Half a century of Sri Lanka research: Subjects, researchers, institutions, journals and impact (1973-2019) / Medio siglo de investigación en Sri Lanka: temas, investigadores, instituciones, revistas e impacto (1973-2019)

Abstract Introduction: Bibliometric analyses of research in Sri Lanka, a lower-middle income island nation in South Asia, has focused mainly on medical research, concluding that there is a need for increased research productivity and impact, and for local solutions to health concerns. There has been no general bibliometric analysis across scientific disciplines in the nation, or any study that covers a long period of time to identify general time trends. Objective: To measure and analyse Sri Lanka research by focusing on subjects, authors, institutions, journals and citation for half a century. Methods: We used an advanced search method to extract publications with the word "Sri Lanka" in the SCI-EXPANDED, and calculated indicators such as total citations from Web of Science Core Collection since publication year to the end of 2019, citations in 2019, and mean citations per publication. Journal data were taken from 2019 Journal Citation Report. Affiliation re-classification was done to ensure consistency regarding the origin of all publications. Publications were further analysed based on collaboration, and first and corresponding authorship. Results: We retrieved 16 069 publications in 19 document types (77 % articles). Corrections had the highest number of authors per publication (616) followed by articles (116). Four articles had more than 5 000 authors and 593 articles had more than 1 000 authors. The highest citations in this database were for international megaprojects where Sri Lanka authors played minor roles. The UK had the most collaborative articles with Sri Lanka (19 %). The articles were published in 3 051 journals across 177 Web of Science categories. The category of Public, environmental and occupational health, with 193 journals, had 6.7 % of all articles, followed by environmental sciences (6.6 %). Conclusion: Sri Lanka has an unusually strong pattern of participating as small role players in international megaprojects about health and physics. Sri Lanka authors should be encouraged to expand their horizons by researching non-applied fields that are the basis of all innovation; to strengthen their own journals so that they have better visibility and impact, and to improve their positions in international projects that are published in larger journals.

Resumen Introducción: Los análisis bibliométricos de la investigación en Sri Lanka, una nación insular de ingresos mediano-bajos en el sur de Asia, se han centrado principalmente en la investigación médica, concluyendo que existe la necesidad de aumentar la productividad y el impacto de la investigación, y de soluciones locales a los problemas de salud. No ha habido un análisis bibliométrico general de disciplinas científicas o algún estudio que cubra un período largo de tiempo para identificar tendencias generales. Objetivo: Medir y analizar la investigación de Sri Lanka centrándose en temas, autores, instituciones, revistas y citas, durante medio siglo. Métodos: Utilizamos un método de búsqueda avanzada para extraer publicaciones con las palabras "Sri Lanka" en el SCI-EXPANDED, y calculamos indicadores como el total de citas de Web of Science Core Collection desde el año de publicación hasta finales de 2019, citas solo en 2019, y media de citas por publicación. Los datos de revistas son del Journal Citation Report 2019. Revisamos manualmente las afiliaciones para garantizar su coherencia, y, de todos los tipos de publicación, analizamos en detalle los artículos en función de la colaboración y la autoría. Resultados: Hallamos 16 069 publicaciones en 19 tipos de documentos (77 % artículos). Las correcciones tuvieron el mayor número de autores por publicación (616), seguidas de los artículos (116 autores en promedio); cuatro artículos tenían más de 5 000 autores y 593 artículos tenían más de 1 000 autores. Las citas más altas en esta base de datos fueron para megaproyectos internacionales en los que los autores de Sri Lanka desempeñaron papeles menores. El Reino Unido tuvo más artículos colaborativos con Sri Lanka (19 %). Los artículos se publicaron en 3 051 revistas de 177 categorías del Web of Science. La categoría d Salud pública, ambiental y ocupacional, con 193 revistas, tuvo el 6.7 % del total de artículos, seguida de Ciencias ambientales (6.6 %). Conclusión: En Sri Lanka hay una tendencia inusual a participar como pequeños actores en megaproyectos internacionales sobre salud y física. Debería alentarse a quienes hacen ciencia en Sri Lanka a ampliar sus horizontes investigando campos no aplicados, que son la base de la innovación; a fortalecer sus propias revistas para lograr mayor visibilidad e impacto, y a mejorar su ubicación en proyectos internacionales que se publican en revistas más grandes.

Estimation of sex from the osteometric measurements of the femur in a contemporary Sri Lankan population / Estimación del sexo a partir de las medidas osteométricas del fémur en una población contemporánea de Sri Lanka

SUMMARY: Sex estimation from human skeletal remains is of vital importance in the buildup of a biological profile of an individual in medico-legal and bioarchaeological studies. The present study is focused on the estimation of sex from osteometric measurements of the complete femur and its fragmentary parts, and the development of a web based application related to this. Fifteen osteometric measurements were taken from 78 dry cadaveric femurs from the Faculty of Medicine, University of Kelaniya. Using R software, linear discriminant analysis and logistic regression methods were applied to build classification models with the help of the application of a stepwise procedure, to identify the best combination of measurements to estimate the sex of the femur. A cross-validation method was applied to estimate the predictive accuracy of each model. Since the linear discriminant analysis model gave more predictive accuracy than the regression model, we suggest using linear discriminant analysis to estimate the sex using osteometric measurements of the femur. From the whole femur measurements, a formula to determine sex was developed with highest total accuracy of 83 % using four parameters; epicondylar breadth, anteroposterior mid-shaft diameter, bi-trochanter length, and maximum shaft diameter. Similarly, measurements of transverse head diameter and bi-trochanter length with a total accuracy of 76 % for the proximal part of the femur, measurements of anteroposterior mid-shaft diameter with a total accuracy of 77 % for the mid-shaft, and measurements of epicondylar breadth and maximum length of the lateral condyle with a total accuracy of 70 % for the distal part of the femur were identified as significant discriminants to determine sex, and formulae were written accordingly. Average accuracy ranged from 83 % to 70 %, with male accuracy slightly higher than that of females. A web application to estimate the sex of femur using these formulae was developed and this will be of great importance for forensic medicine and bio-archaeological research in Sri Lanka.

