Quick Sequential Organ Failure Assessment (qSOFA) is potentially feasible tool to identify risk of deteriorating in the context of infection for to use in resource limited settings. Purpose To compare the discriminative ability of qSOFA and a simplified systemic inflammatory response syndrome (SIRS) score to detect deterioration in patients admitted with infection. Methods Observational study conducted at District General Hospital Monaragala, Sri Lanka, utilising bedside available observations extracted from healthcare records. Discrimination was evaluated using area under the receiver operating curve (AUROC). 15,577 consecutive adult ( ≥ 18 years) admissions were considered. Patients classifi ed as having infection per ICD-10 diagnostic coding were included. Results Both scores were evaluated for their ability to discriminate patients at risk of death or a composite adverse outcome (death, cardiac arrest, intensive care unit [ICU], admission or critical care transfer)....
Current critical care prognostic models are predominantly developed in high-income countries (HIC... more Current critical care prognostic models are predominantly developed in high-income countries (HICs) and may not be feasible in intensive care units (ICUs) in lower- and middle-income countries (LMICs). Existing prognostic models cannot be applied without validation in LMICs as the different disease profiles, resource availability, and heterogeneity of the population may limit the transferability of such scores. A major shortcoming in using such models in LMICs is the unavailability of required measurements. This study proposes a simplified critical care prognostic model for use at the time of ICU admission. This was a prospective study of 3855 patients admitted to 21 ICUs from Bangladesh, India, Nepal, and Sri Lanka who were aged 16 years and over and followed to ICU discharge. Variables captured included patient age, admission characteristics, clinical assessments, laboratory investigations, and treatment measures. Multivariate logistic regression was used to develop three models f...
International journal for equity in health, Jan 17, 2015
IntroductionObesity is an increasing problem in South Asian countries and Sri Lanka is no excepti... more IntroductionObesity is an increasing problem in South Asian countries and Sri Lanka is no exception. The socioeconomic determinants of obesity in Sri Lanka, and in neighbouring countries are inadequately described. Aim was to describe social, cultural and economic determinants of obesity in a representative sample from Kalutara District in Sri Lanka.MethodsThis was a cross sectional descriptive study conducted among adults aged 35¿64 years. A representative sample was selected using stratified random cluster sampling method from urban, rural and plantation sectors of Kalutara District. Data were collected using a pre-tested questionnaire. A body mass index of 23.01 kg/m2-27.50 kg/m2 was considered as overweight and ¿27.51 kg/m2 as obese. Waist circumference (WC) of¿¿¿90 cm and ¿80 cm was regarded as high for men and women respectively. Significance of prevalence of obesity categories across different socio-economic strata was determined by chi square test for trend.ResultsOf 1234 ad...
The potential for interaction between ibuprofen and two histamine H2-receptor blocking drugs--niz... more The potential for interaction between ibuprofen and two histamine H2-receptor blocking drugs--nizatidine and cimetidine--was investigated in six healthy male volunteers aged 20 to 25 years. Each subject received placebo, nizatidine 300 mg and cimetidine 800 mg orally at 9.00 p.m. daily for six doses in three randomised treatment periods separated by eight days. On the third day of each treatment period ibuprofen 400 mg was administered at the same time and venous blood samples were taken at intervals throughout the night and subsequently up to 84 h after administration. There was no difference in the area under the plasma concentration-time curve, rate of absorption or half-life of elimination of ibuprofen between the three treatments. The elimination half-life of ibuprofen on placebo was 2.04 h. The elimination half-life of nizatidine on ibuprofen was 1.72 h and that of cimetidine was 3.54 h. The latter is higher than previously reported in normal subjects. It is concluded that neither H2-blocker affects the kinetics of ibuprofen in man.
