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 Correlates of serum homocysteine in a Sri Lankan population(American Association For Clinical Chemistry, 2010) Chackrewarthy, S.; Wijayasinghe, Y.S.; Gunasekera, D.; Wickremasinghe, R.; Kato, N.Correlates of total serum homocysteine concentration in a Sri Lankan population BACKGROUND: Hyperhomocysteinemia, a possible risk factor for vascular disease occurs at a higher prevalence in South Asian countries. Serum homocysteine concentrations are influenced by genetic, nutritional and lifestyle factors. Correlates of total serum homocysteine concentration (tHcy) are not well characterized in the Sri Lankan population. Such information is important in developing therapeutic and preventative strategies. OBJECTIVE: To investigate the factors potentially associated with fasting levels of serum tHcy in a Sri Lankan population. METHODS: In a cross sectional study, 177 apparently healthy volunteers (91 men and 86 women) aged 38-65 years were selected from residents in an urban health administrative area. Individuals with a history of chronic disease and with any pharmacological treatment were excluded from the study. Information on diet, lifestyle factors and medical history were recorded. Anthropometric indices and blood pressure were measured according standard protocols. Fasting serum levels of tHcy, insulin, creatinine, folate and lipids were estimated using standard protocols. RESULTS: Fasting serum tHcy levels were higher in males than in females (geometric mean +/- SD, 13.75 mumol/l +/- 1.41 Vs. 9.58 mumol/l +/- 1.43, p<0.001) and were positively associated with age (r=0.204, p< 0.01) in both sexes. 32.3% of males and 10.3% of females had mild hyperhomocysteinemia (tHcy>15mumol/l). tHcy levels were significantly higher in smokers than in non-smokers (geometric mean +/- SD, 14.58 mumol/l +/- 1.44 Vs.12.71 mumol/l +/- 1.37, p<0.05) and in alcohol consumers than in non-consumers (geometric mean +/- SD, 14.53 mumol/l +/- 1.43 Vs.12.14 mumol/l +/- 1.32, p< 0.02). In males, tHcy levels were negatively related to serum insulin (r= -0.397, p<0.001) and BMI (r= -0.244, p <0.02) and positively related to serum creatinine (r=0.235, p<0.02). In females, there was a positive relationship between tHcy and systolic blood pressure (r= 0.239, p<0.02) but there was no significant correlation with serum insulin. In both sexes, serum tHcy levels strongly correlated with serum folate (r= -0.412, p<0.001). There were no significant associations between tHcy and serum lipids. Stepwise regression analysis confirmed the associations between tHcy and folate (p<0.001 in both sexes), insulin (p=0.026 in males) and creatinine (p=0.036 in males). CONCLUSION: Low intake of folate, alcohol consumption and smoking were associated with increased tHcy concentrations. Serum insulin and creatinine were independent correlates of tHcy in males, but not in females. Difference in tHcy levels between sexes may partly be attributed to differences in lean muscle mass and to a metabolic link between creatinine synthesis and homocysteine production. Insulin may regulate serum tHcy concentrations by homocysteine remethylation or by increasing homocysteine clearance.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 Vitamin D status and its association with serum parathyroid hormone in preschool children in a Sri Lankan Community(Sri Lanka Medical Assosiation, 2012) Marasinghe, E.; Chackrewarthy, S.; Abeysena, H.T.C.S.; Rajindrajith, S.INTRODUCTION: Despite increased awareness of the adverse health effects of low vitamin D status, data on serum vitamin D status of Sri Lankan preschool children is scarce. AIMS: To investigate the vitamin D status and its association with serum parathyroid hormone in preschool children in a community in the Ragama MOH area. METHODS: In a cross sectional study a total of 340 children (172 girls and 168 boys) aged 2-5 years were selected by random sampling. Fasting levels of serum vitamin D [as 25(OH)DJ and parathyroid hormone (PTH) were determined. The anthropometric characteristics of the children were measured using calibrated equipment. Statistical analysis was performed using SPSS 16.0. RESULTS: The mean fasting 25(OH)D and PTH concentrations were 23.47+8.9 ng/ml and 28.2±17.6 pg/ml respectively. 5.6% and 32.4% of the children had 25(OH)D concentrations indicative of vitamin D deficiency (<10 ng/ml) and insufficiency (10 - 20 ng/ml) respectively. 