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 Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study(Ceylon College of Physicians, 2020) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chackrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.P.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: There are no cardiovascular(CV)-risk prediction models specifically for Sri Lankans. Different risk prediction models not validated among Sri Lankans are being used to predict CV-risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected participants between 40-64 years, by stratified random sampling of the Ragama Medical Officer of Health area in 2007 and followed them up for 10-years. Risk predictions for 10-years were calculated using WHO/ISH (SEAR-B) charts with- and without-cholesterol in 2007. We identified all new-onset cardiovascular events(CVE) from 2007-2017 by interviewing participants and perusing medical-records/death-certificates in 2017. We validated the risk predictions against observed CVEs. RESULTS: Baseline cohort consisted of 2517 participants (males 1132 (45%), mean age 53.7 (SD: 6.7 years). We observed 215 (8.6%) CVEs over 10-years. WHO/ISH (SEAR B) charts with and without-cholesterol predicted 9.3% (235/2517) and 4.2% (106/2517) to be of high CV-risk ≥20%), respectively. Risk predictions of both WHO/ISH (SEAR B) charts with- and without-cholesterol were in agreement in 2033/2517 (80.3%). Risk predictions of WHO/ISH (SEAR B) charts with and with out-cholesterol were in agreement with observed CVE percentages among all except in high risk females predicted by WHO/ISH (SEAR B) chart with-cholesterol (observed risk 15.3% (95% Cl 12.5 - 18.2%) and predicted risk 2::20%). CONCLUSIONS: WHO/ISH (SEAR B) risk charts provide good 10-year CV-risk predictions for Sri Lankans. The predictions of the two charts, with and without-cholesterol, appear to be in agreement but the chart with-cholesterol seems to be more predictive than the chart without-cholesterol. Risk charts are more predictive in males than in females. The predictive accuracy was best when stratified into two categories; low (<20%) and high (≥20%) risk.Item Serum adiponectin levels in overweight and obese women; discrimination between insulin resistance and abdominal obesity(American Association for Clinical Chemistry, 2016) Chackrewarthy, S.; Medagoda, K.; Marasinghe, E.; Wijayasinghe, S.INTRODUCTION: Insulin resistance and abdominal obesity are both associated with lower serum adiponectin concentrations. Since insulin resistance and abdominal obesity are related, the extent to which the association of adiponectin with insulin resistance is dependent on its relationship with abdominal obesity is not clear. The present study investigated the association between insulin resistance and abdominal obesity in its relationship with serum adiponectin. METHODS : Eighty-eight overweight or obese women (BMI>23) in the age group 35-65 years were enrolled. Anthropometric measurements, blood pressure were recorded and a fasting blood sample was obtained for biochemical parameters. Insulin resistance (IR) was quantified by homeostasis model assessment of insulin resistance (HOMA-IR). Abdominal obesity was assessed by waist circumference (WC). Subjects were divided according to WC quartiles: Q1) WC < 89cm (n = 21); Q2) WC 89-96cm (n = 21); Q3) WC 97-102cm (n = 25); and Q4) WC > 102cm (n = 21) and on the basis of insulin resistance. Data were analysed by SPSS 16.0. RESULTS: The mean serum concentration of adiponectin in women were 5.93±1.9 µg/mL. In linear regression analysis, significant correlates of serum adiponectin were serum insulin (r = -0.439, p=0.000) and insulin resistance (r = -0.415, p0.05). High-density lipoprotein (HDL) correlated positively with adiponectin level (p 2.5) subjects had significantly lower (p< 2.5) subjects irrespective of the level of abdominal adiposity. CONCLUSION: High adiponectin levels are associated with insulin sensitivity and a favourable lipid profile. Serum adiponectin levels are more tightly linked with insulin resistance than with abdominal obesity.Item The