iPURSE 2023

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Serum NT-proBNP for predicting left ventricular systolic dysfunction in hospitalized patients in Sri Lanka
(University of Peradeniya, Sri Lanka, 2023-09-20) Rathnayake,B.M.C.; Illeperuma,R.P.; Jayasinghe,S.; Fawcett,T.N.; Maduwage,K.; Jayalath,W.A.T.A.; Ralapanawa,U.
Limited research has delved into the significance of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) in the detection of Left Ventricular Systolic Dysfunction (LVSD) in South Asian populations. Therefore, current observational study was aimed at assessing the use of serum NT-proBNP levels in predicting LVSD in a hospitalised population in Sri Lanka. A random sample of 278 prospective patients referred for echocardiography at Teaching Hospital, Peradeniya provided the consent and venous blood samples were collected for serum NT-proBNP assay by sandwich ELISA method. Then, based on the ejection fraction (LVEF) and fractional shortening (FS), participants were differentiated as LVSD patients (LVEF<50%, FS≤ 29%) and non-LVSD individuals (LVEF>60%). SPSS version 26 was used for results analysis in terms of non-parametric statistical tests. A total of 173 were finally eligible for the analysis, in which 100 were LVSD patients and 73 were non-LVSD individuals. The mean ages of the LVSD and non-LVSD groups were 69.1 (±6.2 years) and 70.8 (±3.8 years) (p=0.718) respectively, suggesting that LVSD is mostly a disease of elderly. The median NT-proBNP value (with IQR) among LVSD patients (528.2 pg/mL,355.2–924.2) was comparatively higher than that of non-LVSD individuals (204 pg/mL,175.5–306.8). NT-proBNP levels gradually increase through non-LVSD, mild, moderate and severe LVSD groups (Kruskal-Wallis H(3)=122.6, p<0.001). Strong correlations of log NT-proBNP level with LVEF (Spearman rho = - 0.859, p<0.001), FS (rho= -0.812, p <0.001) and LV mass (rho= 0.727, p<0.001) suggested that NT-proBNP concentration in serum increases in parallel to deteriorating left ventricular functions. The area under receiver operating curve of serum NT-proBNP for differentiating LVSD was 0.866 (95% CI:0.801 – 0.931) and the optimal cut-off level of NT-proBNP for predicting LVSD was 265pg/mL with 90% sensitivity and 70% specificity. Therefore, the current Sri Lankan study revealed a considerable correlation of serum NT-proBNP level with the severity of LVSD, and the proposed cut-off level can be an optimal reference point to predict LVSD in high- risk local individuals.
Development of an immobilizer for pediatrics during chest radiography
(University of Peradeniya, Sri Lanka, 2023-09-20) Jayasekara, U.M.U.W.; Rathnayaka, R.M.T.G.H.; Rislin, M.U.; Roculamenan, S.
Radiographers have to pay much attention towards paediatric imaging to obtain good quality images considering the accuracy of the final diagnosis of diseases while avoiding unnecessary radiation exposure to the patient. Unexpected results in image quality may arise from the mobilization of patients during the exposure. Therefore, ensuring patient immobilization is paramount importance. As the current practice of immobilization has many disadvantages, an effective method of immobilization for pediatrics is essential. Chest radiography is the most common examination performed in the radiology department. This study was designed to develop an immobilizer for paediatrics during chest radiography. As the initial step, an immobilizer was designed with seating and head resting area, velcro strips as immobilizers and small lead shields as protective devices. Sixty (60) paediatric patients at the age range of birth to two years, who attended for chest radiography examination to radiology unit at Specialized Children’s Hospital in the Central Province were selected as the study population. Chest radiographs (CXRs) those were taken applying the new immobilizer were considered as Experimental Group (EG) and CXRs those were taken without applying the new immobilizer were considered as the Control Group (CG). Quality of the final radiographic images was graded as good, poor and very poor based on the evaluation report given by two senior qualified radiographers considering the recommended image evaluation criteria that are used to assess the quality of the chest radiograph. The incidences of “good” “poor” and “very poor” quality radiographs were 60%, 33.3% and 0% respectively for the experimental group, whereas 43.3%, 43.3% and 13% for the control group. The results showed incidence of good quality radiographs is higher, as well as no very poor quality radiographs were reported among the experimental group. The study concluded that newly produced immobilizer improves the quality of the final chest radiograph.
Estimating species richness from virome data accounting for variations within the virus population
(University of Peradeniya, Sri Lanka, 2023-09-20) Herath, H.M.D.K.; Tang, S.L.