RESUMEN: La estimación del sexo a partir de restos óseos humanos en los estudios médico-legales y bioarqueológicos es de vital importancia en la construcción de un perfil biológico de un individuo. El objetivo de este estudio fue la estimación del sexo a partir de medidas osteométricas del fémur completo y sus partes fragmentarias, y el desarrollo de una aplicación web relacionada con esto. Se tomaron quince medidas osteométricas de 78 fémures cadavéricos secos de la Facultad de Medicina de la Universidad de Kelaniya. Utilizando el software R, se aplicaron métodos de análisis discriminante lineal y regresión logística para construir modelos de clasificación con la aplicación de un procedimiento por pasos, para identificar la mejor combinación de medidas y estimar el sexo a partir del fémur. Se aplicó un método de validación cruzada para estimar la precisión predictiva de cada modelo. Dado que el modelo de análisis discriminante lineal proporcionó una mayor precisión predictiva que el modelo de regresión, sugerimos su utilización para estimar el sexo mediante mediciones osteométricas del fémur. A partir de las mediciones del fémur completo, se desarrolló una fórmula para determinar el sexo con la mayor precisión total del 83 % utilizando cuatro parámetros; anchura del epicóndilo, diámetro anteroposterior del tercio medio de la diáfisis, longitud bitrocánter y diámetro máximo de la diáfisis. De manera similar, utilizamos las mediciones del diámetro transversal de la cabeza del fémur y la longitud del bitrocánter con una precisión del 76 % para la parte proximal del hueso, las mediciones del diámetro anteroposterior del tercio medio de la diáfisis se obtuvo con una precisión del 77 %. El ancho del epicóndilo y la longitud máxima del cóndilo lateral con una precisión del 70 % para la parte distal del fémur se identificaron como discriminantes significativos para determinar el sexo y se escribieron fórmulas. La precisión promedio osciló entre el 83 % y el 70 %, siendo la precisión en los hombres ligeramente superior al de las mujeres. Se desarrolló una aplicación web para estimar el sexo del fémur utilizando estas fórmulas y creemos será importante para la medicina forense y la investigación bioarqueológica en Sri Lanka.

Human skeletal remains analysis rom pallemalala shell midden in Southern Sri Lanka / Análisis de restos óseos humanos del vertedero de conchas de pallemalala en el sur de Sri Lanka

SUMMARY: Sri Lanka, an island off the tip of the Southeast of the Indian subcontinent processes the earliest skeletal evidence of anatomically modern Homo sapiens (37,000 B.P.) and the best human skeletal record sequence in the South Asian region. Adding another to the list, the skeletal remains, which belong to Mesolithic culture were found at Pallemalala shell midden in Southern Sri Lanka during scientific archaeological exploration by Postgraduate Institute of Archaeology, University of Kelaniya. Sri Lanka. The aim of the study was to determine the minimum number of human individuals, age, sex, and pathological conditions related to the ancient Pallemalala commiunity. For the primary analysis, 426 bone fragments were available. Out of those, 233 bones were identified as human bones which represent 7 minimum number of individuals. The rest of the collection comprises some animal bones and shell species. The community was predominated by the female population. The identified age categories were around 20 years, between 35-45 years, and over 45 years. The encountered pathological lesions were bone thickening, alveolar resorption, dental abscesses, dental caries, antemorterm tooth loss, calculus deposits and brown colour stains on teeth. Regarding the dietary pattern, it was evident that their diet may have consisted of coarse foodstuffs with an extremely basic dietary chemistry.

RESUMEN: Sri Lanka es una isla en la punta del sureste del subcontinente indio que procesa la evidencia esquelética más antigua del Homo sapiens anatómicamente moderno (37.000 AP) y la mejor secuencia de registros esqueléticos humanos en la región del sur de Asia. Agregando otro elemento a la lista, los restos óseos, que pertenecen a la cultura mesolítica, se encontraron en el vertedero de conchas de Pallemalala en el sur de Sri Lanka durante la exploración arqueológica científica realizada por el Instituto de Postgrado de Arqueología de la Universidad de Kelaniya, Sri Lanka. El objetivo del estudio fue determinar el número mínimo de individuos humanos, edad, sexo y condiciones patológicas relacionadas con la antigua comunidad Pallemalala. Para el análisis se dispuso de 426 fragmentos óseos. De esos, 233 huesos fueron identificados como huesos humanos que representan un número mínimo de 7 individuos. El resto de la colección se componía de algunos huesos de animales y especies de conchas. La comunidad estaba dominada por la población femenina. Las categorías de edad identificadas fueron alrededor de 20 años, entre 35-45 años y mayores de 45 años. Las lesiones patológicas encontradas fueron engrosamiento óseo, reabsorción alveolar, abscesos dentales, caries dental, pérdida de dientes antemortem, depósitos de cálculo y manchas de color marrón en los dientes. En cuanto al patrón dietético, era evidente que su dieta pudo haber consistido en alimentos toscos con una química dietética extremadamente básica.

