University of Kelaniya

Background The skin is the largest organ of the body, where many microorganisms reside. These microorganisms can produce detrimental effects if introduced into the body through surgical incisions. Therefore, the aseptic applications of the surgical site, with proper antiseptics, are necessary prior to an invasive medical procedure. Objectives This study aims to identify the knowledge, attitudes, and practices on skin asepsis with the use of antiseptics and to identify the most preferred antiseptic by healthcare professionals in Sri Lanka, which allows understanding of whether the current procedure of skin antisepsis is up to the standard. Methods A descriptive cross-sectional study was carried out among 210 healthcare professionals. Results Most participants had poor knowledge (92.9%) and moderate attitudes with moderate practices (55.2%). Conclusion This study highlights the need to improve further the existing skin antiseptic applications to address the gaps in knowledge, attitudes, and practices.

Polyaromatic hydrocarbons (PAHs) released from vehicular emissions and oil refineries deposit on the phyllosphere, compromising the quality of leaf-based food products by posing many health issues. Nevertheless, the tea phyllosphere harbours a variety of endophytes that are highly effective at degrading polyaromatic hydrocarbons, anthracene, and pyrene. The present study attempts to analyse the pyrene and anthracene degrading capability of phyllosphere endophytic fungi that inhabit Camellia sinensis (L.) Kuntze leaves. The frequency of occurrence of endophytic fungi in different leaf tissue layers was examined using light and scanning electron microscopy (SEM). The best pyrene and anthracene degrading strains were selected based on the High-Performance Liquid Chromatography (HPLC) results, and further kinetic assays. Light microscopy and SEM observations highlighted a heterogeneous endophytic fungal distribution among leaf tissue layers; the upper epidermis had the highest fungal distribution compared to other leaf layers. HPLC results revealed that Phyllosticta capitalensis, Colletotrichum gloeosporioides, Colletotrichum siamense, Pseudopestalotiopsis chinensis, and Daldinia eschscholtzii, have higher pyrene and anthracene degradation respectively and their PAH degradation kinetics follow the first-order kinetic model. The best anthracene and pyrene degrader, P. capitalensis showed the lowest half-life. The present investigation highlights the potential of P. capitalensis, the best pyrene and anthracene degrader that can remediate PAHs deposited on the phyllosphere of tea leaves.

Although a new Sri Lankan sport policy framework was introduced in 2012, no research has been done to evaluate the implementation of the policy framework. Consequently, the purpose of this study was to evaluate and identify mitigating factors in achieving the strategic goals of the Sri Lankan sport policy framework. Qualitative data and a quantitative approach were used to analyse and investigate the sport policy framework. A questionnaire (N = 240) and interviews (N = 05) were utilised to gather data from sport participants, non-sport participants and top-level sport administrators. Both quantitative and qualitative analyses suggested that the goals of the national sport policy framework have not been achieved. Lack of financial support, deficiency of government provision, institutional structural issues, and negative attitudes of policy actors were identified as mitigating factors in the process of policy implication. Developing an umbrella organisation for coordinating sport and government's support are vital to resolve those problems.

Key Clinical Message Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look‐alike or sound‐alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.

Background A new type of viral pneumonia, which has been named Coronavirus disease (COVID-19) began in Wuhan, China in late 2019 and has spread across the world since then. It has claimed more than 370 million confirmed cases and over 5.6 million deaths have been reported globally by the end of January 2022. This study aimed to analyze the trends, highly-nuanced patterns, and related key results relative to COVID-19 epidemiology in Sri Lanka. Methods Data on COVID-19 from March 2020 to January 2022 were obtained from published databases maintained by the Epidemiology Unit of the Ministry of Health in Sri Lanka and information regarding populations in administrative districts was obtained from the Department of Census and Statistics, Sri Lanka. Descriptive spatiotemporal analysis and autocorrelations were analyzed using SPSS statistical software. Results In Sri Lanka, the first case of COVID-19 was a Chinese national and the first local case was identified in the second week of March. As of 31 st of January 2022, a total of 610,103 COVID-19 cases had been recorded in the country, and 15,420 patients had died. At the beginning, the disease was mainly concentrated in the Western province and with time, it spread to other provinces. However, very low numbers of patients were identified in the North, Eastern, North Central, and Uva provinces until April 2021. The peak of COVID-19 occurred in August and September 2021 in all provinces in Sri Lanka. Then a decreasing trend of COVID-19 cases showed after September 2021. Conclusions COVID-19 is an emerging public health problem in Western and Southern Sri Lanka where the population density is high. A decreasing trend of COVID-19 cases showed in all provinces after September 2021. Public awareness programs for the prevention and control of the disease in endemic regions are essential to reduce the incidence of this infection.