Species richness is a key species diversity measure. It corresponds to the number of species in an environmental sample. Estimating species richness of a metagenome of viruses (i.e., a virome) based on the reference data is challenging because of the limited amount of sequence data of viruses available in reference databases. A limitation identified with the methods that do not rely on reference sequence data in estimating species richness while being based on the contig spectrum is the assumption of equal genome length for all the species in the sample. This work aims to formulate a mathematical model to estimate species richness from a virome considering the variability of the genome lengths of species in the sample in contrast to the mentioned methods. A model is derived for the expected contig spectrum and the parameters of the model including the species richness is estimated through optimization for the least error between expected and observed contig spectra. Genetic Algorithm is used as the optimization algorithm in parameter estimation. The optimisation procedure incorporated in the proposed approach is shown to be robust based on the results with simulated data. This work enables inference of genome lengths distribution from the metagenomic sequence data in addition to estimating the species richness and can be applied to virome originating from any environmental sample.
Zoom fatigue and burnout among primary school teachers in the Mawanella Education Zone
(University of Peradeniya, Sri Lanka, 2023-09-20) Ishara, M.S.F.; Indrajith, M.H.A.M.; Hewapathirana, S.D.; Imasha, L.A.P.; Indunil, W.N.; Jayalath, W.R.H.R.; Wickramasinghe, N.D.
The COVID-19 pandemic necessitated the virtualization of education, leading to an unprecedented increase in using video conferencing for teaching-learning activities across the globe. However, there is a dearth of local studies assessing the impact of this virtualization on the mental health of teachers. This cross-sectional study with an analytical component was conducted to assess Zoom fatigue, burnout, and their associations among primary school teachers in the Mawanella education zone. All primary school teachers in the setting were invited to complete a self-administered questionnaire (in all three languages), including Zoom Exhaustion and Fatigue Scale (ZEF) and Oldenburg Burnout Inventory (OLBI), circulated as a Google form. Data were analyzed using the SPSS version 22.0. Zoom fatigue was described using the mean (SD) ZEF score. Independent-samples t-test was conducted to compare the mean ZEF scores between different sub-groups. Pearson correlation was used to assess the relationship between ZEF and burnout scores. The final sample comprised of 342 teachers. The majority were females (n=263, 76.9%). The mean (SD) age was 40.2 (8.5) years. The ZEF score ranged from 15.0 to 65.0 with a mean (SD) of 34.6 (8.7). Teachers who; were currently not married, had to learn Zoom technology from school, had poor family support for teaching, reported statistically significantly higher mean ZEF scores than their counterparts (p<0.05). Teachers who; were excessively self-conscious, found multitasking difficult, stressed to use multiple features in Zoom and learn advanced technology, reported significantly higher ZEF scores than their counterparts (p<0.05). There was a statistically significant positive relationship between ZEF and burnout scores (r=0.254, p<0.001). Hence, it was concluded that the scores of Zoom fatigue among primary school teachers in the Mawanella education zone are high. Providing more support to learn the novel Zoom technology would be beneficial to reduce Zoom fatigue among teachers.
Determination of microbial contamination of commercially available generic and branded oral antibiotic suspensions in Galle, Sri Lanka
(University of Peradeniya, Sri Lanka, 2023-09-20) Karunarathna, R.S.B.; Karunanayaka, K.D.S.V.; Wijayaratne, W.M.D.G.B.
Antimicrobials are widely used for the control and management of various infectious diseases. Oral liquid pharmaceuticals are one of the most suitable dosage forms for paediatric usage. Upon opening, these pharmaceuticals are susceptible to contamination. The product quality and stability are degraded by microbial contamination. Thus, the aim of this study was to investigate the microbial contamination of commercially available generic and branded oral antibiotic suspensions in Galle, Sri Lanka during their consumption period. Branded and generic products of amoxicillin with clavulanate, clarithromycin, and azithromycin oral suspensions were selected and manufacturers’ advice was followed when preparing the suspension. One millilitre of the sample was evaluated for each product. Samples were diluted at 1:10 in each sterile Mueller Hinton Agar (MHA). The sample aliquot was transferred to MHA and spread evenly using L shaped glass spreader. The antimicrobial property of each sample was eliminated using neutralizing agents (0.1 M Ammonium hydroxide) and these samples were incubated at 35 ± 2 °C for 16-18 hours in an incubator at the faculty. Then, colonies were recovered from each plate and enumerated them. The arithmetic means count was used for calculating the total viable count of the test sample and they were analysed at the opening. The procedure repeated after 7th, 14th, 21th, and 28th days. Minute levels of microbial contamination of the suspensions were observed. The contamination percentages were 0%, 14%, 14%, 64%, and 73% corresponding to 7, 14, 21, and 28 days after opening. None of the samples exceed the level 103 CFU ml-1, which meets the USP microbial limit. Oral antibiotic suspensions can be contaminated when kept for more than 7 days after reconstitution, even though they have preservatives. Adequate physicochemical properties and microbial quality of oral antibiotic suspension can be preserved through meticulous handling and storage practices
Antibiotic sensitivity pattern of pus isolates at Base Hospital, Gampola
(University of Peradeniya, Sri Lanka, 2023-09-20) Shiffana,S.; Subani,S.; Ekanayaka,S.
