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Anatomic variation and susceptibility for injuries depending on gender were described for the ulnar nerve. The aim of this study was to investigate the association between gender and ulnar never motor conductance and the influence of sidedness for this association. Study was conducted as a retrospective study using nerve conduction study data of ulnar nerve of 2,526 patients. Influences of age, gender, and sidedness on ulnar never motor conduction velocity (UMV) were investigated. Regression analysis was conducted to compare the relationship between UMV and age. Regression was significantly higher in males (-0.253 vs. -0.113), suggesting higher influence of age on UMV in males than in females. When analyzing right and left sides separately, influence of age on UMV is higher in males (-0.286 vs. -0.109) only in right side. Multiple regression analysis was done comparing the influence of age, gender, and sidedness on UMV, and it found that the order of influence is gender, age, and sidedness (Beta values 0.153, -0.140, and 0.029). Ulnar nerve motor conductance depends on gender, age, and sidedness. Males are having lower UMV than females. Age-dependant change of UMV is more prominent in males than in females and is more prominent in right hand than in left hand in males.

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BACKGROUND: The early introduction of clinical material is a recognised strategy in medical education. The University of Ruhana Medical School, where a traditional curriculum is followed, offers students pre-clinical subjects without clinical exposure during their first and second years. INNOVATION: Clinical materials in the form of videos were introduced to first-year students. In the videos, patients and their relatives described the diseases and related problems. Students were instructed to identify the problems encountered by patients and relatives. Each video was followed by a discussion of the problems identified by the students. The medical, social and economic problems encountered by patients and relatives were emphasised during post-video discussions. A lecture was conducted linking the contents of the videos to subsequent lectures. The aim of this study is to investigate whether combining teaching preclinical material with a video presentation of relevant clinical cases facilitates the interest and understanding of students. IMPLICATIONS: Quantitative data were collected using a questionnaire, whereas qualitative data were collected using focus group discussions. Quantitative data showed that students appreciated the video, had 'better' knowledge acquisition and a 'better' understanding of problems encountered by patients. Qualitative analysis highlighted the following themes: increased interest; enhanced understanding; relevance of basic knowledge to clinical practice; orientation to profession; and personalising theories. The introduction of patients in the form of videos helped students to understand the relevance of subject material for clinical practice, increased their interest and facilitated a better understanding of the subject material. Therefore, it seems video is a feasible medium to introduce clinical materials to first-year students who follow a traditional curriculum in a resource-limited environment.

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Medical students following a traditional curriculum get few opportunities to engage in activities such as a literature search, scientific writing, and active and collaborative learning. An analytical essay writing activity (AEWA) in physiology was introduced to first-year students. Each student prepared an essay incorporating new research findings with existing knowledge on a medical topic. Students were expected to study on the topic in detail from textbooks as well as from research publications and write a descriptive and critical analysis. This activity would help them to be aware of new developments in the field and understand the complexity and rapidity of changes in the subject. The aim of this study was to learn how students used the AEWA as a learning process. For this purpose, student perceptions were assessed quantitatively and those of the faculty staff were assessed qualitatively. The data from the students showed considerable achievements in the medical database search, scientific writing, group work, and search for new scientific knowledge. The activity was influenced by prior capabilities in computer use, English language knowledge, and writing ability. Resources available at the medical school had a greater influence on the activity. Faculty staff appreciated the quality of the essay while highlighting areas of improvement. The students seemed to be satisfied with the supervisory role of the faculty staff, whereas the staff felt that the students used the supervisors less than expected. The AEWA was a successful activity promoting many aspects of active and collaborative learning. The low availability of books and information and communications technology (ICT) resources, poor internet connection, and insufficient English language skills were probably responsible for the negative feedback on this activity in this resource-deprived environment.

