Browsing by Author "Chandrasena, L.G."

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Age, sex variation among patients treated with percutaneous transluminal coronary angioplasty (PICA) in Sri Lanka: a retrospective study
(Sri Lanka Medical Association, 2014) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Hettiarachchi, V.S.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: Coronary heart diseases (CHD) remain a major cause of death worldwide, ft is a growing burden for the Sri Lankan health sector. Age and sex has been identified as risk factors for CHD. The private health sector contributes significantly to curative care of CHD. The aim of this study was to determine the variation of age and sex of patients who have been treated with PTCA during the last decade at a private hospital in Colombo. METHODS: A retrospective study was conducted on patients treated with PTCA in a private hospital in Colombo from 2003 to 2013. Details of patients were extracted from medical records and age and sex variations were analyzed. RESULTS: 4578 patients (3315 men; 72.4%) were included. There was significant reduction in mean age at PTCA from 2003 to 2013 (p<0.01). Overall it had declined from 56.4 years (SD=10.5) in 2003 to 50.9 years (SD=12.4) in 2013. From 2003 to 2013 the mean ages of men had reduced by 7 years (p<0.01), while in females the mean age had reduced by 2.2 years (p<0.01) Male to female ratio was 2.58 in 2003 and 2.45 in 2013- Linear regression analysis showed that with each increment year the age at PTCA reduced by 0.54 years (95%Ci =0.64 to -0.44). CONCLUSIONS: Higher proportions of patients were men. Age at PTCA had decreased in both males and females. But sex ratio of patients had not significantly changed during the last decade.
Association between homocysteine, vitamin B12, folate, MTHFR polymorphisms and ischaemic heart disease
(Sri Lanka Medical Association, 2010) Perera, P.P.R.; Chandrasena, L.G.; Indrakumar, J.; Peiris, H.
OBJECTIVES: The present study investigated the association between homocysteine and ischaemic heart disease (IHD) and the factors influencing homocysteine levels. METHODS: A case control study involving 221 patients with IHD and 221 age and sex matched controls admitted to Colombo South Teaching Hospital and an analytical study involving 79 patients awaiting coronary artery bypass grafting at Nawaloka Hospitals PLC were done. RESULTS: Hyperhomocysteinaemia was a significant predictor of IHD after controlling for hypertension and hypercholesteroleamia (adjusted odds ratio 2.38). Hyperhomocysteinaemia was a significant predictor of IHD in the young but not in the elderly. Among persons below 50 years, persons with hyperhomocysteinaemia were 4.5 times more likely to develop IHD as compared to those with normohomocysteinaemia. Vitamin B^ and folate levels showed a negative correlation with serum homocysteine concentrations. The homocysteine concentration did not differ significantly with the genotypes of Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms. CONCLUSIONS: People with hyperhomocysteinaemia have a 2-3 fold increase in risk of developing IHD. Hyperhomocysteinaemia is a predictor of IHD in the young but not in the elderly. A decrease in either vitamin B12 or folate concentrations in serum is associated with higher homocysteine concentrations whereas MTHFR A1298C and C677T gene mutations do not have an effect on the homocysteine concentrations.
Biochemical changes associated withnreperfusion after off-pump and on-pump coronary artery bypass graft surgery
(Institute for Clinical Science., 2009) Chandrasena, L.G.; Peiris, H.; Waikar, H.D.
A prospective study was performed to monitor the postoperative changes in biochemical markers associated with reperfusion injury following (i) cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplagia (CABG); (ii) CPB with a tissue stabilizing device (SUP.CPB); or (iii) surgery on beating heart (off-pump CABG or OPCABG). Of the 48 patients, 16 were subjected to CABG, 16 to SUP.CPB, and 16 to OPCABG. Arterial and venous blood samples drawn 10 min preoperatively and 0.2, 4, 24, and 48 hr after surgery were assayed for plasma lactate, total calcium, and ionized calcium and erythrocyte glutathione peroxidase (GPX) and superoxide dismutase (SOD). Results revealed that ionized calcium, SOD, and GPX levels of all patients increased at 4 hr following surgery but returned to baseline levels at 24 or 48 hr after surgery. Increased postoperative GPX levels reflect a cellular defense mechanism against oxidative damage during reperfusion, while lactate levels during reperfusion reflect delayed recovery of aerobic myocardial metabolism. The postoperative release of lactate, GPX, and SOD in patients undergoing the CABG (on-pump) technique was significantly higher compared to those subjected to OPCABG or SUP.CPB. There were no significant differences in postoperative patterns of release of biomarkers in patients with OPCABG vs SUP.CPB, suggesting that these surgical techniques are equally acceptable
Biochemical markers for early diagnosis of myocardial infarction
(The Kandy Society of Medicine, 1996) Chandrasena, L.G.