Trajetórias de migração e transferências à prova: um dispositivo de acompanhamento e de cuidado de uma criança autista e de sua família / Trayectorias migratorias y transferenciales: un sistema de tratamiento y cuidado para un niño autista y su família / Migratory and transferential trajectories: a support and care system for an autistic child and his family / A l'épreuve des trajectoires migratoires et transférentielles: un dispositif d'accompagnementet de soin d'un enfant autiste et de sa famille

Diagnosticado como autista por uma plataforma especializada, Katal tinha 4 anos quando foi recebido em um centro de cuidado especializado. Diante de sua grande agitação psicomotora e da dificuldade de seus pais em fazer contorno através da narração de sua história, decidiu-se coletivamente que esta criança e sua família seriam recebidas o quanto fosse necessário por uma dupla de profissionais: uma psicomotricista e uma psicóloga, de maneira a poder trabalhar ao mesmo tempo e no mesmo espaço as dinâmicas psicocorporais, psicossociais e intersubjetivas desta situação preocupante. Mostra-se como este dispositivo, fazendo uso de mediadores terapêuticos, favoreceu o aparecimento da figuração e da narrativa da história de migração de extrema complexidade desta família, abrindo assim a possibilidade de diálogo entre a criança e os adultos, mas também entre os adultos, compreendendo um diálogo interior de retomada e de transformação de momentos traumáticos ligados ao exílio

Diagnosticado de autismo por una plataforma especializada, Katal tenía 4 años cuando fue atendido por primera vez en un servicio sanitario. En vista de su gran agitación psicomotriz y de la dificultad de sus padres para tejer un relato mientras lo contienen, decidimos colectivamente que este niño y su familia sean recibidos, en la medida de lo necesario, por un dúo de profesionales: un psicometrista y un psicólogo, para poder trabajar en un mismo tiempo y espacio las dinámicas psicocorporales, psicosocialese intersubjetivas en juego en esta preocupante situación. Mostraremos cómo este dispositivo, al introducir mediaciones terapéuticas aceptando cuestionar su pertinencia, favoreció la figuración y la narración de la trayectoria migratoria de extrema complejidad para esta familia, abriendo así la posibilidad de un diálogo entre el niño y los adultos, pero también entre los adultos, incluyendo un diálogo interior de reanudación y transformación de los momentos traumáticos ligados al exilio

Diagnosed with autism by a dedicated platform, Katal was 4 years old when he was first seen in an health service. In view of his great psychomotor agitation and the difficulty for his parents to weave a narrative while containing him, we decide collectively that this child and his family will be received, as much as necessary, by a duo of professionals: a psychometrician and a psychologist, so as to be able to work in the same time and space on the psychocorporal, psychosocial and intersubjective dynamics at work in this worrying situation. We will show how this device, by introducing therapeutic mediations while accepting to question their relevance, favoured the figuration and the narration of the migratory trajectory of extreme complexity for this family, thus opening the possibility of a dialogue between child and adults, but also between adults, including an inner dialogue of resumption and transformation of traumatic moments linked to the exile

Diagnostiqué autiste par une plateforme dédiée, Katal a 4 ans lorsqu'il est reçu pour la première fois en centre de soin ambulatoire. Devant sa grande agitation psychomotrice et la difficulté pour ses parents de tisser un récit tout en étant contenant pour lui, nous décidons collectivement que cet enfant et sa famille seront reçues, autant que nécessaire, par un duo de professionnel: un psychomotricien et une psychologue, de sorte à pouvoir travailler dans un même temps et un même espace les dynamiques psychocorporelles, psychosociales et intersubjectives à l'œuvre dans cette situation préoccupante. Nous montrerons comment ce dispositif en introduisant des médiations thérapeutiques tout en acceptant d'en questionner la pertinence, a favorisé la figuration et la mise en récit de la trajectoire migratoire d'une extrême complexité pour cette famille, ouvrant ainsi la possibilité d'un dialogue entre enfant et adultes, mais aussi entre adultes, y compris un dialogue intérieur de reprise et de transformation de moments traumatiques liés à l'exil

Morphometric analysis of infraorbital foramen using cone beam computed tomography in a cohort of Sri Lankan adults / Análisis morfométrico del foramen infraorbitario mediante tomografía computarizada de haz cónico en una cohorte de adultos de Sri Lanka

SUMMARY: Infraorbital foramen (IOF) located bilaterally within the maxillary bone about 1 cm inferior to the infraorbital margin is a vital landmark when delivering local anesthesia and during surgical interventions in the midface region. A total of 122 infraorbital foramina in 61 cone beam computed tomographic (CBCT) images of 32 females and 29 males in the age range of 17 to 32 were analyzed to determine the shape, direction, presence of accessory foramina, size and the precise position of IOF in relation to the inferior orbital margin (IOM), maxillary midline (MM), lateral nasal wall (LNW), alveolus (ALV) and maxillary teeth in a group of Sri Lankan people. The IOF was oval in shape (80.3 % and 88.5 % on the right and left side, respectively) in a majority of individuals. The infraorbital foramina were located at a mean distance of 5.56 ± 3.95 and 4.91 ± 2.08 mm, below the IOM on the right and left side, 27.13 ± 2.6 and 26.99 ± 2.73 on the right and left side from the mid maxillary line, 11.96 ± 3.45 mm and 12.18 ± 3.35 from the LNW on the right and left side and 29.59 ± 3.59 and 29.65 ± 3.28 above the alveolar crest on the right and left side. There were no statistically significant differences between the left and right sides or between sexes. Majority of IOF (37.5 % and 55.9 % on the right and left side, respectively) were located in the vertical plane passing though the maxillary second premolar tooth.