We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle.

Background - Gas station attendants are exposed to benzene, toluene and xylenes (BTX) from fuels. The aim was to study the association between this exposure and spirometry parameters in gas station attendants and office workers as controls. Method – In 44 male gas station attendants and 38 office workers in the Gampaha district of Sri Lanka, spirometry was performed according to the guidelines of the American Thoracic Society (ATS). Pre- and postshift end-exhaled air samples were collected from a subgroup of 20 gas station attendants and 11 office workers and analysed for BTX by gas chromatography‒mass spectrometry. Results –The peak expiratory flow rate (PEF) and %-predicted PEF were significantly lower among gas station attendants compared to controls (p = 0.012). Among gas station attendants, the postshift sample benzene level showed a significant negative correlation with %-predicted forced vital capacity (FVC) (Spearman’s correlation coefficient of -0.683, p = 0.014). The %-predicted FVC was lower in gas station attendants working ≥ 5 years compared to those who worked < 5 years (82.71% ±12.53 vs 91.25%±7.50; p = 0.026). In controls, a distinct pattern was observed, indicating a moderate to strong association of postshift toluene and xylenes with all lung function parameters but not benzene. These results were adjusted for smoking. Conclusion –In gas station attendants, we observed restrictive responses in spirometry that were most pronounced for the level of work-related benzene exposure and associated with duration of employment. Air pollutants other than BTX may have contributed to explaining our findings.

Introduction: Hepatocellular carcinoma (HCC) is the most common liver-related cancer and the third leading cause of worldwide cancer-related mortality. Areas covered: There have been many updated guidelines on the management of HCC in the past few years. Given the increasing burden of HCC in clinical practice, knowledge of evidence-based standards of care for these patients is essential for any practitioner managing patients with HCC. Early detection and judicious treatment based on the stage of the HCC can improve patient outcomes. We performed a PubMed (MEDLINE database) search for the latest guidelines related to the screening, detection, diagnosis, staging and management of HCC. We aim to highlight some major considerations and common mistakes in managing HCC and attempt to provide evidence-based recommendations. Expert opinion: The field of HCC management is expected to evolve in the coming years. Increased emphasis on personalized treatment and precision medicine with earlier detection methods, the development of noninvasive diagnostic tools, increased focus on combination therapies and a shift toward more targeted treatments will become more critical.

The use of stated preference methods with monetary payments in developing countries can be problematic as barter and paying with labor are common in rural areas. In response, a growing number of stated preference studies explore using monetary and nonmonetary payment options. We contribute to this literature by exploring the impact of monetary vs. labor payment options on values elicited from choice experiment studies conducted in rural developing country settings. We also contribute to the literature by comparing data-gathering methods, specifically individual surveys vs. group information sessions. Our application is the restoration of an ancient irrigation system known as cascading tank systems in Sri Lanka. We conduct a choice experiment to understand the willingness to pay/willingness to contribute of rural households to restore these irrigation systems. We find that in the individual survey setting, there are no significant differences between monetary and labor payments. We also find that there is no difference between the group and individual survey settings for the monetary payment treatment. For the labor payment treatment, the group setting results in a positive payment coefficient for the labor payment attribute. This highlights that labor payments should be used cautiously in group evaluation settings.