Introduction: Antibiotic Sensitivity Pattern should be determined prior to prescribing medicines in order to treat the suppurative infections. Multiple studies have been carried out to determine the prevalence of microbes in pus samples and its ABST pattern. Considerable variations in bacterial profiles found in pus samples emphasize the importance of determining the prevalence of microbes and the ABST pattern. Therefore, the current study aimed to assess the prevalence of pus culture isolates and its ABST pattern in Base hospital, Gampola. This cross-sectional study was carried out between March to June2023. The ethical clearance was obtained from ethical review committee, National Hospital Kandy. All the pus samples were processed on arrival to the microbiology laboratory without delay. The laboratory manual in microbiology published by the Sri Lanka College of Microbiologist (SLMC 2012) was used as the reference material for microbiological procedures of pus samples. In the present study among 210 pus culture samples, microorganisms such as Coliforms, Staphylococcus aureus, Pseudomonas spp, Coagulase Negative Staphylococci and Gram-Negative Coccobacilli were detected. Coliform was the most common isolate. Coliform showed 100% sensitivity to Meropenem, 95.89% and 91.78% to Amikacin and Gentamicin respectively. 43.84% of coliforms isolated as ESBL. Staphylococcus aureus exhibited 100% sensitivity to Vancomycin, out of 43 samples and 41.86% were MRSA isolates. Pseudomonas spp showed 100% sensitivity to Ceftazidime followed by Gentamicin, Piperacillin Tazo-bactam accounting for 82.76% respectively. In this investigation the most prevalent antibiotic sensitivity pattern for coliform was Meropenem, Gentamicin and Amikacin. According to this current study, a number of antibiotics are effective against organisms without having to use of Carbapenems. Pseudomonas spp showed sensitivity to Ceftazidime. Cefaperazone- Sulbactams and Piperacillin-Tazobactam were alternative drugs used in place of Carbapenems (Meropenem).
Bacterial profile and associated factors with pus culture positivity from pus samples
(University of Peradeniya, Sri Lanka, 2023-09-20) Shiffana,S.; Subani,S.; Ekanayaka,S.
Introduction: Pus is caused by bacterial infection that can be developed anywhere in the body. Several factors are associated with the prevalence of pyogenic infections caused by bacterial etiologies. The current study aimed to assess bacterial profile of pus culture isolates and associated factors with pus culture positivity. A total of 210 pus culture samples were collected from Base Hospital Gampola over the period from March to June 2023. The ethical approval was obtained from the ethical review committee, National Hospital, Kandy. Following type of samples were included such as wound swab, pus and Lower Vaginal swab (LVS). Collected pus samples were processed to identify the causative bacterial pathogens and antibiogram according to the international guidelines provided by Sri Lanka College of Microbiologists. Frequencies of the variables entered into an excel sheet. Chi-Square test was employed to compare the association between variables. Among 210 pus culture samples, various types of organisms were observed such as Coliforms (75,35.7%), Staphylococcus aureus (43,20.5%), Pseudomonas spp (29,13.8%), Coagulase Negative Staphylococci (CNS) (14,6.7%) and Gram-Negative Coccobacilli (GNCB) (6,2.9%). Coliform was the most common isolate. 43.84% of coliforms isolated as ESBL while 41.86% were isolated as MRSA. In the present study, a significant relationship (p=0.003) was noted between the isolated organisms with IPD and OPD. There was a significant relationship observed (p=0.042) between the type of samples and the microorganisms isolated. The current study indicated the significant relationship between age groups and MRSA isolates (p=0.034), gender and ESBL isolates (p=0.028), type of samples and MRSA isolates (p=0.029). There was no significant relationship between ABST patterns of isolates with respect to the defined variables in the current study. The present study revealed the most prevalent pathogen on pus culture samples. This investigation can be used for identifying the high-risk individuals related to pyogenic infections.
Awareness and competence in managing common medical emergencies in a dental clinic by dental nurses at the University Dental Hospital, Peradeniya
(University of Peradeniya, Sri Lanka, 2023-09-20) Karthik,S.; Leuke Bandara,D.; Tilakaratne,A.
