Browsing by Author "Gunasekara, D."

Now showing 1 - 17 of 17

Analysis of effects of meteorological factors on dengue incidence in Sri Lanka using time series data
(Public Library of Science, 2013) Goto, K.; Kumarendran, B.; Mettananda, S.; Gunasekara, D.; Fujii, Y.; Kaneko, S.
In tropical and subtropical regions of eastern and South-eastern Asia, dengue fever (DF) and dengue hemorrhagic fever (DHF) outbreaks occur frequently. Previous studies indicate an association between meteorological variables and dengue incidence using time series analyses. The impacts of meteorological changes can affect dengue outbreak. However, difficulties in collecting detailed time series data in developing countries have led to common use of monthly data in most previous studies. In addition, time series analyses are often limited to one area because of the difficulty in collecting meteorological and dengue incidence data in multiple areas. To gain better understanding, we examined the effects of meteorological factors on dengue incidence in three geographically distinct areas (Ratnapura, Colombo, and Anuradhapura) of Sri Lanka by time series analysis of weekly data. The weekly average maximum temperature and total rainfall and the total number of dengue cases from 2005 to 2011 (7 years) were used as time series data in this study. Subsequently, time series analyses were performed on the basis of ordinary least squares regression analysis followed by the vector autoregressive model (VAR). In conclusion, weekly average maximum temperatures and the weekly total rainfall did not significantly affect dengue incidence in three geographically different areas of Sri Lanka. However, the weekly total rainfall slightly influenced dengue incidence in the cities of Colombo and Anuradhapura. Copyright: 2013 Goto et al.
Association between serum homocysteine and markers of insulin resistance
(Sri Lanka Medical Association, 2010) Chackrewarthy, S.; Wijayasinghe, Y.S.; Gunasekara, D.; Wickremasinghe, A.R.; Kato, N.
OBJECTIVE: To investigate the association between serum homocysteine and markers of insulin resistance in a Sri Lankan population. Similar studies conducted in other ethnic groups have shown conflicting results. METHODS: 177 apparently healthy volunteers (91 men and 86 women) aged 35-65 years were randomly selected from residents in the Ragama MOH area. Anthropometric indices and blood pressure were measured and information on diet, lifestyle factors and medical history were recorded. Fasting plasma glucose and serum levels of homocysteine, insulin, creatinine, folate and lipid profiles were determined using standard protocols. RESULTS: Mean fasting serum homocysteine levels were higher in males compared to females (14.67 (imol/1 ± 6.02 Vs.10.16 u.mol/1 ± 4.28, p
Associations of emotional behavior with nutritional status and lifestyle habits among schoolchildren aged 5-10 years in Sri Lanka.
(Basel : MDPI, 2021) Shinsugi, C.; Gunasekara, D.; Takimoto, H.
We aimed to examine the relationships of lifestyle habits and nutritional status with emotional behavior among schoolchildren in Sri Lanka. Five hundred and eight schoolchildren (195 boys and 313 girls) aged 5-10 years were included. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire. Nutritional status was used for body mass index-for-age z-score. Breakfast consumption, daily moderate- to vigorous-intensity physical activity (MVPA), wake-up time, and bedtime were considered lifestyle habits. The mean total difficulties score ± standard deviation was 12.0 ± 5.3, and the mean prosocial behavior score was 7.4 ± 1.9. In total, 89.2% children ate breakfast, and 41.3% engaged in at least 60 min of MVPA per day. After adjustment for confounding factors, multiple logistic regression analyses showed that breakfast skipping was associated with high scores on conduct problems (adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI): 1.50 to 5.77, p < 0.01) and that late bedtime was related to low prosocial behavior scores (aOR = 2.43, 95% CI: 1.17 to 5.03, p < 0.05). Our findings suggest that promoting regular lifestyle habits helps reduce psychological difficulties in schoolchildren. However, further research, including longitudinal studies, are required to identify the mechanism underlying this relationship.
The Burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka
(Wiley-Blackwell, 2013) Pinidiyapathirage, M.J.; Kasturiratne, A.; Ranawaka, U.K.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Warnakulasuriya, T.; Wickremasinghe, A.R.
AIMS: To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS: Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes
Cardiovascular risk in a Sri Lankan community
(Sri Lanka Medical Association, 2008) Ranawaka, U.K.; Wijekoon, C.N.; Pathmeswaran, A.; de Silva, L.D.R.; Gunasekara, D.; Chackrewarthy, S.; Mizoue, T.; Kato, N.