Background Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease showing a rising prevalence globally. Genetic predisposition plays a key role in the development and progression of the disease pathogenicity. Main body This paper summarizes genetic associations based on their influence on several metabolic aspects such as lipid metabolism, glucose metabolism, hepatic iron accumulation and cholesterol metabolism toward the NAFLD pathogenicity. Furthermore, we present variations in some epigenetic characters and the microRNA profile with regard to NAFLD. Conclusion As reported in many studies, the PNPLA3 rs738409 variant seems to be significantly associated with NAFLD susceptibility. Other gene variants like TM6SF2 rs58542926, MBOAT7 rs641738 and GCKR variants also appear to be more prevalent among NAFLD patients. We believe these genetic variants may provide insights into new trends in developing noninvasive biomarkers and identify their suitability in clinical practice in the future. Graphical abstract

The objectives of this study were to determine selected Hofmeister anions and cations that are important for kidney health, in raw rice samples from selected Chronic Kidney Disease of unknown etiology (CKDu) endemic and non-endemic areas in Sri Lanka and their intake. The anions and cations were analyzed by Ion Chromatography and Microwave Plasma Atomic Emission Spectrometry (MP-AES), respectively, after alkaline and acid digestion in thirty raw rice samples each from CKDu endemic and non-endemic areas, and the dietary intake was estimated. The mean concentrations of fluoride (F⁻), chloride (Cl⁻), phosphate (PO4³⁻), sulfate (SO4²⁻), sodium (Na⁺), magnesium (Mg²⁺), potassium (K⁺), and calcium (Ca²⁺) in raw rice in CKDu endemic areas were 53.317, 1515.3, 2799.6, 2704.9, 30.603, 300.76, 1001.3, and 90.075 mg/kg, respectively. The mean concentration of the anions and cations in raw rice from CKDu non-endemic areas were 22.850, 947.52, 4418.7, 6080.2, 23.862, 364.45, 955.78, and 96.780 mg/kg, respectively. Significantly higher differences (p < 0.05) were reported in the mean concentration of F⁻, Cl⁻, and Na⁺ in raw rice from CKDu endemic areas in comparison with the samples from non-endemic areas. The aggregated estimated daily intake (EDI) and cumulative EDI of F⁻ via consumption of cooked non-traditional samba rice from CKDu endemic areas for adults were the highest (0.155 and 0.172 mg/kg bw/d, respectively), which were higher than the recommended tolerable upper intake value (0.15–0.2 mg/kg bw/d). In contrast, the traditional rice from CKDu non-endemic areas for adolescents, reported the lowest values (0.0210 and 0.0470 mg/kg bw/d, respectively). Adults who consume non-traditional samba rice from CKDu endemic areas were at health risk, while children were the most vulnerable group due to their low body weight. These results indicate that the consumption of rice rich in Hofmeister ions may contribute to the total intake and act as risk factors to negatively affect weak kidneys in CKDu endemic areas. Further research to analyze Hofmeister ions in cooked rice and rice from different countries is recommended. Graphical abstract

Introduction: The COVID-19 pandemic severely strained the health care in Sri Lanka. The subsequent economic crisis compounded this issue. Priority was given to treating those afflicted with COVID-19 and preventing its spread, and healthcare staff faced immense difficulties dealing with the situation. The psychosocial impact of COVID on health care staff has not been properly assessed or addressed. Objectives: A study was conducted to identify the psychosocial impact of COVID-19 among four different categories of health care workers, and perform a needs assessment among these groups. Methods: A convenient sample of frontline health workers, mental health teams, 1926 mental health helpline workers and 1990 Suwa Sariya emergency ambulance service staff were assessed via a self-administered questionnaire for mental health impact, work capacities and needs. Results: Among frontline workers (n=188), 42.5% experienced anxiety symptoms, 12.8% depressive symptoms and 4.1% suicidal thoughts. Most (58.9%) lacked a psychological support system at the workplace. Only 20% have accessed specific programs or services at their workplace to obtain support for mental health issues, and all have benefitted from them. All categories of health workers lacked training and resources. Conclusion: The findings demonstrate that a significant amount of health care workers undergo psychological problems in the course of their work especially in the aftermath of the COVID-19 pandemic. The analysis reveals that Sri Lanka lacks structured psychological support systems for health workers and needs more resources and training. Psychological support for health workers through strengthening resources and training should be prioritised when planning service development.