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Forearm median motor conduction velocity (FMCV) is reduced in carpal tunnel syndrome (CTS). The aim of this study was to investigate the association of FMCV with age and severity of median nerve compression. Forearm median motor conduction velocity and median nerve motor distal latencies were measured in 312 CTS hands. Forearm median motor conduction velocity correlated negatively with age. This correlation persisted in the subgroups of hands with severe and less severe CTS. Forearm median motor conduction velocity correlated negatively with the degree of compression (as measured by median nerve motor distal latencies). This correlation persisted in subgroup of hands with severe CTS but not in less severe ones. Multiple regression analysis comparing the influence of age and median nerve motor distal latencies on FMCV showed higher standardized coefficients (beta) value for age than for median nerve motor distal latencies, suggesting a greater influence for age. The beta value for age is higher in severe group than in less severe group, suggesting that age has higher influence on FMCV in severe group. The degree of compression influences FMCV in hands with severe CTS but not in hands with less severe CTS. This difference in severe and less severe CTS may be because of the differences in the underlying pathophysiological processes in the 2 entities.

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As a peer-assisted learning process, minilectures on physiology were conducted by students. During this process, students lecture to their colleagues in the presence of faculty staff members. These lectures were evaluated by faculty staff and students simultaneously. The aim of this study was to compare feedback from faculty members and students on 66 minilectures conducted by students. Their perception of different qualities of lecture was assessed using a questionnaire. There were significant correlations between students and faculty members for many qualities of the lecture, including the speed of the lecture, retaining attention, clear introduction, and the overall quality of the lecture. However, ratings for gesture, eye contact, language usage, illustration usage, audiovisuals, voice usage, and important points stressed were significantly different between students and faculty members. Multiple regression analysis was performed to assess the degree of effect of different aspects of a lecture on its overall quality. Aspects such as gesture, eye contact, and language usage showed very low ß-values, suggesting a poor contribution of these factors to the overall quality of the lecture for both students and faculty members. The speed of the lecture, retaining attention, and clear introduction were qualities that faculty members and students rated equally, and these were the main contributors to the overall quality of the lecture. Awareness about the possible discrepancy between ratings given by faculty members and students may be important when interpreting the evaluation results of formal lectures by these two groups.

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The curriculum in the University of Ruhuna Medical School is of the traditional type. Most teaching activities are faculty member-led activities. Since student-centered learning processes are considered to improve certain skills and attitudes, we introduced student-led group classes (SGCs) in physiology. Depending on the outcome of the SGCs, we planned to develop it further. We designed this study to compare student perceptions on newly introduced SGCs with traditional tutorials (TTs). Student perceptions were assessed using a mixed qualitative and quantitative method. Students recognized and appreciated some favorable features of the SGC, such as the opportunity for discussion, quality of the knowledge, active participation, improvement of presentation ability, and increased breadth of knowledge. However, the majority of students preferred the TT over the SGC despite the highlighted benefits of the SGC. Students appreciated the focused learning for examinations, written preparation, and more tutor involvement in the TT. Students requested a hybrid of the TT and SGC by incorporating mandatory written answers to the SGC with greater contributions from faculty members. Assessment methods that were not aligned with the SGC and ingrained passive didactic teaching-learning methods by students and faculty members had a negative effect on the implementation of SGCs. Cultural and economical factors also contributed adversely. In the second step of this Plan-Do-Check-Act process, we are planning to introduce new formative assessment to assess higher-order cognitive skills and a compulsory tutor training program. Some favorable components from the TT will be incorporated to the SGC.

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BACKGROUND: The internet is a relatively new medium of disseminating health information. Studies on Internet usage for health information are mainly done in developed countries and very few studies have been carried out in developing countries. METHODS: The Internet usage of patients who were attending specialist clinics in Teaching Hospital Karapitiya and Southern Hospital in Galle, Sri Lanka was investigated. The study was carried out on the following specialities; General Medicine, Pediatrics, General Surgery and Cardiothoracic surgery. Information was collected using an investigator-administered questionnaire while patients were waiting for a consultation. RESULTS: Three hundred and fifty five patients (or guardians in the Pediatric clinic) participated in the study. One hundred seventy two (48.3%) participants have heard about the Internet. There was a relationship between awareness of the Internet and age, educational level and the clinic attended. There was no difference of awareness depending on the gender or the hospital. Only three participants (0.97%) have used the Internet to find information about their disease conditions. Close relatives searched the Internet about the conditions of two participants. Altogether, the Internet was used to search information on the disease condition of five participants (1.4%). CONCLUSION: Very low usage of the Internet for health information retrieval in this study is probably due to low awareness of the Internet and low educational level. This low usage of Internet and the associated reasons shown in this study can be generalized to Sri Lanka and probably to other low-income countries that have lower educational level than Sri Lanka.