OBJECTIVE: Identifying the cardiovascular disease (CVD) [coronary heart disease (CHD) and stroke] risk in a community is important in planning preventive strategies, but such data are lacking from Sri Lanka. We sought to describe the CVD and CHD risk in a Sri Lankan community. DESIGN, SETTING AND METHODS: A community survey was conducted in the Ragama Medical Officer of Health area (Ragama Health Study) involving individuals aged 35-65 years, selected by stratified random sampling. Their 10-year CVD and CHD risks were estimated using three widely used risk stratification ALGORITHMS: Framingham score, NCEP-ATP III (National Cholesterol Education Program – Adult Treatment Panel III), and Systematic Coronary Risk Evaluation (SCORE). Results: In the study population (n=2985), 54.5% were females, and the mean age [SD] was 52.4 [7.8] years. According to the Framingham (CHD risk), NCEP-ATP III (CHD risk) and SCORE (total CVD mortality risk) criteria, 11.5%, 37.2% and 9.7% respectively were classified as 'moderate or high risk'. Risks were not significantly different between sexes, except with NCEP-ATP III criteria (M- 54.1%, F- 21%, p55y- 38%, p55y- 64.7%, p<0.001; SCORE: <55y- 9.0%, >55y- 14.6%, P
The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study
(Elsevier Science Ireland Ltd, 2021) Niriella, M.A.; Ediriweera, D.S.; Kasturiratne, A.; Gunasekara, D.; de Silva, S.T.; Dassanayake, A.S.; de Silva, A.P.; Kato, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.
OBJECTIVES: Despite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. METHOD: In an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. RESULTS: Of 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007). At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. CONCLUSIONS: Only moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying individuals who need medical intervention even among those with milder degrees of fatty liver. We therefore recommend using increased hepatic echogenicity, and not only the more stringent criteria (which include signal attenuation and/or vascular blunting), for the diagnosis of fatty liver in individuals with NAFLD. KEYWORDS: Cardiovascular events; Fatty liver; NAFLD; Outcomes; Ultrasonography; Ultrasound criteria.
A Comparison between revised NCEP ATP III and IDF definitions in diagnosing metabolic syndrome in an urban Sri Lankan population: the Ragama Health Study
(Hindawi Publishing Corporation, 2013) Chackrewarthy, S.; Gunasekara, D.; Pathmeswaran, A.; Wijekoon, C.N.; Ranawaka, U.K.; Kato, N.; Takeuchi, F.; Wickremasinghe, A.R.
Background. The prevalence of metabolic syndrome (MetS) within individual cohorts varies with the definition used. The aim of this study was to compare the prevalence of MetS between IDF and revised NCEP ATP III criteria in an urban Sri Lankan population and to investigate the characteristics of discrepant cases. Methods. 2985 individuals, aged 35-65 years, were recruited to the study. Anthropometric and blood pressure measurements and laboratory investigations were carried out following standard protocols. Results. Age and sex-adjusted prevalences of MetS were 46.1% and 38.9% by revised NCEP and IDF definitions, respectively. IDF criteria failed to identify 21% of men and 7% of women identified by the revised NCEP criteria. The discrepant group had more adverse metabolic profiles despite having a lower waist circumference than those diagnosed by both criteria. Conclusion. MetS is common in this urban Sri Lankan cohort regardless of the definition used. The revised NCEP definition was more appropriate in identifying the metabolically abnormal but nonobese individuals, especially among the males predisposed to type 2 diabetes or cardiovascular disease. Further research is needed to determine the suitability of the currently accepted Asian-specific cut-offs for waist circumference in Sri Lankan adults. Copyright © 2013 S. Chackrewarthy et al
Comparison of urban diabetics with optimal and suboptimal control
(BMJ Publishing Group, 2011) Pinidiyapathirage, J.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
INTRODUCTION: The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. METHODS: A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. RESULTS: There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. CONCLUSIONS: Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.
Correction: Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka.
(Public Library of Science, 2020) Shinsugi, C.; Gunasekara, D.; Gunawardena, N.K.; Subasinghe, W.; Miyoshi, M.; Kaneko, S.; Takimoto, H.
[This corrects the article DOI: 10.1371/journal.pone.0224222.]. Erratum for Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka. PLoS One.2019;14(10):e0224222.
Dengue Encephalitis with Concurrent Infections by Multiple Dengue Virus Serotypes
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Jayarathne, J.A.J.C.; Wijesinghe, W.A.T.A.; Mendis, S.; Waidyasekara, J.; Gunathilaka, P.A.D.H.N.; Gunasekara, D.