Introduction: The COVID-19 pandemic negatively impacted the global economy, disrupted essential health services, and distorted social determinants of health, reducing healthcare accessibility and increasing financial risk. Aim: we aimed to assess the impact of COVID-19 on healthcare accessibility and financial risk protection in Sri Lanka. Methodology: We conducted a cross-sectional study on a representative sample (multi-stage sampling process) of 3151 households in 105 clusters representing all the districts of Sri Lanka. The data collection was conducted using an interviewer-administered questionnaire in early November 2021. This was important to classify three periods of interest, namely: (1) the pre-lockdown period (2) the nationwide lockdown period, and (3) the new normal period. (After Oct 1 to early November 2021). Results: Among 11,463 household occupants, 12.6% reported having chronic diseases, with 76.5% diagnosed prior to six months. The majority had heart disease, high blood pressure, or diabetes. Of them, 53.7% have been followed up during the lockdown, increasing to 80.8% in the new normal period. Provincial variations in expenses were observed, with the highest food expenses in the Western Province. Catastrophic health expenditures affected 9.5% and 3.4% of households at 10% and 25%, respectively. Conclusions: A considerable proportion of those having heart disease, high blood pressure, high blood sugar or diabetes mellitus were not followed up in the lockdown period and the first month of the new normal period. Antenatal care and family planning were the least affected. Participants had incurred high out-of-pocket expenditures for healthcare during the entire period.

Elimination of malaria in 2012 was a major achievement in post-independent Sri Lanka. Sri Lanka missed a golden opportunity in 1963 when only 17 cases of malaria were reported in the country, but could not sustain the momentum resulting in a major resurgence in 1967/69. With the resurgence, the then malaria eradication programme was reverted back to a control programme that lasted for another 30 years. The WHO's Roll Back Malaria Initiative launched in 1998 provided a renewed interest in malaria control and subsequent elimination. With targeted control activities, the burden of malaria started to decrease since year 2000. Although Sri Lanka had reached pre-elimination status as early as 2004, the ongoing separatist war at that time prevented a country-wide elimination drive being implemented. With cessation of hostilities in 2009 and Global Fund financing, both of which were crucial inputs, an elimination drive was launched in September 2009 which eventually eliminated indigenous malaria in November 2012 with malaria-free certification by WHO being obtained in September 2016. Since malaria elimination, the country forged on to the prevention of re-establishment phase primarily focusing on good public practice that included intensified surveillance, both parasitological and entomological; quality assured diagnostic and treatment services; and advocacy at various level including doctors. Despite these measures, an introduced case and an induced case of malaria have been reported. A new vector of urban malaria, Anopheles stephensi, was reported in December 2016. Prevention of re-establishment of malaria should be kept in the radar of public health until malaria is eradicated.