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Information technology (IT)-based components are included as active learning activities in medical curricula that have been shown to be more effective than most passive learning activities. In developing countries, these activities are not popular compared with developed countries. In this study, an IT-based assignment was carried out in physiology for undergraduates in Sri Lanka. We assessed certain basic IT capabilities before the assignment and found that the capability of using MS Word, e-mail, and the internet was limited to 68.3%, 62.0%, and 49.2% of students, respectively, with 40.8% of students having some other IT capabilities. We found a considerable variation in IT capabilities among the students, which depended on IT learning at schools and the geographical locations where students came from. The main source of IT knowledge for students was an introductory IT course given in the medical school with the second source being private IT learning centers. Response to the IT-based assignment was very poor. The reasons for poor participation included a lack of time due to parallel subjects, poor IT knowledge, and poor IT resource availability. However, students were willing to have optional IT-based components and were aware that IT knowledge is important for medical students as well as doctors. This study shows the importance of improving IT knowledge in students and the need of improving IT resources in medical schools. With these improvements, physiology education can be enriched with more interactive IT-based learning activities, which help students to acquire knowledge more efficiently and effectively in developing countries like Sri Lanka.

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This study was designed to investigate the use of websites as a health education medium in Sri Lanka. Approximately 87.2% of the websites contained less than 100 webpages. The quality score was higher in the websites owned by local nonbusiness organisations compared to the websites owned by business organisations. Only 8.1% of the websites provided health education content for the general public as their main content. The total number of websites has not increased compared to the increase in internet usage in Sri Lanka during the last few years. The internet is an underutilised health education tool despite the growth of internet usage in Sri Lanka.

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It has been shown that analgesics such as morphine, lidocaine and clonidine increase the release of spinal acetylcholine. Acetylcholine may therefore play an important role in the regulation of spinal pain threshold. Since behavioral as well as in vitro studies have shown a clear involvement of GABA (gamma-amino butyric acid) receptors in the regulation of spinal nociceptive mechanisms, the present study focused on the role of GABA receptors for spinal acetylcholine release control. GABA receptor agonists and antagonists were infused via a spinal microdialysis probe and acetylcholine release was measured. The GABA(A) receptor agonist muscimol decreased acetylcholine release and the antagonist bicuculline increased acetylcholine release. The GABA(B) receptor agonist baclofen decreased acetylcholine release whereas the antagonist saclofen did not change acetylcholine release. The results suggest that both GABA receptor subtypes have an inhibitory role on spinal dorsal horn acetylcholine release and that the GABA(A) receptors are tonically regulating acetylcholine release.

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Stimulation of spinal serotonin (5-HT) receptors results in analgesia and release of acetylcholine. We investigated the involvement of 5-HT1, 5-HT2, and 5-HT3 receptor subtypes in the regulation of spinal acetylcholine release. A spinal microdialysis probe was placed dorsally at about the C5 level in anaesthetized rats. The selective serotonin reuptake inhibitor citalopram was found to increase acetylcholine release when infused via the microdialysis probe. Several doses of the 5-HT receptor agonists 8-hydroxy-2-(di-n-propylamino)tetraline (8-OH-DPAT, 5-HT1A), 1,4-dihydro-3-(1,2,3,6-tetrahydro-4-pyridinyl)-5H-pyrrolo[3,2-b]pyridin-5-one dihydrochloride (CP93129, 5-HT1B), alpha-methyl-5-hydroxytryptamine maleate (m5-HT, 5-HT2), 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI, 5-HT2C), and 1-(m-chlorophenyl)-biguanide (5-HT3) were subsequently infused via the microdialysis probe. Only 8-OH-DPAT, CP93129, and m5-HT increased acetylcholine release dose dependently. The 5-HT1A receptor selective antagonist (S)-N-tert-butyl-3-(4-(2-methoxyphenyl)piperazine-1-yl)-2-phenylpropanamide hydrochloride and the 5-HT2A receptor selective antagonist ketanserin tartrate inhibited the 8-OH-DPAT and the m5-HT induced acetylcholine release. The results suggest that 5-HT1A and the 5-HT2A receptors are involved in the regulation of acetylcholine release in the spinal cord.