Dengue is a serious public health problem caused by an arbovirus. Abnormal-neurological presentations associated with dengue infection is rare. Herewith, we report a case of a patient with dengue encephalitis who was concurrently infected with multiple serotypes. A 36-year-old, male resident from Poogoda presented to North Colombo Teaching Hospital with a history of generalized tonic-clonic seizures (GTCS) and unconsciousness. On admission, he displayed only a persisting headache. He had no significant illnesses in the past. Detailed history revealed that he has had a fever and left the hospital against the medical advice on the same day. On clinical examination, he was afebrile and blood pressure was 110/80 mmHg. He was well oriented with a Glasgow Coma Scale (GCS) of 15/15 and there was no focal neurological deficit. The funduscopic examination was normal. His initial full blood count revealed a rise in white blood cells with a predominant elevation of neutrophils of 12.44 x 103/uL. His platelet count was reported to be 306 x103/uL and, he was treated for a bacterial infection. On the following day, the patient started developing a fever and GTCS. Aggressive behavior, confusion, and delirium were also demonstrated. Neck stiffness was not observed. Non-contrast computed tomography (NCCT) scan, contrast-enhanced computed tomography (CECT) scan, chest X-ray scan and magnetic resonance image (MRI) of the brain were normal. Electroencephalography (EEG) revealed encephalopathy with non-epileptic discharge. Lumbar puncture was performed on the third day of admission and analysis of cerebrospinal fluid (CSF) was unremarkable. IgM antibody for the dengue virus (DENV) was detected in CSF. All the other viral and parasitological studies were normal. The patient was treated with anti-epileptic, anti-psychotic, antibacterial and antiviral drugs. High fever spikes and seizures were continued. GCS started to deteriorate from 9/15 to 3/15. Urine out-put started to decline. Ultra-sound scanning revealed mild ascites. Blood picture analysis showed evidence of having a severe bacterial infection. On day 9, both CSF and serum specimens were referred to Molecular Diagnostic Laboratory, Faculty of Medicine, Ragama for dengue viral investigations. The presence of NS-1 antigen, IgM/IgG antibodies, and the occurrence of concurrent infections with serotype 2 and 3 in the serum sample confirmed that the patient was infected with DENV. The presence of IgM/IgG antibodies were observed in the CSF sample. On day 10, the patient was transferred to the medical intensive care unit and monitored thoroughly. As the condition was deteriorated, he was ventilated and incubated for 11 days in the intensive care unit. He started to recover gradually after the 31st day. On day 36, the patient was discharged without any residual neurological symptoms. The patient is currently being followed up at the neurological clinic. Dengue encephalitis is a rare and deleterious manifestation of dengue infection. It is believed that concurrent infections with multiple serotypes and serotype replacement may cause disease severity. Therefore, reporting uncommon cases will provide insights for the physicians in early diagnosis and effective management
Descriptive Investigation of Strongyloidiasis Infection and Characterization of Strongyloides stercoralis Using Morphological and Molecular-Based Methods
(Hindawi Pub. Corp., 2020) Gunathilaka, N.; Chandrasena, N.; Wijerathna, T.; Fuji, Y.; Gunasekara, D.; Gunatilaka, R.P.; Premaratna, R.
ABSTRACT: Strongyloidiasis is caused by the nematode Strongyloides stercoralis which has the unique ability to reproduce and complete its entire life cycle within the human host through its autoinfection cycle. Diagnosis of this infection is important because of its potential to cause fatal hyperinfection syndrome or disseminated infections in those with defective cellular immunity. Parasitological methods based on faecal microscopy and culture often fail to detect low-intensity infections. A multiplex polymerase chain reaction (PCR) assay was developed for the detection of S. stercoralis, Ascaris lumbricoides, and Enterobius vermicularis by designing primers specific for the ITS1 region of ribosomal DNA of S. stercoralis and A. lumbricoides and 18S region of rRNA of E. vermicularis. A 61-year-old patient presented with chronic gastrointestinal and respiratory symptoms and weight loss with a stool microscopy positive for helminth larvae. Stool cultures with the Harada-Mori technique yielded L3 larvae which were identified as S. stercoralis based on morphology. The multiplex PCR performed on DNA extracted from stool elicited the expected band at 129 bp on gel electrophoresis of the PCR yield providing molecular evidence of intestinal strongyloidiasis. The patient's gastrointestinal symptoms improved with a six-day course of albendazole (400 mg twice daily). Negative posttreatment stool microscopy, culture, and PCR confirmed successful clearance of infection. Molecular-based PCR assay is a promising tool to diagnose and assess the therapeutic efficacy of anthelmintics in intestinal helminthiases such as strongyloidiasis.