The role of a dental nurse is vital in managing unanticipated medical emergencies (MEs) that could arise in a dental clinic. This audit aimed to assess the basic competency standards (knowledge, skills, and confidence) in the management of MEs in dental practice among dental nurses. The study was conducted among all dental nurses at a University Dental Hospital (n=35), using a structured interviewer- administered questionnaire. Short video clips were used to demonstrate the possible emergencies while the skills were assessed using mannequins. Response rate was 57.14%. The mean age of the participants was 37.13 years (SD=19.75) and all were females. Although, excessive bleeding (by 95% of participants), angina (70%) and hypoglycaemia (65%) were known to them as MEs, out of the given list, only 15% selected angina as a common ME which could occur in a dental practice. All participants (100%) selected excessive bleeding followed by asthma (65%), seizures (60%), hypoglycaemia (50%), vasovagal syncope (50%) and anaphylaxis (40%) as common MEs. Yet, cardiac arrest/cerebrovascular accident were not selected by any. No participant was accurate in identifying all the signs and symptoms of vasovagal syncope, hypoglycaemia, and anaphylaxis. Regarding emergency management, participants scored low in managing a fainted patient (mean score =46.26±29.25) and seizures (mean score =33.75±30.65). Younger age group (≤35years) had significantly higher mean scores for the faint and seizure management (mean score=60±27.09, P=0.04; mean score=70.6±7.20, P=0.001) than those aged ≥35years. Approximately, 60% of the participants expressed very low confidence in performing Basic Life Support (BLS) during emergencies and only 40% demonstrated knowledge of normal vital measures. Notably, no participant accurately demonstrated BLS or manual blood pressure monitoring. Urgent attention is required to address the gaps in identifying possible emergencies, BLS and improving the basic competency levels in managing medical emergencies.
Anterior extensions of parotid gland and its relationship with the buccal branch of facial nerve: a case study
(University of Peradeniya, Sri Lanka, 2023-09-20) Samarakoon, S.M.K.G.H.; Angammana, H.M.R.W.; Ranasinghe, W.G.K.I.; Hettiarachchi, H.A.A.U.S; Gunathilake, G.R.Y.A; Banneheka, B.M.H.S.K.
Variant anterior extensions (AEx) of the parotid gland (PG) is observed such as accessory parotid gland (APG) and facial process (FP), which are in close proximity with the parotid duct over the lateral side of the masseter muscle. APG is a collection of salivary tissue separated from the main PG, whereas FP maintains the continuity. All pathologies occur in main PG including cancer can affects AEx as well. Single or multiple buccal branches (BB) of facial nerve (FN) also runs parallel to parotid duct. However the relationship of the BB with AEx of PG is not well reported in literature. During dissection classes carried out for first year Dental undergraduates, AEx of PG were observed and bilateral dissection of the lateral face of ten cadavers were done. There were four males and six female cadavers with a mean age of 75 years. Nine FP (45%) and 3 APG (15%) were observed out of the 20 sides examined making the incidence of AEx as 60%. Emergence of a single BB (15%) as well as double branches (45%) were observed. The double branches were running separately as well as making connections across the duct. The superior branch was deeply located and the inferior branch was emerging more superficially from PG. In all APG, BB was passing through the glandular mass. In relation to FP, double BB were running in the inferior and superior borders of the mass. In literature, occurrence of the FP was reported increasing with age where as APG was reducing, supporting our observations. However the relationship of FN branches with APG is not well reported in literature. Occurrence of AEx of PG should be considered in clinical practice as well as the BB relationship. Therefore further studies are recommended on the region.
Adaptation and validation of the strengths and weaknesses of ADHD symptoms and normal behavior scale (SWAN) among 5 - 12 year old children in Colombo District
(University of Peradeniya, Sri Lanka, 2023-09-20) Goonetilleke, W.A.R.N.M.T.; Hettigoda, K.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder and is characterized by persistent age-inappropriate core symptoms of inattention, hyperactivity, and impulsiveness that could result impairment in one’s major life activities and wellbeing. Hence, early identification, and prompt treatment are essential. Screening tools are commonly used by clinicians and researchers to assess ADHD, however lack of culturally adapted and validated screening tools in Sri Lankan context hinders the early identification of ADHD in children. TheStrengths and Weaknesses of ADHD symptoms and Normal behavior (SWAN) rating scale assesses the symptoms of ADHD and has 18 items with a 7-point rating. The aim of this study was to adapt and translate the SWAN scale to Sinhala language by establishing content and consensual validity and measure the construct, criterion validity along with assessing the reliability. This is a cross-sectional and correlational study. The psychometric properties of the SWAN Sinhala scale were established using a community sample of 220 parents of school children who were between 5 and 12 years old in Colombo district and a clinicalsample of 50 parents of children that were diagnosed with ADHD at Lady Ridgway Hospital (LRH), Colombo. The reliability of the SWAN scale was measured using the community sample and the achieved internal consistency reliability Cronbach’s alpha value plus the test-retest reliability stability were 0.96, and 0.96, indicating as excellent. The clinical utility of the Sinhala SWAN scale was examined by executing criterion validity through resulting good concurrent validity. Further, convergent validity in the community sample was agreeable and the obtained Principal Component Analysis factor loadings and structures were adequate. In conclusion, the SWAN Sinhala version retains sound psychometric properties as of the original SWAN and will be a valuable instrument to screen ADHD among 5 to 12 year old children in Sri Lankan context.