Changes in erythrocyte glucose-6-phosphate dehydrogenase (G6PD) and reduced glutathione (GSH) activities in the development of senile and diabetic cataracts
(SEAMEO Regional Tropical Medicine and Public Health Project, 2008) Chandrasena, L.G.; de Silva, L.D.R.; de Silva, K.I.; Dissanayaka, P.; Peiris, H.
Oxidative and osmotic stress have been implicated in the pathogenesis of cataracts. Reactive oxygen intermediates (ROI) mediate peroxidation of membrane lipids and cause irreversible damage to lens proteins. The purpose of this study was to assess the changes in erythrocyte glucose- 6-phosphate dehydrogenase enzyme (G6PD) and reduced glutathione (GSH) levels in the development of senile and diabetic cataracts. The activity of erythrocyte G6PD and the concentration of GSH were measured to assess changes in oxidation-reduction status. The oxidation-reduction status of 26 non-diabetic non-cataract (control) subjects were compared with 24 diabetic non-cataract, 30 diabetic cataract and 28 non-diabetic cataract subjects. The results revealed that the GSH and G6PD levels of the subjects with senile cataracts were significantly lower than the subjects without cataracts. The present study reveals the risk of developing senile cataracts is associated with decreased levels of erythrocyte G6PD and GSH. In the formation of diabetic cataracts an adequate supply of NADPH (G6PD activity) is essential to produce osmotically active sorbitol in the lens
The characteristics and long term outcome of patients with ST segment Elevation Myocardial Infarction (STEMI) following Percutaneous Transluminal Coronary Angioplasty (PTCA)
(University of Kelaniya, 2013) Abeysuriya, V.; Kasturiratne, A.; Chandrasena, L.G.; Hettiarachchi, V.S.; Wicremasinghe, A.R.
Introduction &Aims: To determine the characteristics and long term outcome of patients who had STEMI and were treated with PTCA. Method: A retrospective study was conducted among patients diagnosed with ST segment elevation myocardial infarction (STEMI) and treated with PTCA in a private hospital in Colombo from 1st January 2009 to 1st November 2012. Details of patients were abstracted from medical records of patients and the survival status, cause of death and date of death where relevant, were obtained from records, patients themselves or close relatives. Results: 197 patients (153 men; 77.7%) were enrolled. More than 50% had a history of diabetes, dyslipidemia or hypertension. Among the patients who had a history of smoking and alcohol consumption, 98% were men. 82.7 % (95% CI: 77.9% - 90.5%) of patients survived for 3 years. Based on Cox Proportional Hazardous model, site of arterial occlusion (proximal vs distal segment of left anterior descending artery [LAD] [HR 10.98; 95% CI: 1.096-110.205] was significantly associated with poor prognosis of patients. Low ejection fraction, not on regular medication and delay of more than 3 hours between onset to door time were independently (unadjusted) associated with poor long term outcome of patents who had coronary artery involvement other than the LAD artery. Conclusion: A high proportion of patients had traditional risk factors. The three year survival of patients was 83%. Patients with proximal LAD occlusion were 11 times more likely to die within 3 years of PTCA as compared to those who had a distal LAD occlusion.
Characteristics of patients admitted to an emergency treatment unit of a private sector hospital
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Senanayake, M.G.B.; Wickremasinghe, A.R.
BACKGROUND: Studies have highlighted that the private sector contributes a major share in outpatient healthcare and a small proportion in in-patient care in Sri Lanka. There is little or no information on private health sector emergency care. OBJECTIVES: To determine the socio-economic characteristics of patients admitted to an emergency treatment unit (ETU) in a private hospital in Colombo. METHODS: A descriptive cross sectional study was carried out on patients admitted to the ETU of a private hospital in Colombo from October 16th to December 15th 2015. Data were abstracted from medical records, verbal interviews, and the computerized data base maintained by the hospital. RESULTS: 2395 patients (1426 men; 59.2%) were admitted during the study period. The majority of patients were 61 to 70 years (30.4%). 80.3% were employed. 61.6% of patients had an insurance policy of which, 41.5% were private insurance policies. The monthly income ranged between Rs.15, 000 and Rs.150, 000 (mean Rs.43, 700±19,020). The commonest admissions were due to diseases of the digestive system (27.4%). Persons with an educational level of
Clearance of microfilaraemia and red blood cell glutathione peroxidase(GPX) levels in asymptomatic microfilaraemics after single dose and 14 days’ treatment with diethyl carbamazine citrate(DEC)
(Wiley, 2001) Premaratna, R.; Chandrasena, T.G.A.N.; Abeyewickreme, W.; de Silva, N.R.; Chandrasena, L.G.; de Silva, H.J.
