Sri Lankan Experience Research Articles

Etomidate in the Treatment of Severe Cushing Syndrome: The Sri Lankan Experience

Etomidate in the Treatment of Severe Cushing Syndrome: The Sri Lankan Experience

MR Imaging of Mullerian Duct anomalies: Pictorial Review of a Sri Lankan experience

MR Imaging of Mullerian Duct anomalies: Pictorial Review of a Sri Lankan experience

A Sri Lankan experience over a decade in obesity care and understanding future challenges

No abstract available

School alumni associations in modern Australia as transcultural conduits of migrant identity: the Sri Lankan experience

ABSTRACT The literature illustrates that there has been relatively little specific research undertaken on the ways in which pre-migration school connections might have influenced the individual or group migration experience to Australia. Such influence is evident with migrants from Sri Lanka (Ceylon), a gap that the authors have identified in previous work. This paper attempts to bridge this research space by reporting on a pilot study into how Sri Lankan school alumni associations in Australia have influenced the migration experiences of individuals now living in Australia. Data for the study was generated via surveys and interviews with members of alumni organisations. Findings suggest that Sri Lankan school alumni associations can be important drivers and facilitators of both the act of migration and the process of migrant adjustment. They work as conduits enabling their members to remain connected to their ancestral roots in Sri Lanka whilst embedding themselves in modern Australian society.

Paying Respect to the Silent Mentors: A Sri Lankan Experience

Donation of bodies is one of the foremost methods of obtaining cadavers for dissection laboratories. Thanksgiving and memorial services are held by many anatomy institutions and medical schools worldwide, for the donors who selflessly bequeathed their bodies for medical education. In this article, an institutional experience of conducting a memorial service in the form of a Buddhist ceremony to invoke blessings to the donors and their families at the Faculty of Medical Sciences of the University of Sri Jayewardenepura in Sri Lanka, for over 25 years, is presented by the authors. The bodies are donated to the medical faculty with informed written consent taken from the donors prior to their deaths. This process is entirely a voluntary service of goodwill towards medical education by the donors, as no financial compensation is provided by the university to them or to their families. Additionally, the benefits of holding such a memorial ceremony for the students as well as for the family members of the deceased are discussed.

Heart disease complicating pregnancy as a leading cause of maternal deaths in LMIC settings: the Sri Lankan experience.

Heart disease (HD) is one of the leading indirect causes of maternal deaths worldwide, both in high- and low- and middle-income countries (LMICs). This study aims to describe maternal deaths due to cardiovascular disease complicating pregnancy in Sri Lanka. The national Maternal Death Surveillance Response (MDSR) system in Sri Lanka investigates all female deaths during pregnancy and 12 months after delivery. These maternal death investigation records were perused in this analysis. Maternal deaths from 2006 to 2018 with HD complicating pregnancy as the immediate or underlying cause of death were re-coded using the ICD-11 classification. Of the 2855 pregnancy-related deaths reported to the MDSR from 2006 to 2018, 1646 (57.7%) were confirmed as maternal deaths. Of those, 284 (17.25%) were attributed to HD complicating pregnancy. The cause-specific maternal mortality ratio due to heart disease from 2006 to 2018 was 7.24 per 100,000 live births. Rheumatic heart disease was the leading cause of HD (60, 21.1%), while cardiomyopathies (59, 20.7%) and congenital anomalies (34, 12.0%) accounted for a sizeable share. Medically contraindicated pregnancies accounted for 54 (19%) deaths. Application of the 3-delay model identified 186 (65.5%) cases with possible delays. Out of all deaths, 158 (55.6%) cases were categorized as preventable. Preventing maternal mortality from HD in LMICs requires a lifecycle approach with situation-specific interventions and highly specialized care. Community awareness, capacity building related to management, and specific infrastructure development will be key strategies. None.