A study on the effect of coconut lipids on glucose metabolism in rats and cell culture models
(University of Peradeniya, Sri Lanka, 2023-09-20) Perera, M.C.N; Fernando, P.H.P; Alles, C.N.R.A; Yalegama, C
High prevalence of diabetes mellitus demands novel measures to alleviate this condition. Therefore, this study was aimed to elucidate the effect of virgin coconut oil (VCO) or soya oil (SO) on glucose tolerance in diabetic (D) and non-diabetic (ND) rats. Three groups of Sprague Dawley male rats (6 each) were in the ND state and another three in the D state, induced using alloxan. The animals received, either water, VCO or SO, orally at 7.5ml/1000g each. Oral glucose tolerance test (OGTT) results on Day 45 and 90 of treatment were analyzed by one-way-ANOVA. In D group, test treatments did not show significant difference in the results. However, in ND animals there was a statistically significant difference in the glucose tolerance, between the animals fed with water and the animals fed with VCO, and with the animals fed with SO, with a very high significance level (p < 0.001). These results clearly show that VCO and SO were capable of improving the glucose tolerance when insulin was available, but not in its absence as seen with the alloxan treated diabetic animals. Red cell fragility of the above groups of animals was tested by suspending the red cells in saline solutions of varying NaCl concentrations (0 - 0.9 g/dL), and the released hemoglobin measured by spectrophotometry. In both ND and D groups, VCO fed animals showed a lesser red cell fragility than the other groups – indicating that VCO has a cell membrane stabilizing effect. Glucose uptake by the MCF–7 cells in the presence of varying concentrations of VCO hydrolysate and SO hydrolysate, with and without insulin was analyzed, using MEM and ‘Glucose uptake colorimetric assay kit’. Increasing the concentration of the hydrolysates of both oils to an extent (0.3l / 100 l medium), increased the glucose uptake in a dose dependent manner.
Gender evaluation using frontal sinus morphometry by means of computed tomography
(University of Peradeniya, Sri Lanka, 2023-09-20) Perera, M. G. R. S.; Senevirathna, G. D. R. S.; Rupasinghe, W. A. N. S.; Sasinda, K. T.
Gender evaluation is essential in forensic personal identification. Frontal Sinus (FS) was chosen as the gender discrimination tool in this study to evaluate the relationships between gender and FS morphometry using Computed Tomography (CT) owing to the uniqueness and high trauma resistivity of FS. A retrospective, quantitative study was conducted using 288 brain and paranasal sinus CT images of male (144) and female (144) patients available at the Department of Radiology, National Hospital, Kandy, Sri Lanka. Images were analyzed using RadiAnt DICOM viewer software. The presence or absence of the FS, the number of chambers, and the presence or absence of the septum were investigated as FS features. Maximum height, width, antero-posterior (AP) diameter and volume of the both left and right FS were investigated as FS measurements. Data were analyzed using SPSS statistical software. According to the study female group had statistically significant lower values for mean values of all measurements obtained in comparison to the male group. In both groups, the mean values of the left side were greater than the right side for FS maximum AP diameter, height, width, and volume. According to the results accuracy of determination of male patients through the FS measurements, highest accuracy was seen through total volume of FS 66.0%. Although there were lot of similarities in the findings compared to the results of similar studies carried out in different countries in the world, some discrepancies were also there which might be due to anatomical variations in different ethnicities. Significant associations of several FS parameters such as the height and width of the right FS, AP diameter and volumes of both FS with gender were identified and relatively good precision in the determination of gender could be attained in this study. Therefore, FS morphometry could be used as an effective method to determine the gender.
Awareness about modifiable risk factors and adherence to medication among hypertensive patients in a tertiary care hospital in Kandy District
(University of Peradeniya, Sri Lanka, 2023-09-20) Kumara,G.P.J.; Lasanthika,G.V.W.; Ariyasinghe,A.S.; Manawaduge,I.C.
Hypertension affects one in every four Sri Lankans over the age of 20. Adequate knowledge about the modifiable risk factors of hypertension and medication adherence is imperative in achieving good blood pressure control in patients. This study aims to assess the awareness about modifiable risk factors, and adherence to the medication among hypertensive patients attending follow-up clinics at the Teaching Hospital Peradeniya. This descriptive cross-sectional study was carried out on 354 hypertensive patients above 40 years of age, attending the hypertensive clinic at Teaching Hospital Peradeniya. The subjects were recruited through a systematic sampling method. Statistical analysis was done by using SPSS version 26. Descriptive statistics were presented as frequency, percentages, and as mean ± standard deviation for continuous variables (SD). Cross tabulations were done to explore the associations between socio-demographic characteristics and knowledge about modifiable risk factors and medication adherence of the patients by the chi- square test. P value < 0.05 was considered statistically significant. Of the assessed,36.7% had average, 29.9% had good and 33.3% had poor levels of awareness about modifiable risk factors. A significant association was observed between knowledge and the duration of disease (P<0.05), educational status (p=<0.001), and occupation (p=<0.001). A significant relationship was observed between the medication adherence level and duration of disease (P=0.005), and occupation (p<0.05). 52.0% medication adherence was at an intermediate level. Forgetfulness and interruptions of daily routine were common reasons for non-adherence. Hypertensive patients’ knowledge about modifiable risk factors was at an average level and medication adherence was at an intermediate level. Targeted health education strategies are needed to improve the patients’ knowledge about modifiable risk factors of hypertension and increase medication compliance to achieve blood pressure control and prevent adverse consequences.