RESUMEN: El foramen infraorbitario (FIO) ubicado bilateralmente dentro de la maxila, aproximadamente 1 cm inferior al margen infraorbitario, es un punto de referencia vital cuando se administra anestesia local y durante intervenciones quirúrgicas en la región media de la cara. Se analizaron un total de 122 forámenes infraorbitarios en 61 imágenes de tomografía computarizada de haz cónico (CBCT) de 32 mujeres y 29 hombres en un rango etario de 17 a 32 años para determinar la forma, dirección, presencia de forámenes accesorios, tamaño y posición precisa de FIO en relación con el mar- gen orbitario inferior (MOI), la línea mediana maxilar (MM), la pared nasal lateral (PNL), el alvéolo (ALV) y los dientes maxilares en un grupo de personas de Sri Lanka. En la mayoría de los adultos se observó que el FIO tenía forma ovalada (80,3 % y 88,5 % en el lado derecho e izquierdo, respectivamente) Los forámenes infraorbitarios se ubicaron a una distancia media de 5,56 ± 3,95 y 4,91 ± 2,08 mm, por debajo del MOI en los lados derecho e izquierdo; 27,13 ± 2,6 y 26,99 ± 2,73 en el lado derecho e izquierdo desde la línea maxilar mediana, 11,96 ± 3,45 mm y 12,18 ± 3,35 de la PNL en el lado derecho e izquierdo y 29,59 ± 3,59 y 29,65 ± 3,28 por encima de la cresta alveolar en los lados derecho e izquierdo. No hubo diferencias estadísticamente significativas entre los lados izquierdo y derecho o entre sexos. La mayoría de IOF (37,5 % y 55,9 % en el lado derecho e izquierdo, respectivamente) se ubicaron en el plano vertical que pasa por el segundo premolar maxilar.

Hand and handprint measurements in the estimation of stature in a Sri Lankan population / Mediciones de manos y huellas de manos en la estimación de la estatura en una población de Sri Lanka

SUMMARY: The present study was undertaken to generate sex-specific simple and multiple regression models for the estimation of stature using hand and handprint measurements in a Sri Lankan population. The sample comprises 51 males and 66 females in the age range of 20 to 26 years. The stature and eight measurements from each hand and its corresponding print of each subject were collected using standard anthropometric instruments and techniques. All hand and handprint measurements showed significantly positive correlation (p value < 0.05) with the stature in both sexes. Stature prediction accuracy for simple linear regression equations ranged from ±4.41-5.92 cm and ±4.0- 5.22 cm for the left and right hand measurements in males and females, respectively. The corresponding figures for the left and right handprint measurements were ±4.57-5.95cm and ±4.36-5.52 cm, respectively. The highest stature prediction accuracy was shown by the multiple regression models derived from hand measurements. The stature estimating formulae reported in this study using hand measurements have important application in the identification of unknown human remains, particularly when they are partial, mutilated or dismembered. Similarly, it is envisaged that formulae derived from the handprint measurements will be useful in crime scene investigations.

RESUMEN: El estudio se llevó a cabo para generar modelos de regresión simple y múltiple de acuerdo al sexo, para la estimación de la estatura utilizando medidas de manos y huellas de manos en una población de Sri Lanka. La muestra comprendió 51 hombres y 66 mujeres entre 20 a 26 años de edad. Se analizaron la estatura y ocho medidas de cada mano y su impresión correspondiente de cada sujeto utilizando instrumentos y técnicas antropométricas estándar. Todas las mediciones de manos y las huellas de manos indicaron una correlación significativamente positiva (valor de p <0.05) con la estatura en ambos sexos. La precisión de la predicción de la estatura para las ecuaciones de regresión lineal simple varió de ± 4,41 a 5,92 cm y ± 4,0 a 5,22 cm en las medidas de la mano izquierda y derecha en hombres y mujeres, respectivamente. Las cifras correspondientes para las medidas de la huella de la mano izquierda y derecha fueron ± 4,57-5,95 cm y ± 4,36-5,52 cm, respectivamente. La precisión de predicción de la estatura más alta se mostró mediante los modelos de regresión múltiple derivados de las mediciones manuales. Las fórmulas de estimación de la estatura reportadas en este estudio utilizando medidas manuales tienen una aplicación importante en la identificación de restos humanos desconocidos, particularmente cuando son parciales, o se encuentran mutilados o desmembrados. Además, se prevé que las fórmulas derivadas de las mediciones de huellas de manos serán útiles en las investigaciones criminales.

Understanding Experiences of Young Adult Males with Below-Knee Amputation

@#PURPOSE: This study was done to explore the experiences of young adult males with below-knee amputation at surgical wards and clinics in Teaching Hospital, Kurunegala, Sri Lanka. DESIGN: The study used the phenomenology design of qualitative research. METHODS: Face-to-face interviews were conducted for data collection using a theme list with a saturation point reached at 16 participants. The duration of an interview was 30-45 minutes and was recorded on audiotape and transcribed later. Phases of familiarization with the data, coding, searching for themes, reviewing themes, defining and naming themes, and writing up were conducted accordingly to thematic analysis. FINDINGS: The young adult male below-knee amputees showed changes in lifestyle with dependence on others, supporting aids, and experiencing discomfort. They showed mental distress with dissatisfaction with life and suffering of life. Additionally, they lacked power with identity changes and encounter economic problems in their lives. CONCLUSIONS AND RECOMMENDATIONS: It is essential to give special education to the staff caring for the below-knee amputees to minimize their unpleasant and challenging experiences. Health staff can motivate family members and friends for individuals' mental adjustment to their new life. Additionally, the social attitude of the community should be changed positively regarding amputated patients.

A study of morphological and morphometric variations in Sri Lankan femoral diaphysial nutrient foramina / Estudio de las variaciones morfológicas y morfométricas de los forámenes nutricios diafisarios de fémur en Sri Lanka

SUMMARY: Blood supply to the diaphysis of long bones is majorly through nutrient artery, which enters the bone via nutrient foramen. The present study aims to identify morphological and morphometric variations of nutrient foramina of the femur, which is the largest long bone of the body extending from the pelvis to knee. A sample of 81 Sri Lankan adult femur were analyzed. The mean length of the femur analyzed was 436.93 mm and mean foramen index was 43.52. The majority of the bones had a single nutrient foramen. The predominant location of the nutrient foramen was on the posterior aspect of the bone in the middle third of the shaft according to the study. Majority of foramina were directed distally. The indices on nutrient foramen are important for procedures such as bone grafts and tumor resections, in managing trauma, orthopedic procedures and radiological interpretations.