Kaluthanthri Patabndi Chamila Dalpatadu ( chamila.gunerathne@gmail.com ) University of Colombo ... more Kaluthanthri Patabndi Chamila Dalpatadu ( chamila.gunerathne@gmail.com ) University of Colombo https://orcid.org/0000-0001-6564-2387 Prasad Katulanda University of Colombo Faculty of Medicine Gaya Katulanda Ministry of Healthcare Nutrition and Indigenous Medicine Priyanka Herath Ministry of Healthcare Nutrition and Indigenous Medicine Leonard Wanninayake University of Colombo Faculty of Medicine Chrishantha Niroshan Ministry of Healthcare Nutrition and Indigenous Medicine Saroj Jayasinghe University of Colombo Faculty of Medicine
Background and study aims: Osteoarthritis (OA) has become a burden globally for the healthcare se... more Background and study aims: Osteoarthritis (OA) has become a burden globally for the healthcare sector due to the number of people developing or living with the condition. Knee osteoarthritis (KOA) is the most common form of arthritis causing disability and impaired quality of life especially in the elderly. The WHO report on priority diseases and reasons for inclusion 2018, provides an in-depth review of the various diseases or conditions including osteoarthritis in its chapter sixth has been selected and grouped according to the nature of the pharmaceutical gap(s) associated with it. The Osteoarthritis Research Society International (OARSI) also identified OA as a serious disease and one of their major concerns is treatments for osteoarthritis. There are numerous drug treatments for osteoarthritis; however, their efficacy and adverse effect profiles often limit their use. Currently, pharmacological (drug), non-pharmacological, and surgical measures are considered in the treatment of OA with the aim of reducing pain and improving the function of the knee joint. At present, there is no proven disease-modifying therapy or cure available for OA. Sri Lankan Traditional Medicine regimens are widely used to treat OA and there are many treatment regimens including decoctions, pills, pastes, and fermentation procedures recorded which may be effective for the long-term management of OA. The aim of this study is to compare the clinical efficacy and safety of Sri Lankan Traditional Medicine to conventional treatment for KOA
Computational and Mathematical Methods in Medicine, 2020
The COVID-19 pandemic has resulted in increasing number of infections and deaths every day. Lack ... more The COVID-19 pandemic has resulted in increasing number of infections and deaths every day. Lack of specialized treatments for the disease demands preventive measures based on statistical/mathematical models. The analysis of epidemiological curve fitting, on number of daily infections across affected countries, provides useful insights on the characteristics of the epidemic. A variety of phenomenological models are available to capture the dynamics of disease spread and growth. The number of daily new infections and cumulative number of infections in COVID-19 over four selected countries, namely, Sri Lanka, Italy, the United States, and Hebei province of China, from the first day of appearance of cases to 2nd July 2020 were used in the study. Gompertz, logistic, Weibull, and exponential growth curves were fitted on the cumulative number of infections across countries. AIC, BIC, RMSE, and R 2 were used to determine the best fitting curve for each country. Results revealed that the mo...
COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern... more COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern medical officer working in a tertiary care hospital during the first wave of the pandemic in Sri Lanka. Her narrative describes how the stress of the pandemic brought into sharp focus the strengths and weaknesses in the health system. We suggest some strategies to improve our health services as the world faces the second wave and an uncertain future. These include structural changes in healthcare services at institutional and national levels, focused educational programmes for healthcare professionals to impart generic skills of disaster management, and the development of telehealth services and computerisation of health systems. We believe that we must maintain this focus to ensure that our patients can be guaranteed quality healthcare in the future.
This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Br... more This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting. Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited. A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury. One hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivo...
Oral Presentation Abstract (OP07), 120th Annual Scientific Sessions, Sri Lanka Medical Associatio... more Oral Presentation Abstract (OP07), 120th Annual Scientific Sessions, Sri Lanka Medical Association, 2014 Colombo, Sri Lanka
Introduction Quick Sequential Organ Failure Assessment (qSOFA) is potentially feasible tool to id... more Introduction Quick Sequential Organ Failure Assessment (qSOFA) is potentially feasible tool to identify risk of deteriorating in the context of infection for to use in resource limited settings. Purpose To compare the discriminative ability of qSOFA and a simplified systemic inflammatory response syndrome (SIRS) score to detect deterioration in patients admitted with infection. Methods Observational study conducted at District General Hospital Monaragala, Sri Lanka, utilising bedside available observations extracted from healthcare records. Discrimination was evaluated using area under the receiver operating curve (AUROC). 15,577 consecutive adult ( ≥ 18 years) admissions were considered. Patients classifi ed as having infection per ICD-10 diagnostic coding were included. Results Both scores were evaluated for their ability to discriminate patients at risk of death or a composite adverse outcome (death, cardiac arrest, intensive care unit [ICU], admission or critical care transfer)....
Current critical care prognostic models are predominantly developed in high-income countries (HIC... more Current critical care prognostic models are predominantly developed in high-income countries (HICs) and may not be feasible in intensive care units (ICUs) in lower- and middle-income countries (LMICs). Existing prognostic models cannot be applied without validation in LMICs as the different disease profiles, resource availability, and heterogeneity of the population may limit the transferability of such scores. A major shortcoming in using such models in LMICs is the unavailability of required measurements. This study proposes a simplified critical care prognostic model for use at the time of ICU admission. This was a prospective study of 3855 patients admitted to 21 ICUs from Bangladesh, India, Nepal, and Sri Lanka who were aged 16 years and over and followed to ICU discharge. Variables captured included patient age, admission characteristics, clinical assessments, laboratory investigations, and treatment measures. Multivariate logistic regression was used to develop three models f...