Anatomical variations in the drainage of retromandibular venous system: a case study on Sri Lankan cadavers
(University of Peradeniya, Sri Lanka, 2023-09-20) Gunathilake,G.R.Y.A.; Angammana,H.M.R.W.; Hettiarachchi,H.A.A.U.S.; Ranasighe,W.G.K.I.; Samarakoon,S.M.K.G.H.; Banneheka,B.M.H.S.K.
Understanding the Retromandibular venous system holds significant importance in both, diagnostic and therapeutic procedures, especially in oral-maxillofacial, vascular, and plastic surgery, interventional radiology, as well as in intensive care. Retromandibular vein (RMV) is formed by the union of superficial temporal vein (STV) and maxillary vein (MV) within the parotid gland which splits into anterior and posterior divisions towards the inferior pole of the gland. The anterior division joins with the facial vein (FV), and forms Common facial vein (CFV) which drains to the internal jugular vein (IJV). The posterior division, along with the posterior auricular vein, contributes to the external jugular vein (EJV), which drains to the Subclavian vein (SCV). However, variations in venous drainage is possible due to their complexity in development. This reports such variations observed during anatomy dissection classes conducted for dental undergraduates using ten cadavers. Excluding the damaged specimens, we selected seventeen sides for the study, which includes one unilateral and eight bilateral specimens. Normal venous drainage was observed in six (35.2%) and out of these, two had double RMV after a short communication between STV and MV and in another two, RMV was forming a ring. Notably, in ten specimens (58.8%), CFV drained into EJV instead of IJV where seven EJV drained to the junction between SCV and IJV, and three drained to SCV. In one case (5.9%), FV was connected to both EJV and IJV by two branches. Such variations likely arise from the regression or retention of anastomosing venous channels formed during embryological development of the venous system. Therefore, it is recommended to confirm the venous pattern before any intervention. This study underscores the importance of understanding Retromandibular venous system variations to ensure safe and effective medical procedures.
Observed anatomical variations in the relationship between the retromandibular venous system and facial nerve branches
(University of Peradeniya, Sri Lanka, 2023-09-20) Hettiarachchi, H.A.A.U.S; Angammana, H.M.R.W.; Ranasinghe, W.G.K.I.; Samarakoon, S.M.K.G.H.; Gunathilake, G.R.Y.A.; Banneheka, B.M.H.S.K.
The retromandibular vein (RMV) as well as facial nerve (FN) are contents within the parotid gland where FN branches are running lateral to RMV. RMV holds dual importance in radiology and surgery, acting as a navigational guide and a critical anatomical landmark. Radiologically, it aids in localizing parotid gland tumors relative to FN. In surgical contexts like superficial parotidectomy, the RMV assists in dissecting the FN and its branches. This study reports of observations of the relationships between FN and the RMV among ten dissected cadavers at the Faculty of Dental Science, University of Peradeniya. There were four male and six female cadavers with a mean age of 75 years. Eight were bilaterally dissected on the parotid region and two were unilaterally dissected, having twelve sides of dissected specimens. Three cases (25%) displayed laterally running FN branches in relation to RMV. In one case (8.3%) FN branches were medial to RMV and in another (8.3%) temporofacial (TF) branch was medial and cervicofacial (CF) was lateral to RMV. Additionally, distinct patterns included the facial nerve forming rings around the superficial temporal vein in four cases (33.3%) and around the RMV in two cases (16.6%). The RMV also formed a ring, housing facial nerve branches, in two cases (16.6%). These variations hold significant surgical implications, shedding light on the relationship between the FN and RMV. Moreover, the identification of facial nerve rings around the superficial temporal vein and RMV suggests a need for their inclusion in existing classification systems. In summary, this study enriches our understanding of head and neck surgical procedures by uncovering crucial anatomical insights. The acquired knowledge benefits surgeons, radiologists, and researchers, aiming to enhance patient outcomes and mitigate surgical risks hence further studies on the region and reconsidering existing classifications are recommended.
Awareness about early symptoms and risk factors of myocardial infarction among people in a grama niladhari division in Anuradhapura District
(University of Peradeniya, Sri Lanka, 2023-09-20) Senarthne, S.G.N.M.; Dahanayake,D.W.P.
