Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Idiopathic pancreatitis: Is it a consequence of an altering spectrum of bile nucleation time?.(BMJ Publishing Group, 2009) Abeysuriya, V.; Deen, K.I.; Navaratne, N.M.M.; Kumarage, S.K.INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case-control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 +/- 0.33 kg/m2; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 +/- 0.23 kg/m2; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 +/- 0.2 kg/m2) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 +/- 0.23 kg/m2, undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULT(S): Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 +/- 0.2 vs controls, 12.74 +/- 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 +/- 0.24 days vs controls, 12.74 +/- 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 +/- 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 +/- 0.2 days, p = 0.002, t test). CONCLUSION(S): NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.Item Variation of segment specific carotid artery intima-media thickness in a selected Sri Lankan population.(Sri Lanka Medical Association, 2021) Abeysuriya, V.; Wijesinha, A.N.I.; Priyadharshan, A.; Wickremasinghe, A.R.Introduction and objective Carotid artery intima-media thickness (CIMT) is a strong predictor of coronary heart disease (CHD). The literature debates considering segment-specific CIMT variation while constructing country-specific risk prediction models to screen at-risk populations. We evaluated segment-and site-specific variation in CIMT to derive a composite score for Sri Lankans. Methods The study was conducted from November 2019 to October 2020 in a private hospital in Colombo. Based on predefined inclusion-exclusion criteria, cases (having a CHD diagnosis, n=338) and controls (n=356) were recruited. People without any suggestive medical history of having angina type chest pain , no significant ECG changes suggestive of acute coronary syndrome, negative treadmill test, normal echocardiographic evidence and negative test results of Troponin I and T were considered as controls. Ultrasound examination of the common-carotid-(CCA), the carotid-bulb-(CB) and the internalcarotid segments-(ICA) of the carotid vessel were conducted by a radiologist, and CIMTs were measured. A composite-CIMT score defined as the average value of all six segments of both the left and right sides was derived. Results 694 participants were enrolled. The mean-(+SD) age of the study sample was 60.2(±9.86) years. The highest mean-(+SD) CIMT value was in the CB-(0.89 (±0.09mm)) in the CHD group and in the CCA-(0.72 (±0.11mm)) in the non-CHD group. The lowest mean-(+SD) CIMT was in the ICA in both the CHD group-(0.86 (±0.08mm)) and in the non-CHD-(0.69 (±0.11mm)). There was a significant difference in the mean CIMT values between the right and left sides (p<0.05 for all) in both the two groups. The composite value for CHD and non-CHD groups was 0.88(±0.07) mm and 0.71(±0.09) mm (P<0.001). Conclusion Carotid artery segment-specific-CIMT variations are present in this population. Further analyses should be carried out to determine if a composite-CIMT value is a better predictor of CHD.Item Anatomical variations of the musculocutaneous nerve - A cadaveric study(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.Item The socio-demographic and economic profile of patients attending emergency services in a private hospital(Sri Lanka Medical Association, 2018) Abeysuriya, V.; Chandrasena, L.G.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: Studies have highlighted that the private sector contributes a major share in outpatient healthcare and a small proportion in inpatient care in Sri Lanka. There is little or no information on the contribution of the private health sector in emergency care. METHODS: A descriptive cross sectional study was carried out on patients admitted to an emergencytreatment unit of a private hospital in Colombo from October 15th to December 15th 2016. Data were abstracted from medical records, verbal interviews, and the computerized database maintained by the hospital. Data were analyzed using the SPSS 16. RESULTS: 2395 patients (1426 men; 59.2%) were admitted during the study period. The majority of patients were 61 to 70 years (30.4%) and 80.3% were employed. 61.6% of patients had a health insurance policy; 67.3% of these were private insurance policies. 