Detection of Leishmania donovani DNA within field-caught Phlebotomine Sand Flies (Diptera: Psychodidae) in three cutaneous leishmaniasis endemic foci of Kurunegala District, Sri Lanka
(Hindawi Pub. Corp., 2021) Wijerathna, T.; Gunathilaka, N.; Gunawardena, K.; Fujii, Y.; Gunasekara, D.
ABSTRACT: Leishmaniasis is a parasitic infection transmitted through the bite of female phlebotomine sand flies. Microscopy is the gold standard to detect parasites within the sand flies and for vector incrimination. However, molecular-based detection has become more popular nowadays in the identification of Leishmania parasites since it provides detection and species identification simultaneously with no need of laborious procedures. The entomological surveys were conducted monthly from May to October 2017 using standard entomological techniques. Field-caught sand flies were identified to the species level followed by DNA extraction. The polymerase chain reaction (PCR) was performed using species-specific primers to detect Leishmania donovani parasites. A total of 1,662 sand flies were encountered from the entomological surveys, and the majority of them were Phlebotomus argentipes (n = 1517; 91.27%), while others were Sergentomyia punjabiensis (n = 140; 8.72%). Leishmania donovani parasite DNA was detected only from P. argentipes (2.3%; n = 2). The detection of Leishmania DNA in P. argentipes suggests the possible role of this species as a vector for leishmaniasis in Sri Lanka.
Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka
(Public Library of Science, 2019) Shinsugi, C.; Gunasekara, D.; Gunawardena, N.K.; Subasinghe, W.; Miyoshi, M.; Kaneko, S.; Takimoto, H.
Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5-10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child's body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08-5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16-0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition. Erratum in: PLoS One. 2020;15(3):e0230785.
Encapsulation of essential oil blend in β-CD nanoparticles as a repellent for slow release
(Moleclar Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2015) Jayaweera, V.; Eliyapura, A.; Gunasekara, D.; Weerasinghe, L.; Gunathilaka, P.A.D.H.N.; Abeyewickreme, W.; Karunaratne, V.
BACKGROUND: Malaria, dengue, and other tropical diseases carried by arthropods such as mosquitoes, ticks and fleas have greatly affected life expectancy, infant mortality, quality of life and work productivity. Essential oils such as citronella, lemon eucalyptus, peppermint, lemon, eucalyptus, lemongrass, geranium, and lavender are known for their mosquito repellency. Due to high volatility of essential oils, these are needed to be reapplied to the skin every 30–60 minutes. Therefore, development of a long lasting mosquito repellent is needed for effective repellent activity. The aim of this experiment is to develop a new blend which encompasses citronella, lemon eucalyptus, lemon and lavender. This oil blend is encapsulated using β-Cyclodextrin (β-CD) to decrease the volatility of the oil blend and increases the long-lasting repellency. METHODS: Citronella, lemon eucalyptus, lemon and lavender were obtained in 15% v/v, 15% v/v, 1% v/v and 1% v/v respectively for a total volume of 100 ml. These oils were mixed with 0.2% w/v of β-Cyclodextrin for encapsulation. The blend was sonicated for 20 min and dissolved in ethanol. This final encapsulated mixture was subjected to bioassays using 110 adult Aedes albopictus mosquitoes against the control. Sitting and biting mosquito behavior patterns were studied against the releasing time. RESULTS: The bioassay results indicated that the encapsulated repellent product is effective against the mosquitos up to 6 hours with zero sitting and biting comparatively to the control. In the 7th hour showed single mosquito sitting with zero biting. CONCLUSION: The encapsulated repellent is effective against the Ae, albopictus mosquitoes for 6 hour time period. Therefore, it is a long-lasting repellent that protect against dengue fever caused by mosquitoes.
Hilar cholangiocarcinomas - from nihilism to aggressive treatment
(The College of Surgeons of Sri Lanka, 2012) Liyanage, C.; Nawaratne, M.; Pathirana, A.; Gunasekara, D.; Pranahewa, L.; Prasad, R.; Wijeratne, T.; Bogammana, M.; Wijesooriya, R.; Siriwardhana, R.