RESUMEN: El suministro de sangre a la diáfisis de los huesos largos se realiza principalmente a través de la arteria nutricia, que ingresa al hueso a través del foramen nutricio diafisario. El presente estudio tiene como objetivo identificar las variaciones morfológicas y morfométricas del foramen nutricio del fémur, el hueso largo más grande del cuerpo que se extiende desde la pelvis hasta la rodilla. Se analizó una muestra de 81 fémures adultos de individuos de Sri Lanka. La longitud media de los fémures analizados fue de 436,93 mm y el índice de foramen medio fue de 43,52. La mayoría de los huesos tenían un solo foramen nutricio. Según el estudio, la ubicación predominante del foramen nutricio estaba en la cara posterior del hueso en el tercio medio del eje. La mayoría de los forámenes estaban dirigidos distalmente. Los índices sobre el foramen nutricio son importantes para procedimientos tales como injertos óseos y resecciones tumorales, en el manejo de traumatismos, procedimientos ortopédicos e interpretaciones radiológicas.

Psychological Distress among Adolescents in Laos, Mongolia, Nepal, and Sri Lanka

PURPOSE: The purpose of this study was to explore psychological distress and examine the relationship between this distress and individual, family, and school factors among adolescents in four low- and middle-income countries (LAMICs) in Asia (i.e., Laos, Mongolia, Nepal, and Sri Lanka). METHODS: A total of 4,098 adolescents attending public schools in the four LAMICs were surveyed as part of the Healthy School Development Project, which aimed to develop school capacity for improving (1) health among all school members and (2) the school environment through tailored school health programs. Psychological distress, family factors (i.e., parental understanding and monitoring, and parental tobacco and alcohol use), and school factors (i.e., having close friends, not bullied, school attendance, and health education) were assessed using self-report questionnaires. Data were collected from September to November in 2012 and 2013. Data analysis comprised descriptive statistics, Chi-squared testing, and logistic regression. RESULTS: Over half of the participants were women (53.2%–64.1%), and 33.7% (in Sri Lanka) to 53.8% (in Laos) were aged older than 15 years. Approximately 32.9% reported the presence of psychological distress; moreover, 7.9%–13.2% reported suicidal ideation. Parental monitoring and being bullied were associated with psychological distress in all four countries. CONCLUSION: One-third of adolescents experience psychological distress across these four LAMICs, which poses a substantial public health issue. Adolescents can benefit from family and school-based approaches for screening, ameliorating, and preventing psychological distress.

Applicability of McDonald 2010 and Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) 2016 Magnetic Resonance Imaging Criteria for the Diagnosis of Multiple Sclerosis in Sri Lanka

BACKGROUND AND PURPOSE: The magnetic resonance imaging in multiple sclerosis (MAGNIMS) group recently proposed guidelines to replace the existing dissemination-in-space criteria in McDonald 2010 magnetic resonance imaging (MRI) criteria for diagnosing multiple sclerosis. There has been insufficient research regarding their applicability in Asians. Objective of this study was to determine the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of McDonald 2010 and MAGNIMS 2016 MRI criteria with the aim of verifying their applicability in Sri Lankan patients. METHODS: Patients with clinically isolated syndrome diagnosed by consultant neurologists were recruited from five major neurology centers. Baseline and follow-up MRI scans were performed within 3 months from the initial presentation and at one year after baseline MRI, respectively. McDonald 2010 and MAGNIMS 2016 MRI criteria were applied to all MRI scans. Patients were followed-up for 2 years to assess the conversion to clinically definite multiple sclerosis (CDMS). The sensitivity, specificity, accuracy, PPV, and NPV for predicting the conversion to CDMS were calculated. RESULTS: Forty-two of 66 patients converted to CDMS. Thirty-seven fulfilled the McDonald 2010 MRI criteria, and 33 converted to CDMS. MAGNIMS 2016 MRI criteria were fulfilled by 29, with 28 converting to CDMS. The sensitivity, specificity, accuracy, PPV, and NPV were 78%, 83%, 64%, 89%, and 69%, respectively, for the McDonald 2010 criteria, and 67%, 96%, 77%, 96%, and 62% for the MAGNIMS 2016 MRI criteria. CONCLUSIONS: MAGNIMS 2016 MRI criteria were superior to McDonald 2010 MRI criteria in specificity, accuracy, and PPV, but inferior in sensitivity and NPV.

Differences in High Dose Antipsychotic Prescriptions in Patients with Schizophrenia in Asian Countries/Areas: Findings from the REAP-AP Study

The REAP-AP study recruited 3,746 patients with schizophrenia, in March and April 2016, from 71 centers in 15 Asian countries/territories namely Bangladesh, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, Thailand and Vietnam. Our findings reveal a trend according to which high dose antipsychotic prescription is more prevalent in Eastern Asia (especially, Japan and Korea) than in other regions of Asia. This historical factor may be associated with our finding of an Eastern Asian preponderance of high dose antipsychotic prescription.