Abstract Available
Clearance of microfilaraemia and red blood cell glutathione peroxidase(GPX) levels in asymptomatic microfilaraemics after single dose and 14 days’ treatment with diethyl carbamazine citrate(DEC)
(Sri Lanka Medical Association, 2001) Premaratna, R.; Chandrasena, T.G.A.N.; Abeyewickreme, W.; de Silva, N.R.; Chandrasena, L.G.; de Silva, H.J.
Abstract Available
Clostridium difficile infection in inflammatory bowel disease patients in Sri Lanka
(Sri Lanka Medical Association, 2012) Waraketiya, P.R.; de Silva, A.P.; Wijesinghe, N.T.; Waraketiya, P.R.; Wijewantha, H.S.; Chandrasena, L.G.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Over the last decade an increase in Clostridium difficile associated diarrhoea (CDAD) has been observed among Caucasians (1%). The frequency of CDAD is very high in Caucasian IBD patients; 8.7% in one study of IBD patients in remission. This has led to guidelines recommending routine screening for CDAD in IBD. Clinical impressions are that CDAD is rare among Sri Lankans. AIMS: This study was conducted to determine the frequency of CDAD in a cohort of Sri Lankan IBD patients and healthy controls. METHODS: Cases [n=154] were histologically confirmed IBD patients, in clinical remission. The controls [n=100) were non-IBD patients who presented to medical clinics without diarrhoea and with no exposure to antibiotics for up to 8 weeks prior to recruitment. Immunoassays for Clostridium difficile toxins A and B were performed on stool samples obtained from both groups. RESULTS: The frequency of CDAD was 0.7% (n=l) and 0% (n=0) in IBD patients and controls respectively. CONCLUSIONS: Compared to Caucasians, CDAD was very rare in this cohort of Sri Lankans, including those with IBD. Routine screening for CDAD does not seem necessary in our setting.
Composite carotid intima-media thickness as a risk predictor of coronary heart disease in a selected population in Sri Lanka
(Public Library of Science,, 2022) Abeysuriya, V.; Wijesinha, N.A.I.; Priyadharshan, P.P.; Chandrasena, L.G.; Wickremasinghe, A.R.
Background: Segment-specific variations of carotid intima-media thickness (CIMT) have not been assessed in South Asian populations. The purpose of this study was to determine if segment-specific CIMTs or a composite-CIMT score is a better risk predictor of coronary heart disease in South Asian populations. Methods: A comparative prospective study was conducted from November 2019 to October 2020 in a hospital in Colombo, Sri Lanka. Based on pre-defined inclusion and exclusion criteria, cases (having a diagnosis of Coronary Heart Disease (CHD), n = 338) and controls (non-CHD group, n = 356) were recruited. Ultrasound examination of the common carotid (CCA), the carotid bulb (CB) and the internal carotid segments (ICA) of the carotid vessels was conducted by a radiologist, and CIMTs were measured. A composite-CIMT score defined as the average value of all six segments of the left and right sides was derived. Results: 694 participants were enrolled (male n = 399, 57.5%). The mean (±SD) age of the study sample was 60.2 (±9.86) years. There were variations in segment-specific values between the left and right vessels. The mean composite-CIMT value of the CHD group was significantly higher than that of the non-CHD group. A composite-CIMT score of 0.758 had a sensitivity of 98.4% and a specificity of 64.6% in distinguishing CHD from non-CHD groups (Area under the curve (AUC): 0.926). Conclusions: Carotid artery segment-specific CIMT variations were present in this population. The composite CIMT score is better than segment-specific CIMTs in predicting CHD and may be used to predict CHD in this population.
Delta-bilirubin: an unrecognised entity
(Sri Lanka Medical Association, 1994) Chandrasena, L.G.; de Silva, K.
Effect of oral supplementation with vitamin E on the oxido-reductive status of red blood cells in normal mice and mice subject to oxidative stress by chronic administration of adriamycin
(Sage Publishing, 1999) Thabrew, M.I.; Samarawickrema, N.A.; Chandrasena, L.G.; Jayasekara, S.