INTRODUCTION: Hllar-Cholangio-carcinomas (HCC) are aggressive tumours with a dismal prognosis. The general tendency amongst all specialities is to palliate them. As response to adjuvant therapy is marginal we have embarked on aggressive management of these patients with the available surgical and endoscopic expertise. METHODS: Patients presenting to the North Colombo Teaching hospital· and the Gastrointerology unit of the National hospital in 2011 were included . All had Tri phasic CT , MRCP or ERCP prior to be discussed at MDT with all the above authors regarding further management. Patients with Bismuth 1 v lesions and unfit for surgery underwent Combination ERCP/doublestenting/RFA of lesion/Rendezvous procedure/Percutaneous, stenting or PTC. RESULTS: 32 patients were treated .5/32 had radical surgical resections (2 extended right hepatectomy with bile duct resecton and lymphadenectomy (BDR+LA), 2 extended left hepatectomy +BDR+LA, and 1 extended heft hepatectomy with BDR+LA+Reconstruction of Right hepatic artery and right portal vein. I underwent segment iii bypass. 7 patients underwent ERCP and serial RFA with stenting. 3/5 patients are alive and disease free at 6-12 months. CONCLUSIONS: Where possible HCC patients should be offered a curative resection. RFA gives longer and better palliation compared to standard stenting. These patients should be managed by a specialized team as aggressive management may improve their survival.
Risk estimates of cardiovascular diseases in a Sri Lankan community
(Sri Lanka Medical Association, 2016) Ranawaka, U.K.; Wijekoon, C.N.; Pathmeswaran, A.; Kasturiratne, A.; Gunasekara, D.; Chackrewarthy, S.; Kato, N.; Wickremasinghe, A.R.
OBJECTIVES: Quantifying the risk of cardiovascular disease (CVD) in a community is important in planning preventive strategies, but such data are limited from developing countries, especially South Asia. We aimed to estimate the risks of coronary heart disease (CHD), total CVD, and CVD mortality in a Sri Lankan community. METHODS: A community survey was conducted in an urban health administrative area among individuals aged 35- 64 years, selected by stratified random sampling. Their 10-year CHD, total CVD, and CVD mortality risks were estimated using three risk prediction tools: National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III), Systematic Coronary Risk Evaluation (SCORE), and World Health Organisation/ International Society of Hypertension (WHO/ISH) charts. RESULTS: Among study participants (n=2985), 54.5% were females, and mean age (SD) was 52.4 (7.8) years. According to NCEP-ATP III (‘hard’ CHD risk), WHO/ISH (total CVD risk), and SCORE (CVD mortality risk) criteria, 25.4% (95% CI 23.6-27.2), 8.2% (95% CI 7.3-9.2), and 11.8 (95% CI 10.5-13.1) respectively were classified as at ‘high risk’. The proportion of high risk participants increased with age. ‘High risk’ was commoner among males (30.3% vs 20.6%, p<0.001) according to NCEPATP III criteria, but among females (9.7% vs. 6.7%, p<0.001) according to WHO/ISH criteria. No significant gender difference was noted in SCORE risk categories. CONCLUSIONS: A large proportion of individuals in this community are at risk of developing cardiovascular diseases, especially in older age groups. Risk estimates varied with the different prediction tools, and were comparatively higher with NCEP-ATP III charts.
Use of Mid-Upper Arm Circumference (MUAC) to predict malnutrition among Sri Lankan school children
(MDPI Publishing, 2020) Shinsugi, C.; Gunasekara, D.; Takimoto, H.
ABSTRACT:The double burden of malnutrition (under- and overnutrition) is a serious public health issue in childhood. The mid-upper arm circumference (MUAC) is a simple tool for screening nutritional status, but studies of the optimal cutoff to define malnutrition are limited. This study aimed to explore the prediction of malnutrition by MUAC in Sri Lankan schoolchildren. The participants were 538 students (202 boys, 336 girls) aged 5-10 years. Spearman's rank correlation was calculated for MUAC and both body-mass-index-for-age z-score (BAZ) and height-for-age z-score (HAZ). Receiver operating characteristic (ROC) analysis was conducted to assess the ability of MUAC to correctly classify malnutrition, after stratifying for age and birth weight. MUAC correlated significantly with BAZ (r = 0.84) and HAZ (r = 0.35). The areas under the ROC curve for thinness, overweight, obesity, and stunting were 0.88, 0.97, 0.97, and 0.77, respectively. The optimal MUAC cutoff values for predicting thinness and stunting were 167.5 mm and 162.5 mm, respectively; the optimal cutoffs for predicting overweight and obesity were 190.5 mm and 218.0 mm, respectively. These cutoffs differed after stratification by age group and birth weight. Our results confirm MUAC to be a useful tool for monitoring growth in schoolchildren. KEYWORDS: BMI-for-age z-score; Sri Lanka; anthropometry; child malnutrition; cutoffs; height-for-age z-score; mid-upper arm circumference; overweight and obesity; schoolchildren; thinness and stunting.