Red blood cell acetylcholinesterase activity among healthy dwellers of an agrarian region in Sri Lanka: a descriptive cross-sectional study

BACKGROUND@#Assessment of acetylcholinesterase-inhibitor insecticide (AChEII) toxicity depends on the measurement of red blood cell acetylcholinesterase (RBC-AChE) activity. Its interpretation requires baseline values which is lacking in scientific literature. We aim to find the measures of central tendency and variation for RBC-AChE activity among dwellers of Anuradhapura, where the use and abuse of AChEIIs were rampant for the last few decades.@*METHODS@#A descriptive cross-sectional study with a community-based sampling for 100 healthy non-farmers (male:female = 1:1) was done using pre-determined selection criteria. Duplicate measurements of RBC-AChE activity were performed according to the modified Ellman procedure. Pearson's correlation and regression analysis were sort for RBC-AChE activity against its possible determinants.@*RESULTS@#RBC-AChE activity had a mean of 449.8 (SD 74.2) mU/μM Hb with a statistical power of 0.847. It was similar to values of "healthy controls" from previous Sri Lankan toxicological studies but was low against international reference value [586.1 (SD 65.1) mU/μM Hb]. None of the possible determinants showed a significant strength of relationship with RBC-AChE activity.@*CONCLUSION@#The baseline RBC-AChE activity among people of Anuradhapura is low in comparison with international reference values. This arises a need to find a causative mechanism.

Acetylcholinesterase inhibitor insecticides related acute poisoning, availability and sales: trends during the post-insecticide-ban period of Anuradhapura, Sri Lanka

BACKGROUND@#Acetylcholinesterase inhibitor insecticides (AChEIIs) were used extensively in the agrarian region of Anuradhapura for the past few decades. As a result, the region faced a heightened risk of toxicity. Carbaryl, carbofuran, chlorpyrifos, dimethoate, and fenthion were the five hazardous AChEIIs banned from Anuradhapura in 2014. Assessment of post-ban trends in acute poisoning will reveal the impact of the ban. Data on availability and sales of remaining AChEIIs will guide towards preventive measures against related toxicities.@*METHODS@#Cross-sectional surveys were conducted at Anuradhapura district of Sri Lanka. Details related to acute AChEII poisoning were sorted from the Teaching Hospital Anuradhapura. Main insecticide vendors in Anuradhapura were surveyed to find information on availability and sales of AChEIIs. Chi-square for goodness of fit was performed for trends in acute poisoning and sales.@*RESULTS@#Hospital admissions related to acute AChEII poisoning have declined from 554 in 2013 to 272 in 2017. Deaths related to acute AChEII poisoning have declined from 27 in 2013 to 13 in 2017. Sales of all five banned AChEIIs had reduced by 100%. Sales of the remaining AChEIIs were declining, except for acephate, phenthoate, and profenofos. However, one of the top selling, most frequently abused carbosulfan, had the highest risk of toxicity. Chi-square for goodness of fit showed a significance (P < 0.001) between the trends of hospital admissions for acute AChEII poisoning and the sales related to AChEIIs.@*CONCLUSIONS@#Hospital admissions related to acute poisoning was declining along with the overall sales of remaining AChEIIs, during the post-AChEII ban period. Nevertheless, future vigilance is needed on the remaining AChEIIs to predict and prevent related toxicities.

Handgrip Strength and Its Associated Factors among Community-dwelling Elderly in Sri Lanka: A Cross-sectional Study

PURPOSE: Low muscle strength is central to geriatric physical disabilities and mortality. The purpose of the present study was to examine handgrip strength (HGS) and its associated factors among community-dwelling older people in Sri Lanka. METHODS: A cross-sectional study was conducted in the Kandy district using multistage sampling. A total of 999 older people were recruited, with a female preponderance. Data were collected using interviewer-administered questionnaires on demographic characteristics, depression, and physical activity. Anthropometric measurements including weight, height, mid-upper arm circumference, calf circumference, and HGS were recorded. Complex sample general linear model was used to examine the association between HGS and its associated factors. RESULTS: The mean highest HGS of the study group was 12.56 kg (95% confidence interval: 11.94–13.19). Male older people had a higher HGS (17.02, 95% confidence interval: 15.55–18.49 kg) than females (10.59, 95% confidence interval: 10.12–11.06 kg). For both men and women, older age was associated with lower HGS, while mid-upper arm circumference was associated with better HGS. Diabetes mellitus, vegetarian diet, and alcohol consumption were associated with HGS for women only. CONCLUSION: Men had a higher HGS compared with women. Age, mid-upper arm circumference, diabetes mellitus, vegetarian diet, and alcohol consumption were factors associated with HGS among community-dwelling older people in Kandy district, Sri Lanka. HGS can be used as a feasible strategy to improve health status of older people by community health nurses.

Occipito-frontal circumference as a personal stature predictor in a group of Sri Lankan adults / Circunferencia occipito-frontal como predicción de la estatura en un grupo de adultos de Sri Lanka

SUMMARY: Accurate estimation of the personal stature is important in calculating body mass index, assessing nutritional status and the risk of cardiovascular disease, prediction of energy needs and in adaptation of cytostatic drug doses. However, various situations such as, patients in emergency or critical care settings or immobilized patients who are bed ridden or in wheelchairs make it difficult or even impossible to obtain the personal stature using standardized methods. Thus, the need for an alternate method of personal stature prediction arises. Despite its potential practical utility, little is known concerning the relationship between occipito-frontal circumference (OFC) of the head and personal stature among the adult Sri Lankans. Therefore, the goal of this study was to propose population and sex specific regression formula for personal stature estimation using the OFC. Personal stature and OFC was recorded in a total of 156 cadavers belonging to 55 - 89 years of age: (male: n=74; female: n=82). Subjects with any craniofacial deformities or history of neurological disorders were excluded from the study. The mean stature (cm) (male:162.08 ± 9.02 ; female:157.04 ± 9.59) and OFC (cm) (male: 54.09 ± 3.28 ; female: 52.88 ± 2.83) of the study subjects were found to be significantly different (P< 0.01) between the sexes. Correlation coefficient between the OFC and personal stature was statistically significant and positive in both males (0.62) and females (0.86) indicating a strong relationship between the two parameters. Linear regression formulae for the prediction of personal stature using the OFC were derived as follows: male: 70.52 + 1.69 (OFC); female: 3.48 + 2.92 (OFC). Stature prediction equations that require a measuring tape as the only tool to record the OFC provides a practical alternative for the height estimation of patients who are unable to stand due to various reasons. It is a simple, cost effective, non invasive and objective method for personal stature prediction. Accurate prediction of a patient's stature will in turn, reduce potential errors that may occur when stature is estimated only by visual observation in emergency or clinical situations. Complementary studies are necessary to evaluate the applicability of these equations in other age groups too.