6% of the children were stunted and prevalence of wasting and" underweight were 17% and 14% respectively. Prevalence of stunting was significantly higher in girls (p<0.05J. Linear regression analysis showed a.significant inverse association between serum levels of 25(OH)D and PTH (r = -0.226, p<0.02). Intake of milk and diary foods had a positive association with 25(OH)D levels although statistically insignificant (r = 0.224, p>0.05). CONCLUSIONS: This study highlights the presence of sub-optimal vitamin D status in preschool children in a tropical country. Inverse changes in PTH may deleteriously affect skeletal development and growth. The need for appropriate interventions to optimise vitamin D status is emphasized.Item Effects of white coconut oil, virgin coconut oil and grated coconut on blood glucose and serum lipids in Wistar rats(Sri Lanka Medical Association, 2015) Samaranayake, H.A.E.; Chackrewarthy, S.; Karunakaran, R.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: This study investigated the effects of white coconut oil (WCO), virgin coconut oil (VCO) and grated coconut on blood glucose and serum lipids in Wistar rats. METHOD: Four groups of male Wistar rats (1-4) were maintained on four isocaloric test diets, containing WCO, VCO, WCO + grated coconut (1:1 ratio) and VCO + grated coconut (1:1 ratio) respectively. After 36 weeks of feeding blood glucose and serum lipids were assayed. Results were analysed using SPSS version 16.0. RESULTS: Compared with the baseline levels, mean blood glucose levels decreased in all four groups; -13.87, -7.22, -41.88, and -41.85 mg/dt respectively. Rats fed with mixtures of oil and grated coconut (groups 3 and 4) showed a significantly higher decrease in blood sugar (p<0.05) compared with diets containing oil only (groups 1 and 2). No significant differences (p>0.05) in blood sugar levels were observed between groups fed with diets containing oil only or between groups fed with diets containing mixtures of oii+ grated coconut. Compared with baseline levels, mean differences in serum total cholesterol (TC) were 9.05, -8.08, 6.11,1.65 mg/dl, triglycerides -31.1, -20.75, -30.5, -49.8 mg/d! and high density lipoproteins (HDL) -1.47, 8.32, 0.816, -10.82 mg/dl in groups 1-4 respectively. Although statistically not significant, lower TC and higher HDL levels were observed in rats fed with VCO containing diet. CONCLUSION: Inclusion of grated coconut in the diet results in significant hypoglyceamic action. Although statistically not significant VCO may have beneficial effects on serum lipids which warrants further investigation.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 Cardiovascular risk profile of the estate population of Sri Lanka(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Chackrewarthy, S.; Perera, P.S.; Wijayasinghe, Y.S.; Williams, S.; Williams, S.S.; Kato, N.; Wickremasinghe, A.R.OBJECTIVES: To estimate the prevalence of biochemical and anthropometric risk markers of cardiovascular diseases in the estate population of Sri Lanka. METHODS: Using a cross sectional design, consenting adults aged 35-64 years resident in 3 selected estates in the Nuwara-Eliya District were recruited with the support of estate medical assistants and welfare officers. AH participants were subjected to an interview, blood pressure and anthropometric measurements and collection of fasting blood samples. RESULTS: Of the 401 participants recruited, 53% were females and 99% were cither Indian or Sri Lankan Tamils. The mean age of the participants was 50.3 years (SD 8.5). 47 (12%) participants had a BMI >25, 8 (2%) a BMI >30. 29 males (15%) and 29 females (14%) had a waist circumference [WC] >90cm and >80 cm, respectively. 151 (38%) participants had systolic blood pressure (SBP) > 140mmHg , 127 (32%) had diastolic blood pressure (DBF) > 90mmHg and 170 (42%) had either SBF > 140 or DBF > 90. 41(10%) participants had fasting blood glucose (FBG) >126mg/dL. In 197 (49%) participants, some form of dyslipidaemia was present. Males had a significantly higher mean BMI, FBG and triglyceride (TG) level and a significantly lower high density lipoprotein (HDL) level as compared to females. CONCLUSIONS: Obesity, as defined by BMI or WC, was low in this population as compared to other reported studies from different population groups in the country. But prevalence of hypertension and dyslipidaemia (especially high TG and low HDL levels in males) was high.Item 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