38.4% of insurance policies were self-financed. The monthly income ranged between Rs.15, 000 and Rs.150, 000 (mean Rs.41, 800±26,180). Persons less than 60 years were more likely to have insurance cover (1.58 times in state policies and 1.34 times in private insurance) as compared to patients 60 years and over. Persons with an education less than A-Levels were more likely (OR=l.78) to have private insurance cover as compared to a person with a higher education.CONCLUSION: Persons with varying economic backgrounds seek emergency health care in private hospitals. A large percentage of patients seeking emergency health care in private hospitals have to bear out-of-pocket expenditure. The older the person, the less likely that (s)he has health insurance cover.Item Idiopathic pancreatitis: is it a consequence of an altering spectrum of bile nucleation time?(BMJ Publishing, 2009) Abeysuriya, V.; Deen, K.I.; Navarathne, N.M.M; Kumarage, S.K.INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case–control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 ¡ 0.33 kg/m2 ; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 ¡ 0.23 kg/m2 ; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 ¡ 0.2 kg/m2 ) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 ¡ 0.23 kg/m2 , undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULTS: Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 ¡ 0.2 vs controls, 12.74 ¡ 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 ¡ 0.24 days vs controls, 12.74 ¡ 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 ¡ 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 ¡ 0.2 days, p = 0.002, t test). CONCLUSION: NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.Item Cut off value of TSH for early prediction of poor neurodevelopment of 5 to 9 year old children in Sri Lanka(Sri Lanka Medical Association, 2012) Abeysuriya, V.; Perera, K.P.J.; Kasturiratne, A.; Wickremasinghe, A.R.INTRODUCTION AND AIMS: To assess the relationship between TSH and neuro-development of children between 5- 9 years of age and to identify the cutoff value of TSH for early prediction of poor neuro developmental outcome. METHODS: A descriptive cross sectional study was carried out in 20 randomly selected estates in the Ratnapura district of Sri Lanka from August to December 2010. A validated neurodevelopment assessment tool was used to assess the neuro-development of 1683 randomly selected children. Neuro¬development was expressed as a General Quotient (GQ) score and a score <100 was identified as evidence of poor neuro-development Of 1683 children screened, 519 were randomly selected with consent from the parents; blood was assayed for TSH using the 3rd generation TSH Chemiluminescent immunometric assay. ROC curve analysis was used to find out the cut off value of TSH that best predicts poor neuro¬development in children. RESULTS: Of 519 children whose TSH levels were assayed, 494 had TSH levels within the normal range between 0.60 to 5.40 ulU/ml, of whom 16% had a GQ score <100. There was a significant association between TSH levels and neuro-development [p=0.0001). The best cutoff value of TSH to predict a GQ score <100 was 1.5 p.IU/ml. [Area under cure=73.4%, sensitivity= 97.0% and specificity =70.6%). CONCLUSIONS: The best cutoff value of TSH for prediction of poor neuro-development in children 5 to 9 years of age is 1.50 p.IU/ml.Item Survival of patients treated with Percutaneous Transluminal Coronary Angioplasty following ST segment elevation myocardial infarction(Sri Lanka Medical Association, 2013) Abeysuriya, V.; Kasturiratne, A.; Chandrasena, L.G.; Hettiarachchi, V.S.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVE: Objective was to determine the survival of patients treated with Percutaneous Transluminal Coronary Angioplasty (PTCA) following ST segment elevation myocardial infarction (STEMI) and factors affecting survival. METHOD: A retrospective study was conducted among patients diagnosed with STEMI and treated with PTCA in a private hospital in Colombo from 1st January 2009 to 1st November 2012. Details of patients were collected from the medical records and survival status, cause and date of death where relevant, were obtained from medical records, patients or next of kin. RESULTS: Data of 197 patients were obtained. Of them 153 (77.7%) were males. The mean age of males was 55.30 ± 9 30 years and of females 58.80 ±7.10 years. Twenty three pat (11.7%) had died due to all causes and 13 (6.6%) due to cardiovascular diseases. Of the sample 82.7 % (95% CI 77.9-90.5) survived for 3 years. Survival was associated with (unadjusted) history of smoking, diabetes, dyslipidemia, hF ABP positivity, not