Myocardial infarction (MI) is one of the most devastating disorders under coronary heart diseases. Though many studies have been done to determine the awareness about early symptoms and risk factors of MI among general population throughout the world, no extensive studies have been reported from Sri Lanka in this regard. Aim of this study was to investigate the awareness of early symptoms and the risk factors of MI among general population in a Grama Niladhari Division in Anuradhapura District. A descriptive, cross-sectional study was conducted in a Grama Niladhari Division in Anuradhapura district among 375 participants by using systematic sampling method. Data was collected using a self-administered questionnaire. Cross-tabulations were done to explore the associations between independent and dependent variables. Of the 375 participants, 45.3% (n=170) were males and 54.7 % were females. Out of 375 participants, 144 (38.4%) had a poor awareness about early symptoms and risk factors of MI, while 131 (34.9%) of participants had average awareness. Only 100 (26.7%) had good awareness. The majority of participants had recognized central chest pain (73.3%, n=275), shortness of breath (71.2%, n=267) and pain radiating along the left arm (69.6%, n=261) as early symptoms of MI. High blood cholesterol (75.7%, n=284), high blood pressure (72.5%, n=272) and smoking (70.1%, n=263) were the most frequently mentioned risk factors. Awareness about early symptoms had a significant association with educational level (P<0.05). Our findings show that one-third of participants had poor awareness about early symptoms and risk factors of MI. Awareness about early symptoms had a significant association with educational level. These findings indicate that the implementation of community-related awareness programs on risk factors and early symptoms of MI among Sri Lankan general population would be important to minimize the morbidity and mortality of MI.
Unusual manifestations of dengue: a case series
(University of Peradeniya, Sri Lanka, 2023-09-20) Kothalawala,I.S.; Ralapanawa,D.M.P.U.K.; Jayalath,W.A.T.A.; Abeyagunawardena,S.
Dengue fever ranges from asymptomatic infection to dengue shock syndrome. However, there are patients presenting with atypical symptoms, as highlighted in this case series. A 27-year-old male presented with clinical features suggestive of appendicitis and a positive dengue NS1 antigen test. However, the ultrasound scan revealed a normal appendix. This case highlights the possibility of dengue fever presenting with atypical abdominal signs which pose a significant diagnostic challenge. A 57-year-old female presented with one day history of fever and a positive dengue NS1 antigen test. Ultrasound scan revealed evidence of significant leaking on day one of fever; which is unusual as leaking usually occurs at three to seven days of fever. This highlights the importance of screening for fluid leakage from the initial presentation. A 35-year-old female presented with a seven days history of fever. On the day eight of fever, an ultrasound scan showed significant leaking. Her dengue NS1 antigen test was positive, but dengue IgM antibodies were not detected. This is very unusual considering the classic serological progression of the disease. Furthermore, this patient showed evidence of leaking, whilst having a positive NS1 antigen test, which is very unusual. A 59-year-old female presented with fever for four days and became irritable, somnolent and aggressive; but there was no clinical evidence of meningitis. She had a positive dengue IgM antibody test. An electroencephalogram, revealed an encephalopathy. However, CSF analysis was not performed due to profound thrombocytopenia, making it difficult to exclude any other encephalitic pathogens. Such atypical manifestations described above might be unrecognized and underreported. So, every clinician needs to have a high index of suspicion, or else these uncommon manifestations of a common disease could be easily missed, leading to devastating consequences.
Antibacterial efficacy of selected hand sanitizer products available in local market in Kandy, Sri Lanka
(University of Peradeniya, Sri Lanka, 2023-09-20) Jinadasa,R.; Kathireson,H.
This study aimed to evaluate the antibacterial efficacy of selected locally available hand sanitizers. Seventeen products were characterized by sterility testing and in vitro kill curve assay using Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, and Pseudomonas aeruginosa ATCC 27953. Approximately 1.5 x 108 CFU/ml bacterial suspensions were mixed with equal volumes of sanitizers and viability was assessed for 30 minutes. The reduction of culturable bacterial load on hands of 10 volunteers who were trained on hand hygiene using sanitizers were assessed using thumbprint method. According to label information 11 products contained isopropyl alcohol (IPA) 75%-80% v/v, one product contained 1% IPA with 20% “herbal extracts”, another product contained undisclosed quantity of IPA. Two products contained ethyl alcohol (ETA) 75% v/v, one product was labeled as “contains IPA and ETA 75% v/v”. The remaining product was labeled as “contains alcohol”. Three products did not have registration from the National Medicines Regulatory Authority (NMRA). All but the product containing 1% IPA with 20% “herbal extracts” was sterile. This product was contaminated with Pseudomonas spp (7.1X104 CFU/ml), and therefore, excluded from the kill curve and thumbprint experiments. It was not registered with NMRA, but labeled as produced by “ISO 9001-2015 certified company.” In the kill curve assays, 10 out of 16 products completely inactivated E. coli immediately, while 4 products needed 1 minute, and one product needed 5 minutes exposure to achieve complete inactivation. Thirteen products completely inactivated S. aureus immediately, while one product needed 1 minute, and one product needed 5 minutes exposure to achieve complete inactivation. Fifteen products completely inactivated P. aeruginosa immediately. The remaining product labeled “containing 75% v/v ETA and kills 99.9% germs” failed to inactivate all three bacteria tested, even after 30 minutes exposure. This product was not registered with NMRA. In the thumbprint method, only 13 out of 16 products reduced at least 50% of culturable bacteria on the hands (range 60% - 90%), despite label claims of nine products indicating “kills 99.9% germs”. The lowest performing product (~10% efficacy) was the product that failed kill curve assay. The other two low performing products included the product containing undisclosed quantity of IPA and the product labeled as “contains IPA and ETA 75% v/v”. The findings highlight the need for stringent regulation of the quality of the hand sanitizers in the local market.