Ragama Health Study: the methodology of the prospective cohort study for the establishment of diagnostic criteria for metabolic syndrome in Sri Lankans(Sri Lanka Medical Association, 2008) Wickremasinghe, A.R.; de Silva, H.J.; de Silva, H.A.; de Silva, N.R.; Kasturiratne, A.; Pinidiyapathirage, J.; Chackrewarthy, S.; Pathmeswaran, A.; Weerasinghe, G.A.K.; Abeyewickreme, W.; Makaya, M.; Mizoue, T.; Kato, N.BACKGROUND: Sri Lanka is in the midst of the epidemiologic transition with non-communicable diseases being a leading cause of death and hospitalization. This pilot study is a part of an international study conducted by the International Medical Centre of Japan (IMCJ) in collaboration with the Faculty of Medicine, University ofKelaniya. OBJECTIVE; To determine the prevalence of major metabolic disorders and to establish diagnostic criteria for metabolic syndrome in the Sri Lankan population as a pilot study. DESIGN, SETTING AND METHODS: A random sample of 3500 adults 35-64 years was selected from the electoral register. Houses of selected subjects were visited and the selected subject invited to participate in the study. Subjects were instructed to fast for 12 hours and refrain from smoking and consumption of alcohol overnight prior to presenting at the Family Medicine clinic of the Faculty of Medicine, University of Kelaniya. At the clinic, subjects were assigned an unique identification number and a detailed history taken and investigations carried out. Heights, weights, blood pressure and waist and hip circumference were measured using standard techniques. Subjects underwent an ultrasound scan of the liver and a sample of blood was obtained for full. blood count, blood picture, lipid profile, serurn insulin, serum alanine transferase, fasting blood sugar and for genetic analysis. Samples of blood for genetic analysis have been stored at -30° C until further analysis. In addition, subjects were administered a food frequency questionnaire and an assessment of daily physical activities recorded. All subjects with abnormal results of investigations are being followed up.Item Prevalence of metabolic syndrome in a Sri Lankan community(Sri Lanka Medical Association, 2008) Chackrewarthy, S.; Gunasekera, D.; de Silva, L.D.R.; Pathmeswaran, A.; Wijekoon, C.N.; Ranawaka, U.K.; Mizoue, T.; Kato, N.OBJECTIVE: To estimate the prevalence of metabolic syndrome (MetS) in a Sri Lankan community. Limited information is available about MetS in Sri Lankans. DESIGN, SETTING AND METHODS: A total of 2948 individuals (1345 males and 1603 females) who participated in the Ragama Health Study comprised the study population. Prevalence of MetS was estimated using three widely used criteria: International Diabetes Federation (IDF), WHO and National Cholesterol Education Programme - Adult Treatment Panel III (NCEP-ATP III). RESULTS: Age and sex adjusted prevalence rates of MetS were 38.9%, 38.9% and 41.6% as defined by IDF, WHO and NCEP-ATP III respectively. Prevalence increased with age (for age groups 35-44, 45-54 and 55- 65 years respectively; IDF - 27.9%, 40,1%, 42.9% ; WHO - 28.7%, 43.2%, 52.6%; NCEP ATP III - 34.6%, 46.7%, 50.6%; P<0.001 in all). MetS was commoner in women (IDF - 45.8% Vs. 23.0%, P<0.001; WHO - 37.3% Vs. 40.5%, P>0.05; NCEP-ATP III - 49.8% Vs. 33.1%, P<0.001). Prevalence of central obesity (using Asian cutoff values) was higher in women. (70.8% Vs. 35.5%, P<0.001). CONCLUSION: Prevalence of MetS is high in this community. Preventive measures towards reducing trie risks associated with MetS should be promoted.Item 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%, PItem Prevalence of Chronic Kidney Disease among older adults in urban Sri Lanka - Tip of the iceburg?