The effect of oral vitamin E supplementation on the oxido-reductive status of red blood cells in normal mice and those subject to oxidative stress by chronic administration of the anti-tumour drug Adriamycin was investigated. Mice were randomly separated into three groups of 20 animals each and maintained on diets identical in all respects except for vitamin E content. Group 1 received a low vitamin E diet that provided 10 mg vitamin E/kg body weight/day, group 2 received a normal mice chow diet (45 mg vitamin E/kg body weight/day) while group 3 received a high vitamin E diet (200 mg vitamin E/kg body weight/day). In comparison with the normal mice in group 1, their counterparts in groups 2 and 3 exhibited significantly higher (P 0.001) activities of superoxide dismutase (SOD) in red blood cells (79.4 percent higher in group 2 and 114.2 percent higher in group 3, respectively) and produced lower concentrations of malondialdehyde (MDA) (22.9 percent less in group 2 and 51.2 percent less in group 3, respectively), with little difference in the glutathione peroxidase (GPX) activity. In Adriamycin-treated animals on the low vitamin E diet (group 1) the red blood cell SOD activity and MDA production were 46.2 percent and 200.7percent higher (P 0.001), respectively, and the GPX activity was 39.1percent lower than in the red blood cells of untreated (normal) animals in the same group. The Adriamycin-induced changes were significantly less in animals receiving higher doses of vitamin E (groups 2 and 3). Thus, in the group maintained on the high vitamin E diet (group 3), Adriamycin administration resulted in only a 38.9 percent increase in the MDA production above that generated by red blood cells of normal mice in the same group, with no significant change in the SOD or GPX activities. Thus, in normal conditions as well as in conditions of oxidative stress, high doses of vitamin E appear to be able to protect the oxido-reductive status of red blood cells by modulating the extent of lipid peroxidation as well as the activities of antioxidant enzymes.
Effect of vitamin E supplementation on adriamycin induced changes in oxido-reductive status of mouse red blood cells
(University of Kelaniya, 2000) Thabrew, M.I.; Samarawickrama, N.A.; Chandrasena, L.G.; Jayasekara, S.
Erythrocyte antioxidant enzymes in patients with cataract
(Institute for Clinical Science., 2006) Chandrasena, L.G.; Chackrewarthy, S.; Perera, P.T.; de Silva, D.
The pathogenesis of cataract has been found to be influenced by a number of factors including oxidative stress. Catalase, glutathione peroxidase (GPX), and superoxide dismutase (SOD) are some of the antioxidant enzymes that protect the body from oxidative damage. The present study investigates the activities of erythrocyte catalase, GPX, and SOD with respect to senile cataract (non-diabetic cataract) and osmotic cataract (diabetic cataract) in a Sri Lankan population. One hundred and two non-diabetic subjects (50 with cataract and 52 non-cataract) and 106 diabetic subjects (56 with cataract and 50 non-cataract) were recruited into the study. Erythrocyte catalase, GPX, and SOD activities were assayed and the data were analysed by t-test (p <0.05 for significance). In the non-diabetic group, significantly low levels of catalase, GPX, and SOD activities were associated with cataract when compared with non-cataract. No significant changes in catalase, GPX, and SOD activities were observed in the diabetic group between cataract and non-cataract. Senile cataract (non-diabetic cataract) was associated with significantly low levels of erythrocyte catalase, GPX, and SOD when compared with osmotic cataract (diabetic cataract). Positive correlations were observed between catalase and SOD (r = 0.75), catalase and GPX (r = 0.63), and SOD and GPX (r = 0.59) in subjects with senile cataracts. Our results indicate that erythrocyte antioxidant enzyme levels are decreased in senile cataract as opposed to osmotic cataract. Assays of these erythrocyte enzyme activities could provide a marker to identify individuals predisposed to senile cataract.
Fifty years after Watson and Crick
(University of Sri Jayewardenepura, 2007) Chandrasena, L.G.; Peiris, H.; Welihinda, J.
Abstract
Glutathione peroxidase and severity of ischaemic heart disease in a cohort of Sri Lankan patients
(Sri Lanka Medical Association, 2010) Perera, P.P.R.; Chandrasena, L.G.; Indrakumar, J.; Peiris, H.