Investigation of an outbreak of recurrent subclinical mastitis in a dairy goat farm in Central Province, Sri Lanka
(University of Peradeniya, Sri Lanka, 2023-09-20) Jinadasa,R.; Nizananthan,K.; Attanayake,Y.D.N.
Mastitis is one of the costliest diseases in dairy goat herds worldwide. An outbreak of recurrent subclinical mastitis lasting for several months in a large-scale goat farm in the Central Province was investigated in this study. The affected animals were refractory to antibiotic treatment. However, the antibiotic treatment was undertaken without antibiotic sensitivity testing. Mycoplasma species are significant pathogens responsible for mastitis in goats, and the infections are often refractory to conventional antibiotic therapy. Therefore, the objectives of the current study were to determine whether Mycoplasma species are associated with subclinical mastitis in dairy goat farm. A total of 26 milk samples were collected from dairy goat farm in Gampola Veterinary Range, Central Province, Sri Lanka during two consecutive visits within one month. The samples were analyzed using microbiological culture, biochemical tests and PCR to investigate Mycoplasma species. The first set of samples (10 samples in total) were negative for bacterial and fungal growth. Out of the 16 samples from the second visit, 09 yielded bacterial growths, dominated by Klebsiella spp, followed by Staphylococcus aureus and Bacillus species. All the samples were negative for fungal growth. Out of the 9 samples that were positive for bacterial growth, 2 were positive for Mycoplasma spp. by PCR specific for 16SrRNA gene. This is the first study to confirm the presence of Mycoplasma spp in the milk from Sri Lankan dairy goats, however, due to budgetary limitations, it was not confirmed whether it’s a pathogenic species. Further studies on the phylogenetic analysis of Mycoplasma species in Sri Lankan goat farms are required to confirm the occurrence, epidemiology, and specific species of Mycoplasma involved in Sri Lanka.
Complementary and alternative medicine usage among chronic kidney disease patients in a tertiary care setting
(University of Peradeniya, Sri Lanka, 2023-09-20) Ratnayake,R.M.I.U.K.; Ravihari,W.A.; Choki, P.T.; Rimzy,A.A.; Rathnasooriya,D.T.; Abeysekera,R.A.
There is a growing trend of patients with Chronic Kidney Disease (CKD) seeking assistance from Complementary and Alternative Medicine (CAM) in Sri Lanka, influenced by the traditional medical history and cultural beliefs. The lack of tangible evidence of its effectiveness requires a more nuanced understanding of the area, given that there are potentially detrimental effects of certain CAM practices leading to development or worsening of the disease. This study was conducted to investigate the prevalence and patterns of CAM usage among CKD patients and identify potential associated factors among the users. A cross-sectional, observational study was performed at the CKD clinics of Teaching Hospital Peradeniya and National Hospital Kandy from June to August 2023. CKD patients were interviewed using an interviewer-based questionnaire regarding their CAM usage for the treatment of CKD. Out of the total 201 patient responses, 21.9% (n=44) patients admitted to the use of CAM for their CKD condition. Of the patients using CAMs, biologically based therapies were used by 56.8% (n=25), and 50% (n=22) used Ayurvedic medicine, while 40.9% (n=18) claimed to have used mind-body techniques. Out of the CAM users, only 20.5% (n=9) patients asserted to have discussed the use of CAM with their physician. The long duration of the disease showed a statistically significant association with the CAM usage (p=0.03), while gender (p=0.87), ethnicity (p= 0.6), stage of the disease (p=0.5) didn’t show a significant association. This study reveals that a considerable amount of CKD patients uses CAM alongside conventional treatment, whilst only a minority having discussed this with their physician. Also, this study highlights the trend of patients turning towards CAM as the disease progresses. Overall, this study emphasises on the importance of open discussion between patients and healthcare professionals, that may contribute to a more holistic and coordinated approach in managing CKD.

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