being on regular medication, occlusion site of LAD and regular follow up. Based on Cox proportional hazards model (adjusted), site of arterial occlusion (proximal vs distal segment of left anterior descending artery [HR 10.98; 95% CI 1.096- 110.205] was significantly associated with survival of patients after ontrolling for other risk factors. CONCLUSION: The three year survival of patients with STEMI who underwent PTCA was 83%. Patients with proxM LAD occlusion were 11 times more likely t< years of PTCA as compared to those who had a distal LAD occlusion.Item 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.Item The standard versus locally improvised banding for bleeding oesophageal varices: case control study(Sri Lanka Medical Association, 2010) Navarathne, N.M.M.; Abeysuriya, V.; Wanigasuriya, I.W.M.P.INTRODUCTION: Endoscopic band ligation is one of the effective therapeutic modalities in variceal bleeding. However the availability of endoscopic banding is mainly overshadowed by its overwhelming cost; especially in a country like Sri Lanka. This study assesses the therapeutic outcome of standard verses locally improvised endoscopic banding in oesophageal varices. METHODS: A study was carried out among 446 (90- standard band ligation, 356-locaIly improvised) patients with acute oesophageal variceal bleeding who were referred to gastroenterology unit of National Hospital of Sri Lanka between January 2005 to December 2008. Consecutive patients with oesophageal variceal bleeding were recruited either uTreceive standard or locally improvised bands, based on the availability of standard banding sets in the unit. The early re-bleeding and hospital mortality rates were compared. RESULTS: Ninety patients (M: F^ 68: 22, mean age: 49.3 years, range- 35 years to 68 years) were treated with standard (Six shooter or Super?) variceal bands, whilst, 356 (Male: 272, Female: 84, mean age: 48.3 years, range- 34 years to 71 years) had locally improvised bands. Early re-bleeding rate with locally improvised band therapy was 8.4% whereas with standard banding, it was 3.3% (p=0.02). In-hospital mortality (of any cause) rates for standard and locally improvised bands were 6/90 (6.6%) and 26/356 (7.3%) respectively (p=0.02). The cost for each standard banding set is LKR 20000±2000 and locally improvised bands approximately LKR 5±0.57 (p=0.001) CONCLUSION: There are differences in re-bleeding and in-hospital mortality with the use of locally improvised band therapy. However the cost of locally improvised band therapy is low.Item Prevalence of poor neuro-developmental outcome and hypothyroidism among 5-9 year-old children in the plantation sector of Sri Lanka(Sri Lanka Medical Association, 2011) Abeysuriya, V.; Perera, K.P.J.; Kasturiratne, A.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: To describe the prevalence of poor neuro-developmental outcome and its relationship to hypothyroidism among 5-9 year-old children in the plantation sector of Sri Lanka. METHODS: This descriptive cross-sectional study was conducted in 20 randomly selected estates in the Ratnapura district. Using a validated tool based on Griffiths mental development scale, neruo-developmental outcome of 1683 children aged 5-9 years was assessed. The results were expressed using the General Quotient (GQ) score [GQ score<100 = poor neruo-developmental outcome]. A 2ml blood sample was obtained from a sub-sample of 519 children after obtaining informed written consent from the parents/guardians and TSH level was assayed. Presence of clinical symptoms of hypothyroidism and visible/palpable goitre were assessed among those who had a TSH>5.4 u-IU/ml (biochemical hypothyroidism). RESULTS: GQ<100 was identified in 9.4% of children and a high TSH (>5.4uTU/ml) was detected in 3.7% of children. Low TSH (<0.6uiU/ml) was detected in 1.2%. The prevalence of poor neuro-developmental outcome with high TSH was 2.1%. There was no association between TSH levels and age and sex. TSH level was significantly associated with neuro-developmental outcome (p<0.001). 15.8% of children with biochemical hypothyroidism had clinical symptoms of hypothyroidism and goitre was visible or palpable in 15.7%. Poor neuro-developmental outcome was present in 58% of these children. CONCLUSIONS: Poor neuro-developmental outcome was evident in a large proportion of children with biochemical hypothyroidism without clinical features of hypothyroidism. These findings indicate a link between poor neuro-development and sub clinical hypothyroidism which has not been described before.