Background Sri Lanka has maintained a rigorous programme to prevent the re-establishment of malaria ever since the disease was eliminated in October 2012. It includes efforts to sustain case surveillance to ensure early diagnosis and management of malaria. Yet, in April of 2023 the death occurred of an individual with imported malaria. Case presentation The deceased was a 37-year-old Sri Lankan male who returned to Sri Lanka on the 10th of April after a business trip to several countries including Tanzania. He was febrile on arrival and consulted three Allopathic Medical Practitioners in succession in his home town in the Western Province of Sri Lanka, over a period of 5 days starting from the very day that he arrived in the country. Malaria was not tested for at any of these consultations and his clinical condition deteriorated. On the evening of 14th of April he was admitted to the medical intensive care unit of a major private hospital in the capital city of Colombo with multiple organ failure. There, on a request by the treating physician blood was tested for malaria and reported early the next morning as Plasmodium falciparum malaria with a high parasitaemia (> 10%). The patient died shortly after on the 15th of April before any anti-malarial medication was administered. The deceased had been a frequent business traveller to Africa, but with no past history of malaria. He had not taken chemoprophylaxis for malaria on this or previous travels to Africa. Discussion The patient’s P. falciparum infection progressed rapidly over 5 days of arriving in Sri Lanka leading to severe malaria without being diagnosed, despite him seeking healthcare from three different Medical Practitioners. Finally, a diagnosis of malaria was made on admission to an intensive care unit; the patient died before anti-malarial medicines were administered. Conclusions This first death due to severe P. falciparum malaria reported in Sri Lanka after elimination of the disease was due to the delay in diagnosing malaria.

This paper aims to investigate the impact of Intellectual Capital on Value Creation mediated through Knowledge Management in Sri Lankan companies. The ‘static’ and the ‘dynamic’ aspect of knowledge and the theoretical models, which are based on the relationship between Intellectual Capital and Knowledge Management forced the authors to address this research problem. The study was based on the top corporate personnel’s views collected through a self-administered questionnaire. Out of 297 Public Listed Companies listed on Colombo Stock Exchange and 517 private companies registered in Ceylon Chamber of Commerce, 263 companies were selected as the sample. Value creation was measured through both non-financial value drivers and financial value drivers, which was an innovative feature of this study. The data was analyzed using multivariate analysis through Partial Least Square Structural Equation Modeling. The findings confirmed a partial mediation of knowledge management. Further, findings revealed a significant and positive impact of intellectual capital on value creation and a significant positive impact of intellectual capital on knowledge management. The impact of knowledge management on value creation was also a significant positive one.

The fundamental goal of this study is to develop a conceptual framework that integrates entrepreneurial intention, startup preparation, and startup decision. Thus, the Systematic Literature Review (SLR) technique and article selection based on the PRISMA approach is applied in this study. Between 2000 and 2020, the study included 38 papers from well-known databases. After reviewing previous literature, this study identified seven research gaps. Eventually, it developed a conceptual framework with three contextual variables: perceived educational support, perceived relational support, perceived structural support with perceived behavioral control, entrepreneurship intention, start-up preparation, and start-up decision. This first study combines all seven variables, resulting in start-up decisions under a single framework. The essential constraints are relying on a few databases and using only 38 peer-reviewed publications published in scholarly journals and written in English. Furthermore, academic research articles published between 2000 and 2020 are excluded. This study proposes practitioners of the aspects required early in beginning a business, which supports formulating effective policies for prospective entrepreneurs to enhance economic growth and innovation at the firm and national levels.

Sri Lanka has successfully met the challenge of controlling both lymphatic filariasis (LF) and soil-transmitted helminthiases (STH) as public health problems. The primary public health strategy for combatting both conditions has been preventive chemotherapy. The national programme for the elimination of LF implemented five annual rounds of mass chemotherapy in the endemic districts from 2002 to 2006 using a combination of diethylcarbamazine and albendazole. The overall microfilaria rate declined from 0.21% in 2001 before the mass chemotherapy, to 0.06% in 2016, at declaration of elimination of LF as a public health problem by the World Health Organization. Currently Sri Lanka is in the phase of post-validation surveillance. Achieving control of STH has been more difficult. Mass deworming programmes have been implemented for nearly a century, and national-level surveys reported prevalence rates declining from 6.9% in 2003 to 1% in 2017. However, neither of these infections has been completely eliminated. A situation analysis indicates continued transmission of both among high-risk communities. This paper explores the reasons for persistence of transmission of both LF and STH in residual pockets and the measures that are required to achieve long-term control, or perhaps even interrupt transmission in Sri Lanka. This article is part of the theme issue ‘Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs’.