Health and Nutritional Status Among Internally Displaced Children under Five Years, during the Civil War: Sri Lankan Experience

AbstractAround the globe, 1 in 6 children become vulnerable to grave physical and mental violence, hunger, sexual assaults, and exploitation of human rights due to war. These adversities are multi-dimensional, synergistic, and often subtle. This study attempted to evaluate the health and nutritional status of children aged under five years and living in the war zone of Sri Lanka, in view of improving the health services delivered to them. The study used a descriptive cross-sectional design. The study sample, 400, was based on probability proportionate and then systematic sampling drawn from IDP camps located in the Vavuniya district. Validated instruments along with hemoglobin and anthropometry measurements were administered. Among children, more than half were malnourished based on weight for height z-score (WHZ) anthropometry index (<-2 SD) One-fourth had not received age-appropriate vaccinations. More than 50% had psychological symptoms. Maternal and Child Health service gaps were observed along with deficits in the curative service. Identifying and addressing these complex health and nutritional problems in a multi-sector collaborative manner is a priority; the main focuses are nutrition, vaccination, mental healthcare, and essential maternal care. Keywords: child health, malnutrition, mental health, war, displacement AbstrakDi seluruh dunia, 1 dari 6 anak rentan terhadap kekerasan fisik dan mental yang berat, kelaparan, kekerasan seksual, dan eksploitasi hak asasi manusia akibat perang. Masalah ini bersifat multi-dimensi, sinergis, dan seringkali tidak terlihat. Studi ini mencoba mengevaluasi status kesehatan dan gizi anak berusia di bawah lima tahun dan tinggal di zona perang Sri Lanka untuk meningkatkan layanan kesehatan yang diberikan kepada mereka. Penelitian ini menggunakan desain deskriptif cross-sectional. Sampel penelitian sebanyak 400 anak didasarkan pada probabilitas proporsional dan kemudian penarikan sampel sistematis dari kamp-kamp pengungsi yang terletak di Distrik Vavuniya. Instrumen yang divalidasi bersama dengan pengukuran hemoglobin dan antropometri juga dilakukan. Diketahui lebih dari setengah anak-anak mengalami malnutrisi berdasarkan indeks antropometri Berat Badan menurut Tinggi Badan (BB/TB)(<-2 SD). Seperempatnya belum menerima vaksinasi sesuai usia. Lebih dari 50% memiliki gejala psikologis. Kesenjangan layanan Kesehatan Ibu dan Anak terobservasi bersama dengan kurangnya layanan kuratif. Mengidentifikasi dan mengatasi masalah kesehatan dan gizi yang kompleks ini dengan cara kolaborasi multisektor merupakan prioritas; fokus utamanya adalah gizi, vaksinasi, perawatan kesehatan mental, dan perawatan ibu yang esensial. Kata Kunci: kesehatan anak, malnutrisi, kesehatan mental, perang, pengungsian.

A cross-cultural approach to issues of male dominance and domestic violence

Harmful masculine norms, attitudes, and behaviours are considered the cause of most cases of gender-based violence against women and girls in most parts of the world. This premise applies to the patriarchal society of Sri Lanka as well. Regarding various policy-level efforts made to reduce the frequency of gender-based violence in Sri Lanka, this paper explores the efficacy of adapting a cross-cultural evidence-based approach to gender relations tried under the Parivartan programme in India in an effort to improve masculinity-based gender norms in Sri Lanka. The programme’s content and consensual validities are assessed by using the Delbecq technique which involves experts from a variety of relevant fields. At the onset of the programme, each expert independently rates the relevant concepts and teaching techniques that are generally used by cricket coaches on male cricketers of 12-14 years. Towards the end, after a group discussion by experts, a second rating is made of the same concepts and teaching techniques. The two ratings are compared, and the programme is revised to suit Sri Lankan society. The Sri Lankan experience of the cross-cultural evidence-based approach to gender relations inspired by the Parivartan programme in India shows satisfactory content and consensual validities. Therefore, this paper argues that the Delbecq technique is a useful tool to devise in improving masculinity-based gender norms in the society of Sri Lanka.