(The International Society of Nephrology, 2015) de Silva, S.T.; Kasturiratne, A.; Chackrewarthy, S.INTRODUCTION: Prevalence of chronic kidney disease (CKD) is increasing worldwide, mainly due to increasing diabetes mellitus (DM) and hypertension (HPT) in aging populations. Although these diseases affect many, data on population prevalence of CKD in Sri Lanka is scarce. However, a CKD of uncertain aetiology (CKDu), mainly seen in the North Central parts of the country, receives much attention. The prevalence of CKDu among adults in the affected areas was estimated to be 15.3% in 2012. Our objectives were to identify the prevalence of CKD in an urban adult Sri Lankan population and compare that to the prevalence of CKDu. METHODS: Subjects were randomly selected from the Ragama Health Study (RHS), an on-going community based research project of the Ragama Medical Officer of Health area with 3012 adult participants. Data was obtained using an interviewer-administered questionnaire. Serum creatinine was tested and estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula. CKD was defined as eGFR <60 ml/min/1.73m2, using the KDIGO/KDOQI classifications. RESULTS: Of 301 participants with a mean age of 57.5 years (range 40-73 years), 178/301 (59.1%) were female. 43/301 had eGFR <60 ml/min/1.73m2, giving a CKD prevalence of 14.3% in our sample. 34/43 (79.1%) were in CKD Stage IIIA. 5/43 (11.6%) had only DM, 14/43 (32.6%) had only HPT and 13/43 (30.2%) had both DM and HPT, as probable aetiological factors for CKD. A cause of CKD could not be readily identified in 11/43 (25.6%). Patients with CKD were significantly older than 60 years (p<0.000), and were more likely to have DM (p<0.012), HPT (p<0.000), coronary artery disease (p<0.031) and hyperlipidemia (p<0.0230), compared to those without CKD. CONCLUSIONS: CKD prevalence in our sample was similar to the prevalence of CKDu in North Central Sri Lanka. As expected, DM and HPT were the primary associated co-morbidities. Most CKD patients were in stage IIIA, where early recognition and better control of co-morbidities are known to retard progression. CKD of known aetiology is under-recognized in Sri Lanka, and is probably as significant a problem as CKDu. Large population-based studies are needed to better understand the actual size of the problem.Item Hypoglycaemic and Hypolipidaemic effect of an ethylacetate fraction of Artocarpus heterophyllus (jak) leaves in streptozotocin induced diabetic rats(Sri Lanka Association for the Advancement of Science, 2009) Chackrewarthy, S.; Jayasekera, S.; Thabrew, M.I.; Weerasooriya, M.K.B.Previous investigations have shown that aqueous extracts of Artocarpus heterophyllus (jak) leaves (family Moraceae) can exert significant hypoglycaemic activity, and improve the glucose tolerance of healthy rats and humans, and newly diagnosed maturity onset diabetic patients. A preliminary study carried out by the authors with fractions separated from A. heterophyllus leaves showed that the ethylacetate fraction exerts the greatest hypoglycaemic activity in rats. The objective of the present study was to determine the effects of prolonged administration of ethylacetate fraction of A. heterophyllus leaves on serum glucose and lipid levels in streptozotocin induced diabetic rats since no reports are available on the effects of A. heterophyllus leaves on hyperlipidaemia associated with diabetes despite its clinical significance. Oral administration of the ethylacetate fraction (20 mg kg -1 bw) of A. heterophyllus leaves daily for five weeks significantly lowered serum glucose, cholesterol and triglyceride levels in streptozotocin induced diabetic rats. Compared to the control diabetic rats, the extract treated rats had 39% less serum glucose, 23% lower serum total cholesterol and 40% lower serum triglyceride levels and 11% higher body weight at the end of the fifth week. The percentage reductions in the serum parameters mediated by the test fraction were comparable with those produced by glibenclamide (57%, 32% and 42% reductions in serum glucose, cholesterol and triglycerides, respectively). The stimulation of insulin release by active principles in the ethylacetate fraction may be one of the mechanisms by which this fraction mediates its hypoglycaemic effect. It may be concluded that the ethylacetate fraction of A. heterophyllus leaves contain one or more hypoglycaemic and hypolipidaemic principles which have the potential to be developed further for the treatment of diabetes specifically associated with a hyperlipidaemic state.