RESUMEN: La estimación precisa de la estatura es importante para calcular el índice de masa corporal, evaluar el estado nutricional, como también el riesgo de enfermedad cardiovascular, las necesidades energéticas y la adaptación de las dosis de los fármacos citostáticos. Sin embargo, varias situaciones, por ejemplo en situaciones de emergencias médicas o cuidados intensivos, los pacientes inmovilizados en cama o en silla de ruedas, se hace difícil o incluso imposible obtener la estatura usando métodos estandarizados. Por lo tanto, surge la necesidad de un método alternativo de predicción personal de la estatura. A pesar de su potencial utilidad práctica, se sabe poco sobre la relación entre la circunferencia occipito-frontal (COF) de la cabeza y la estatura entre los adultos de Sri Lanka. El objetivo de este estudio fue proponer una fórmula específica para la estimación de la estatura de acuerdo a población y sexo utilizando la COF. La estatura individual y la COF se registraron en un total de 156 cadáveres pertenecientes a individuos de 55-89 años de edad (hombre: n = 74, mujer: n = 82). Los sujetos con deformidades craneofaciales o antecedentes de trastornos neurológicos fueron excluidos del estudio. Se encontró que la estatura media (cm) (varón: 162,08 ± 9,02, mujer: 157,04 ± 9,59) y OFC (cm) (hombre: 54,09 ± 3,28, mujer: 52,88 ± 2,83) era significativamente diferente (P < 0,01) entre los sexos. El coeficiente de correlación entre la COF y la estatura fue estadísticamente significativo y positivo tanto en varones (0,62) como en mujeres (0,86), lo que indica una fuerte relación entre los dos parámetros. Las fórmulas de regresión lineal para la predicción de la estatura utilizando la COF se obtuvieron de la siguiente manera: hombres: 70,52 + 1,69 (COF); mujeres: 3,48 + 2,92 (OFC). Las ecuaciones de predicción de la estatura que requieren una cinta métrica como la única herramienta para registrar la COF proporcionan una alternativa práctica para estimar la altura en aquellos pacientes que no pueden ponerse de pie por diversos motivos. Es un método sencillo, rentable, no invasivo y objetivo para la predicción personal de la estatura. La predicción exacta de la estatura del paciente, a su vez, reducirá los errores potenciales que pueden ocurrir cuando la estatura se estima sólo por observación visual en situaciones de emergencias o clínicas. Estudios complementarios son necesarios para evaluar la aplicabilidad de estas ecuaciones en otros grupos de edad.

Eight Cases of Dengue Fever in a Volunteer Group from Sri Lanka and Its Ocular Involvement / 대한내과학회지

Dengue fever is an acute febrile disease that is caused by a mosquito-borne flavivirus. It has become a major infectious disease threat in tropical and subtropical areas. In Korea, travel-associated dengue fever is increasing. Thirty-five Koreans went to Sri Lanka to do volunteer activities. Eight of the volunteers developed fever, myalgia, and rash; they were diagnosed with dengue fever. Two patients had macular hemorrhages and edema with no ophthalmic symptoms. The maculopathy caused by the dengue fever improved without specific treatment.

Clinico-Epidemiological Patterns of Cutaneous Leishmaniasis Patients Attending the Anuradhapura Teaching Hospital, Sri Lanka

Cutaneous leishmaniasis (CL) caused by Leishmania donovani is an endemic vector-borne disease in Sri Lanka. Over 2,500 cases have been reported since 2000 and the number of CL cases has dramatically increased annually. Total 57 clinically suspected CL patients attending the dermatology clinic in Anuradhapura Teaching Hospital were recruited from January to June 2015. Slit skin smears and skin biopsies were taken from each of the subjects. Clinical and epidemiological data were obtained using interviewer administered questionnaire. Forty-three (75.4%) patients among 57 were confirmed positive for L. donovani. The majority of infected patients was males (P=0.005), and the most affected age group was 21–40 years. Soldiers in security forces, farmers, and housewives were identified as high risk groups. The presence of scrub jungles around the residence or places of occupation (P=0.003), the presence of sandflies (P=0.021), and working outsides more than 6 hr per day (P=0.001) were significantly associated with CL. The number of lesions ranged from 1–3, and the majority (76%) of the patients had a single lesion. Upper and lower extremities were the prominent places of lesions, while the wet type of lesions were more prevalent in females (P=0.022). A nodular-ulcerative type lesion was common in both sexes. The presence of sandflies, scrub jungles, and outdoor activities contributed to spread of Leishmania parasites in an endemic pattern. Implementation of vector control programs together with health education with regard to transmission and prevention of CL are necessary to control the spread of this infection.