Adrenocortical tumors in children: Sri Lankan experience from a single center, and a mini review

BackgroundPediatric adrenocortical tumors include both benign adenomas and highly virulent malignant tumors. However, they are very rare among children. The aim of this study is to evaluate the clinicopathological data of children presenting with adrenocortical tumors and assess their survival in a South Asian population.Case presentationThis is a retrospective cohort study that includes patients diagnosed with adrenocortical tumors from August 2020 to August 2022 followed-up at Lady Ridgeway Hospital. Seven children were diagnosed with adrenal cortical tumors. Their ages ranged from 10 months to 6.5 years. Five of them were boys. All displayed signs of peripheral precocious puberty. One boy phenotypically had features of Beckwith–Wiedemann syndrome. The median time for diagnosis after the onset of symptoms was 4.4 months. The preoperative diagnosis was based on clinical manifestations, elevated dehydroepiandrosterone sulfate levels, and suprarenal masses on computed tomography. All five boys had right-sided suprarenal masses, while the two girls had them on the left side. All underwent surgery for tumor resection. The diagnosis was confirmed based on the histopathology of the adrenal specimens. Four children had a Wieneke score of 4 or more, suggesting the possibility of adrenocortical carcinoma; however, only two of them behaved as malignant tumors. To date, two children have developed local recurrences within a very short period.ConclusionAdrenocortical tumors are uncommon in children, and treatment options are limited. To identify early recurrences, routine clinical, radiological, and biochemical examinations at least once every 6–8 weeks is important.

Outcomes of COVID-19 in Kidney Transplant Recipients: The Sri Lankan Experience.

Coronavirus disease 2019 (COVID-19) causes severe illness in the immunocompromised. This study aimed to describe the severity and outcomes of kidney transplant recipients (KTRs) treated for COVID-19 during the first 16 months of the pandemic in Sri Lanka. We conducted a cross-sectional survey of all nephrology centers in Sri Lanka using a self-administered electronic data collection sheet. All practicing nephrologists were invited. KTRs who had been treated/were under treatment for COVID-19 between March 1, 2020 and June 30, 2021 were included. Data on patient demographics, management practices, and outcomes were collected. Outcomes included graft loss, requirement of kidney replacement therapy (KRT), duration of hospital stay, highest level of treatment setting, highest level of respiratory support, and mortality. Fifteen nephrologists (12 centers) responded with data regarding 58 KTRs with COVID-19, 10 of whom were receiving ongoing treatment; 47/58 (81%) were male. Forty (69%) were between 30 and 59 years of age and 15 (25.9%) were aged 60 years or above. Fourteen (24.1%) were within 1 year of transplantation. Fifty-three (91.4%) were on triple immunosuppression. Antiproliferative was reduced/withheld in 89.1% and calcineurin inhibitor was reduced/withheld in 42.1%. Overall mortality was 16/48 (33.3%). Seventeen (29.3%) required intensive care. Six (10.3%) received noninvasive ventilation, and 11 (19.0%) received invasive ventilation. Ten of the ventilated patients died. Six needed acute KRT, five of whom died. One patient survived with a loss of graft. There was no association between modifications to the immunosuppression and outcomes. COVID-19 causes poor outcomes and severe illness in KTRs. Special preventive and therapeutic strategies are urgently required.

Dermatological manifestations among patients with COVID-19: The Sri Lankan experience