OBJECTIVES: To study the association between glutathione peroxidase (GPx) levels in relation to severity and extent of cardiac ischemia and age in a cohort of Sri Lankans. METHODS: Seventy nine patients with ischaemic heart disease (IHD) awaiting coronary artery bypass grafting (CABG) were recruited to the study. GPx was measured before CABG. The severity and extent of myocardial ischemia were measured by the vessel, stenosis and extent scores by perusing the coronary angiograms. RESULTS: The mean GPx concentration of the study sample was 120.44 units GPx/mg Hb which is below the normal value of 275 units GPx/mg Hb. The mean vessel, stenosis and extent scores of the study sample were 2.04 (out of a possible 3) 9.86 (out of a maximum of 32) and 46.42% respectively. The GPx levels showed a significant inverse correlation with the vessel, stenosis and extent scores (p < 0.01), No significant correlation was observed between the GPx levels and age in the study population. CONCLUSIONS: GPx may be a predictor of severity and extent of ischaemia in ischemic heart disease patients. GPx levels did not change with the age.
Hemoglobin variants in patients with type-2 diabetes mellitus
(SEAMEO Regional Tropical Medicine and Public Health Project, 2010) Chandrasena, L.G.; Peiris, H.; Williams, S.; Siribaddana, S.H.
Measurement of HbA1c levels in diabetic patients is an established procedure for evaluating long-term control of diabetes. Despite its usefulness, conditions that effect hemoglobin concentration, such as hemoglobinopathies give rise to inappropriate HbA1c values. Since information about hemoglobinopathies in the diabetic population in Sri Lanka is limited, a prospective cross-sectional study was carried out among 2,695 diabetic subjects attending the diabetic clinic at Nawaloka Hospital, Sri Lanka. Hemoglobin type and HbA1c were measured by the HPLC method. The results reveal among 2,695 diabetic subjects, 53 (2%) had abnormal hemoglobin types (HbF and HbS). HbA1c concentrations in diabetic patients without Hb abnormalities show a higher correlation with fasting blood glucose than those with hemoglobin abnormalities. This study emphasizes that patients with inappropriate HbA1c values should be investigated for hemoglobinopathies.
Hepatitis B and C virus markers among new entrant medical students
(Sri Lanka Medical Association, 1999) Premawardhena, A.P.; Premaratna, R.; Jayaweera, G.; Costa, S.; Chandrasena, L.G.; de Silva, H.J.
AIM: To investigate the presence of hepatitis B and C virus markers in new entrant medical students at the Faculty of Medicine, University of Kelaniya. METHOD: 456 students (mean age 24 years, SD 3.5, 257 men) were investigated before they were exposed to clinical work, using a questionnaire to assess sociodemographic factors and possible risk factors for contracting hepatitis B or C. Blood samples were tested for HBs Ag and anti HBs (n = 456), and anti-HCV (n = 162 randomly selected samples) with a third generation sandwich radioimmunoassay technique. RESULTS: The students were from 20 of the 25 districts in the country, although their distribution was not inform. A past history of hepatitis or jaundice was obtained from 24 (5.3 percent ) and 6 (1.3 percent ) students respectively. None of them had been vaccinated against hepatitis B. At least one risk factor for hepatitis B or C was present in 32 (7 percent ) of them. None of the samples were positive for HBsAg or anti-HCV, and only two (0.44 percent ) were positive for anti-HBs. CONCLUSION: Our results support the view that exposure to hepatitis B and C seems to be uncommon in this country, at least up to young adulthood. As most new entrant medical students are not immune to these infections there is a strong case to vaccinate them against hepatitis B before they are exposed to clinical work.
Is the length of hospital stay in the private sector longer if the patient has insurance?
(Sri lanka Medical Association, 2015) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: Hospital length of stay (LOS) describes the duration of a single episode of hospitalization. The aim of this study was to determine the association between hospital LOS in a private hospital in Colombo and presence of insurance cover among patients admitted between 2009 and 2014. METHOD: A retrospective study was conducted at a private hospital in Colombo. All admissions between 2009 and 2014 had been computerised; data pertaining to length of stay, age, sex and availability of insurance cover were extracted for all patients from the database. RESULTS: There were 188,557 admissions (98,116 men; 52%) between 2009 and 2014. The mean LOS gradually declined from age less than 10 years to 30 to 40 years and then increased with increasing age. Men had a significantly higher LOS than females (2.7 vs 2.4 days). The average length of stay significantly declined in both sexes from 2009 to 2014 [P<0.05]. 19% of hospital days were in the age group less than 20 years and 40% are in the age group 21-50 years. 61% of the patients had insurance and 17% of them were in the age group 51 to 60 years. More than 50% of the admissions among insured and non- insured were men. The LOS among the insured was significantly higher than the non-insured (2.7 vs 2.2 days) [PO.05]. CONCLUSION: Higher LOS was associated with older age, male patients and availability of insurance. The most of the insured patients were in the age group of 51 to 60 years.