International journal for equity in health, Jan 17, 2015
IntroductionObesity is an increasing problem in South Asian countries and Sri Lanka is no excepti... more IntroductionObesity is an increasing problem in South Asian countries and Sri Lanka is no exception. The socioeconomic determinants of obesity in Sri Lanka, and in neighbouring countries are inadequately described. Aim was to describe social, cultural and economic determinants of obesity in a representative sample from Kalutara District in Sri Lanka.MethodsThis was a cross sectional descriptive study conducted among adults aged 35¿64 years. A representative sample was selected using stratified random cluster sampling method from urban, rural and plantation sectors of Kalutara District. Data were collected using a pre-tested questionnaire. A body mass index of 23.01 kg/m2-27.50 kg/m2 was considered as overweight and ¿27.51 kg/m2 as obese. Waist circumference (WC) of¿¿¿90 cm and ¿80 cm was regarded as high for men and women respectively. Significance of prevalence of obesity categories across different socio-economic strata was determined by chi square test for trend.ResultsOf 1234 ad...
The potential for interaction between ibuprofen and two histamine H2-receptor blocking drugs--niz... more The potential for interaction between ibuprofen and two histamine H2-receptor blocking drugs--nizatidine and cimetidine--was investigated in six healthy male volunteers aged 20 to 25 years. Each subject received placebo, nizatidine 300 mg and cimetidine 800 mg orally at 9.00 p.m. daily for six doses in three randomised treatment periods separated by eight days. On the third day of each treatment period ibuprofen 400 mg was administered at the same time and venous blood samples were taken at intervals throughout the night and subsequently up to 84 h after administration. There was no difference in the area under the plasma concentration-time curve, rate of absorption or half-life of elimination of ibuprofen between the three treatments. The elimination half-life of ibuprofen on placebo was 2.04 h. The elimination half-life of nizatidine on ibuprofen was 1.72 h and that of cimetidine was 3.54 h. The latter is higher than previously reported in normal subjects. It is concluded that neither H2-blocker affects the kinetics of ibuprofen in man.
Kaluthanthri Patabndi Chamila Dalpatadu ( chamila.gunerathne@gmail.com ) University of Colombo ... more Kaluthanthri Patabndi Chamila Dalpatadu ( chamila.gunerathne@gmail.com ) University of Colombo https://orcid.org/0000-0001-6564-2387 Prasad Katulanda University of Colombo Faculty of Medicine Gaya Katulanda Ministry of Healthcare Nutrition and Indigenous Medicine Priyanka Herath Ministry of Healthcare Nutrition and Indigenous Medicine Leonard Wanninayake University of Colombo Faculty of Medicine Chrishantha Niroshan Ministry of Healthcare Nutrition and Indigenous Medicine Saroj Jayasinghe University of Colombo Faculty of Medicine
Background and study aims: Osteoarthritis (OA) has become a burden globally for the healthcare se... more Background and study aims: Osteoarthritis (OA) has become a burden globally for the healthcare sector due to the number of people developing or living with the condition. Knee osteoarthritis (KOA) is the most common form of arthritis causing disability and impaired quality of life especially in the elderly. The WHO report on priority diseases and reasons for inclusion 2018, provides an in-depth review of the various diseases or conditions including osteoarthritis in its chapter sixth has been selected and grouped according to the nature of the pharmaceutical gap(s) associated with it. The Osteoarthritis Research Society International (OARSI) also identified OA as a serious disease and one of their major concerns is treatments for osteoarthritis. There are numerous drug treatments for osteoarthritis; however, their efficacy and adverse effect profiles often limit their use. Currently, pharmacological (drug), non-pharmacological, and surgical measures are considered in the treatment of OA with the aim of reducing pain and improving the function of the knee joint. At present, there is no proven disease-modifying therapy or cure available for OA. Sri Lankan Traditional Medicine regimens are widely used to treat OA and there are many treatment regimens including decoctions, pills, pastes, and fermentation procedures recorded which may be effective for the long-term management of OA. The aim of this study is to compare the clinical efficacy and safety of Sri Lankan Traditional Medicine to conventional treatment for KOA
Computational and Mathematical Methods in Medicine, 2020
The COVID-19 pandemic has resulted in increasing number of infections and deaths every day. Lack ... more The COVID-19 pandemic has resulted in increasing number of infections and deaths every day. Lack of specialized treatments for the disease demands preventive measures based on statistical/mathematical models. The analysis of epidemiological curve fitting, on number of daily infections across affected countries, provides useful insights on the characteristics of the epidemic. A variety of phenomenological models are available to capture the dynamics of disease spread and growth. The number of daily new infections and cumulative number of infections in COVID-19 over four selected countries, namely, Sri Lanka, Italy, the United States, and Hebei province of China, from the first day of appearance of cases to 2nd July 2020 were used in the study. Gompertz, logistic, Weibull, and exponential growth curves were fitted on the cumulative number of infections across countries. AIC, BIC, RMSE, and R 2 were used to determine the best fitting curve for each country. Results revealed that the mo...
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