Background: Patients diagnosed with COVID-19 demonstrate a wide spectrum of cutaneous manifestations, some of which are at a high prevalence. These manifestations, of which some are unique, have been considered to occur due to COVID-19 infection and the associated inflammatory response. Furthermore, there are reports on exacerbation of previously diagnosed dermatoses and cutaneous side effects of medications and vaccines administered.Methodology: The first phase of the study included a descriptive cross-sectional study conducted at the National Hospital of Sri Lanka (NHSL) among PCR-positive COVID patients to identify their skin conditions. Secondly, to ascertain an overall understanding of the country’s situation, a comprehensive questionnaire was circulated among the members of the Sri Lanka College of Dermatologists, to obtain information on the patients they have encountered.Results: Out of the patients at NHSL only 1.7% (n=8) had developed associated skin manifestations. Two (0.4%) developed novel conditions: thrombophlebitis and a maculopapular exanthem. Six (1.3%) patients had exacerbation of pre-existing conditions including eczema, psoriasis and discoid lupus erythematosus. The dermatologists revealed a wide variety of manifestations with the majority experiencing an exacerbation of pre-existing conditions and a few developing novel lesions including COVID-toes and Kawasaki-like diseases in children which are considered specific for COVID-19.Conclusions: The study demonstrates a range of COVID-19-associated dermatoses. These can present before or with other COVID-19 symptoms. Further, studies are necessary to precisely determine the timing and pathophysiology of different manifestations. Dermatological findings are important and should prompt the early involvement of dermatologists as appropriate.

Privacy of Personal Health Information (eHealth) and Covid 19 Pandemic: The Sri Lankan Experience

Sri Lanka Journal of Medicine is the official journal of the Kandy Society of Medicine. It is a peer-reviewed journal currently published biannually. Original articles, reviews, brief reports, case reports, points of view, and letters to the editor, in all fields of medical science and practice are accepted for publication.The Sri Lanka Journal of Medicine is now indexed in DOAJ

Integration of Traditional and Innovative Methods in Anatomy Dissections: A Sri Lankan Experience

Introduction: Routine methods of teaching gross anatomy including cadaver dissections have been a keystone of the anatomy curriculum and certain difficulties have led medical educationists to explore teaching using modern technology. This study aims to share the institutional experience of incorporating new methods into routine dissections at the Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.Methodology: Prior to dissections, recommended anatomy 3D software and videos were shown in LED panels. Mock spots were conducted weekly. Applied anatomy sessions were conducted by clinicians. Ultra sound scan (USS) based teaching sessions were conducted by a consultant radiologist. Another study area with multiple illuminators with radiological films was present. Routine feedback was taken from students.Results: The use of LED panels for teaching was found to be helpful by most (82.6%) students. A majority (84%) also found that mock spots were helpful for their studies and 89.2% preferred the use of 3D software. Percentage 82.6% of students found USS guided teaching useful while 85.4% of students found X-ray & CT useful. Majority (91.5%) found the applied anatomy teaching sessions useful. The majority of students’ comments indicated recommendations for them to be continued for future batches.Conclusion: This initiative demonstrates that the combination of traditional and innovative methodologies in the teaching of gross anatomy is favored by students and the applied anatomy sessions can provide vertical integration of the subject.

Relative Profitability of Multinational Enterprises in a Developing Host Country: The Sri Lankan Experience

Empirical evidence on the profitability of multinational enterprises vis-a-vis local finns in developing countries appears to be sparse and contradictory. This paper attempts to shed some light on this aspect through an analysis of the balance sheet data of a sample of manufacturing finns in Sri Lanka. The analysis does not support the generally-held view that multinational enterprises are more profitable than their local counterparts. It suggests that profitability cannot be explained by either origin (MNF/local finn) or sector, or age.

NGOs as Partners of Local Development and Governance: The Sri Lankan Experience

During seven decades of independence, Sri Lankan politics have been characterized by strong central government despite various initiatives to decentralize power to local levels. Hence, local government has little capacity to respond to local development needs. The increase in NGO activity following the tsunami of 2004 and the end of the civil war in 2009 provides an opportunity to examine the potential of NGOs as partners with local government in promoting local development. Drawing on research into the views of national, provincial and local political representatives and administrative officials, NGO officials and representatives of community-based organizations in the southern and eastern provinces, this paper examines instances of the NGO involvement addressing local development and governance in Sri Lanka. It examines the impact of a strong central government on NGOs working at the local level, and the conditions for NGOs to be effective in promoting local development. It identifies instances where NGOs have played a key role as intermediaries between local government and local communities as they have promoted local development.