Impact of fishing with Tephrosia candida (Fabaceae) on diversity and abundance of fish in the streams at the boundary of Sinharaja Man and Biosphere Forest Reserve, Sri Lanka / Impacto en la diversidad y abundancia de peces en riachuelos de la frontera de la Reserva Forestal de Sinharaja, Sri Lanka al pescar con Tephrosia candida (Fabaceae)

AbstractLocal communities in some Asian, African and American countries, use plant toxins in fish poisoning for fishing activities; however, the effects of this practice on the particular wild fish assemblages is unknown. This study was conducted with the aim to investigate the effects of fish poisoning using Tephrosia candida, on freshwater fish diversity and abundance in streams at the boundary of the World Natural Heritage site, Sinharaja Forest Reserve, Sri Lanka. A total of seven field trips were undertaken on a bimonthly basis, from May 2013 to June 2014. We surveyed five streams with similar environmental and climatological conditions at the boundary of Sinharaja forest. We selected three streams with active fish poisoning practices as treatments, and two streams with no fish poisoning as controls. Physico-chemical parameters and flow rate of water in selected streams were also measured at bimonthly intervals. Fish were sampled by electrofishing and nets in three randomly selected confined locations (6 x 2 m stretch) along every stream. Fish species were identified, their abundances were recorded, and Shannon-Weiner diversity index was calculated for each stream. Streams were clustered based on the Bray-Curtis similarity matrix for fish composition and abundance. Physico-chemical parameters of water were not significantly different among streams (P > 0.05). A total of 15 fish species belonging to four different orders Cypriniformes, Cyprinodontiformes, Perciformes and Siluriformes were collected; nine species (60 %) were endemic, and six (40 %) were native species. From these, 13 fish species were recorded in streams with no poisoning, while five species were recorded in streams where poisoning was practiced. Four endemic and one native fish species were locally extinct in streams where fish poisoning was active. Fish abundance was significantly higher in control streams (32-39/m2) when compared to treatment streams (5-9/m2) (P < 0.05). We concluded that fish poisoning with T. candida may have resulted in a significant reduction in species richness, total abundance and Shannon-Weiner diversity index of fish species in the studied streams at the boundary of Sinharaja forest. We recommend that this fishing practice should be strictly regulated, and to inform local communities about the legal status of fish poisoning, its consequences and the importance of fish diversity for local livelihoods and conservation purposes. Rev. Biol. Trop. 64 (3): 1129-1141. Epub 2016 September 01.

ResumenLas comunidades de algunos países asiáticos, africanos y americanos utilizan las toxinas de las plantas para pescar, sin embargo, los efectos de esta práctica en grupos de peces silvestres son desconocidos. Este estudio se llevó acabo con el objetivo de investigar los efectos del envenenamiento de peces con Tephrosia candida en la diversidad y abundancia de peces de agua dulce en riachuelos de la frontera la Reserva Sinharaja en Sri Lanka. En total se realizaron siete giras bimensuales al campo de mayo 2013 a junio 2014. Se muestrearon cinco riachuelos con condiciones ambientales y climáticas similares en la frontera de la reserva de Sinharaja. Como tratamientos se seleccionaron tres riachuelos con práctica activa de envenenamiento de peces y dos riachuelos sin envenenamiento de peces como controles. También, en intervalos bimensuales, se midieron los parámetros físico-químicos y de corriente del agua en riachuelos seleccionados. Se utilizó la electropesca y redes en tres sitios (6 x 2 m) seleccionados al azar a lo largo de cada riachuelo para el muestreo de peces. Se identificaron los peces a nivel de especie, se anotó su abundancia y se calculó el índice de diversidad de Shannon-Weiner para cada riachuelo. Con base en la matriz de similitud de Bray-Curtis se agruparon los riachuelos para composición y abundancia de peces. Los parámetros físicoquímicos del agua fueron no significativamente distintos entre los riachuelos (P > 0.05). Se recolectó un total de 15 especies de peces que pertenecen a cuatro órdenes: Cypriniformes, Cyprinodontiformes, Perciformes y Siluriformes; nueve especies (60 %) fueron endémicas y seis (40 %) nativas. Trece especies se encontraron en riachuelos donde no se practica el envenenamiento mientras que cinco especies se encontraron en riachuelos donde sí se daba esta práctica. Cuatro especies endémicas y una nativa estaban extintas en riachuelos donde la práctica del envenenamiento era activa. La abundancia de peces fue significativamente alta en los riachuelos control (32-39/m2) al compararse con los tratamientos (5-9/m2) (P < 0.05). Se concluye que el envenenamiento de peces con T. candida puede haber resultado en una reducción significativa de la riqueza de especies, la abundancia total y el índice de diversidad de Shannon-Weiner de las especies de peces en los riachuelos estudiados en la frontera de la reserva Sinharaja. Se recomienda que esta práctica de pesca sea estrictamente regulada y que se informe a las comunidades locales acerca del estado legal del envenenamiento de peces, sus consecuencias y de la importancia de la diversidad de peces para el sustento local y para propósitos de conservación.

Research Progress on Gene Alterations of Amelogenin Locus in Gender Identification / 法医学杂志

There are two kinds of amelogenin gene mutation, including mutation in primer-binding region of amelogenin gene and micro deletion of Y chromosome encompassing amelogenin gene, and the latter is more common. The mechanisms of mutation in primer-binding region of amelogenin gene is nucleotide point mutation and the mechanism of micro deletion of Y chromosome encompassing amelogenin gene maybe non-allelic homologous recombination or non-homologous end-joining. Among the population worldwide, there is a notably higher frequency of amelogenin gene mutations in Indian population, Sri Lanka population and Nepalese population which reside within the Indian subcontinent. Though amelogenin gene mutations have little impact on fertility and phenotype, they might cause incorrect result in gender identification. Using composite-amplification kit which including autosomal STR locus, amelogenin gene locus and multiple Y-STR locus, could avoid wrong gender identification caused by amelogenin gene mutation.

A Case of Rhinosporidiosis of the Nasal Cavity / 대한이비인후과학회지

Rhinosporidiosis is a chronic granulomatous infectious disease caused by Rhinosporidium seeberi, which is endemic to South India, Sri Lanka, and parts of Africa. It is primarily an infection of the nose. Although involvement of other parts of body has occasionally been reported, it rarely presents as a disseminated disease. We describe a case of nasal rhinosporidiosis in Korea and discuss its clinical manifestations and management.