Acknowledgement: The author greatly appreciate the assistance received from Dr. P. Semage and the other medical staff of the GH Anuradhapura to conduct this study and Dr Vajira Weerasinghe, Dept of physiology, for his help in the statistical analysis, Dr. Mallika Sabanayagam, Dept of anatomy for valuable comments on the manuscript and Dr. Anusha Perera, Faculty of Medicine, University of Peradeniya, for typing the manuscript.
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