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Aspirin and paracetamol have been shown to suppress non-inflammatory pain conditions like thermal, visceral and mechanical pain in mice and rats. The non-inflammatory antinociception appears to be mediated by central receptor mechanisms, such as the cholinergic system. In this study, we tested the hypothesis that the non-inflammatory antinociception of aspirin and paracetamol could be mediated by an increase of intraspinal acetylcholine release. Microdialysis probes were placed intraspinally in anesthetized rats for acetylcholine sampling. Subcutaneously administered aspirin 100 and 300 mg/kg increased, while paracetamol 300 mg/kg decreased intraspinal acetylcholine release. Intraspinal drug administration did not affect acetylcholine release. Our results suggest that an increased intraspinal acetylcholine release could be involved in part of the non-inflammatory pain suppression by aspirin, but not by paracetamol.

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Epibatidine has been used in a wide dose range and was found to produce both nociceptive and antinociceptive effects. The different effects were partly explained by an action on multiple nicotinic receptor systems. The present study investigated the possibility that part of the action of intraspinally or subcutaneously administered (+/-) epibatidine, is mediated through an action on muscarinic receptors. Radioligand receptor assays were performed using homogenates of rat spinal cord and muscarinic M1-M5 receptors expressed in Sf9 cells. The intraspinal acetylcholine releasing effect of intraspinally and subcutaneously administered (+/-) epibatidine was studied with and without with atropine pretreatment. (+/-) Epibatidine has affinity for muscarinic receptors both in spinal cord tissue and expressed in Sf9 cells. The intraspinal administration of 160 microM (+/-) epibatidine produced an increase in acetylcholine release that was reduced by pretreatment with 100 microM atropine. Subcutaneous administration of 30 microg/kg (+/-) epibatidine produced an increase in intraspinal acetylcholine release that was not inhibited by 5 mg/kg subcutaneous atropine pretreatment. We conclude that (+/-) epibatidine, in microM concentrations, is a partial muscarinic receptor agonist that may interact with spinal muscarinic receptors to increase acetylcholine release. Epibatidine induced spinal acetylcholine release observed after subcutaneous administration appears not to be mediated via muscarinic receptor. The dual action on both nicotinic receptors and muscarinic receptors may explain the potent analgesic effect observed after epibatidine administration.

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Activation of cholinergic receptors in the spinal cord increases the intraspinal release of acetylcholine (ACh) and produces potent analgesia. The mechanisms that regulate the release of spinal ACh are not fully known. In the present study, we investigated the role of nicotinic ACh receptors in the regulation of intraspinal ACh release. Using an in vivo intraspinal microdialysis technique, nicotine was administered alone and in combination with the nicotinic antagonists mecamylamine (50 microM), dihydro-beta-erythroidine (DbetaE) (500 microM) and methyllycaconitine (MLA) (40 nM). Administration of nicotine (1 microM-1 mM) produced a dose dependent increase of intraspinal ACh release, while 10 mM nicotine resulted in dramatic increase in ACh release followed by a decrease to baseline. Administration of mecamylamine or DbetaE also induced an increased ACh release while MLA caused a decreased release. Mecamylamine and DbetaE, but not MLA pretreatment attenuated the stimulatory effect of 100 microM nicotine on intraspinal ACh release. It is suggested that spinal ACh release is regulated by different nicotinic ACh receptors. These receptors may tonically regulate spinal ACh release either directly or indirectly via inhibitory interneurones. Some of these receptors may be desensitised by high nicotine concentrations leading to a reduction of ACh release.

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