Becoming an “owner” in a learner-centred context: a Sri Lankan experience at a postgraduate taught course in management and technology

PurposeThere is a need for a shift of the pedagogy to student-centeredness in the teaching–learning process of the higher education sector in countries such as Sri Lanka, where the education system is still identified with the dominant “teacher-centeredness” pedagogy. Within this backdrop, this study aims to understand whether a learner-centred teaching (LCT) can be practised effectively within a postgraduate taught course in Sri Lankan public sector university system.Design/methodology/approachOntologically, this study is placed within the interpretivist paradigm and adopted qualitative methodology. Reflections and experiences of 2 facilitators and 63 participants were thematically analysed.FindingsFour themes emerged from the data as key phases of LCT-based learning process, namely: “changing role of the facilitators,” “emerging a collaborative learning environment,” “creating a platform for contextualising the knowledge gained in class” and “becoming an owner of the learning.”Originality/valueWithin the learning process, participants became “owners” rather than “renters” because of facilitators maintaining low power distance and participants developing a sense of empowerment, leading to engaging in the learning process willingly. Further, this study shows how the classroom shifted from the state of learner-centred to learner-driven. These novel findings become the main theoretical contribution of this research to existing knowledge.

Frontal Sinus Pattern Analysis for Human Identification Using Non- Contrast Computed Tomography Images- a Sri Lankan Experience

Frontal Sinus Pattern Analysis for Human Identification Using Non- Contrast Computed Tomography Images- a Sri Lankan Experience

Heart Disease Complicating Pregnancy as a Leading Cause of Maternal Deaths in LMIC Settings: The Sri Lankan Experience

Heart Disease Complicating Pregnancy as a Leading Cause of Maternal Deaths in LMIC Settings: The Sri Lankan Experience

Frontal sinus pattern analysis for human identification using non-contrast computed tomography images: A Sri Lankan experience.

Morphometry of frontal sinuses has been studied extensively in many countries. However, these findings cannot be generalized due to genetic and environmental factors affecting the skeletal structure. The main aim of this study was to morphometrically analyze the frontal sinuses in patients who underwent non-contrast computed tomography (NCCT) skull imaging at Teaching Hospital Peradeniya and to assess its association with age and sex. This retrospective study included 300 NCCT skull images obtained by a multi-slice computed tomography(MSCT) scanner at the Teaching Hospital Peradeniya. This age- and sex-matched sample was selected using consecutive sampling and consists of seven age groups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-89). Right and left frontal sinus values (length, height, width of each sinus, and total width) were measured using the RadiaAnt DICOM Viewer 2020.2.3 software, and age and sex were obtained from the CT images. The association among the variables was analyzed using the t-test and binary logistic regression model. In our study sample, 59% (n = 177) were male and the mean age was 57.94 years. The means of left side sinus values were larger than right sinus values, which was statistically significant. A statistically significant association was seen between frontal sinus parameters and sex; those of males were higher than that of females. No significant association between the sinus size and age was observed. Morphometric analysis of frontal sinuses using NCCT images is useful for the sex differentiation of unknown bodies for medico-legal purposes. Furthermore, the mean sinus values specific to the current study population will also be helpful in ethnic differentiation.

COVID-19 pandemic and assessments of final year medical students in psychiatry: an innovative Sri Lankan experience

The Sri Lanka Journal of Psychiatry (SLJP) is a peer-reviewed, open access journal published bi annually by the Sri Lanka College of Psychiatrists.The Journal publishes original papers, brief reports including case reports and commentaries relevant to psychiatry and allied sciences. The Sri Lanka Journal of Psychiatry is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.Cover“Perseverance”. These tenacious fishermen in Mannar continue their livelihood despite numerous difficulties. L. N. P. Samarasinghe, Acting Consultant Psychiatrist, Base Hospital Nikaweratiya, Sri Lanka.