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 Incidence and predictors of metabolic syndrome among urban, adult Sri Lankans: a community cohort, 7-year follow-up study(European Association for the Study of Diabetes, 2017) de Silva, S.T.; Niriella, M.A.; Kasturiratne, A.; Kottahachchi, D.; Ranawaka, U.K.; Dassanayake, A.; de Silva, A.P.; Pathmeswaran, P.; Wickremasinghe, R.; Kato, N.; de Silva, H.J.BACKGROUND AND AIMS In 2007, we reported a 38.9% prevalence of metabolic syndrome (MetS) in an urban, adult population. Published data on incident MetS from South Asia is lacking. This study investigated the incidence and risk factors for MetS after a 7-year follow-up of the initial cohort. MATERIALS AND METHODS: The study population (selected by age-stratified random sampling from the Ragama MOH area) was screened in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions, structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests were performed. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Total body fat (TBF) and visceral fat percentage (VFP) were measured in 2014, using impedance. Abnormal TBF was defined as >32% for females and >25% for males. Abnormal VFP was defined as >10% for both sexes. Non-alcoholic fatty liver disease (NAFLD) was diagnosed on established ultrasound criteria, safe alcohol consumption (Asian standards: <14 units/week for men, <7 units/week for women) and absence of hepatitis B and C markers. RESULTS: 2137/2967 (72.0%) of the initial cohort attended follow-up [1229 (57.5%) women; mean-age 52.4 (SD-7.7) years]. 1000/2137 [548 (54.8%) women; mean age 57.5 years (SD-7.74)] had MetS (prevalence-46.8%). Out of 1246 individuals who initially did not have MetS in 2007, 318 [225 (70.8%) women; mean age 57.5 (SD 7.7) years] had developed incident MetS after 7 years (annual incidence-2.13%). Comparison of incident MetS with those with no MetS in 2014 is shown in Table 1. On logistic regression, female sex (OR 3.6, p<0.001), central obesity [OR 4.58, p<0.001], BMI >23kg/m2 [OR 4.84, p<0.001], increase in weight 2%-5% [OR 2.02, p<0.001], increase in weight >5% [OR 5.3, p<0.001), increase in waist circumference (WC) 5-10-cm [OR 3.68, p<0.001], increase in WC >10cm [OR 10.34, p<0.001] and NAFLD (OR 2.44, p<0.001) in 2007 were independently predictive of incident MetS in 2014. Abnormal VFP [OR 4.23, p<0.001] and abnormal TBF [OR 5.25, p<0.001] were also associated with incident MetS. CONCLUSION: In this prospective community study, the annual incidence of MetS was 2.13%. Female gender, increase in weight and WC from baseline and the presence of NAFLD predicted the development of incident MetS. Obesity at baseline was the only defining individual component of MetS that predicted future MetS.Item Common infective causes of abdominal pain(Sri Lanka College of Microbiologists, 2008) Dassanayake, A.Abstract availableItem Hepatocellular carcinoma in Sri Lanka: Where do we stand?(Sri Lanka Medical Association, 2013) Siriwardana, R.C.; Liyanage, C.A.H.L.; Jayatunge, D.S.P.; Dassanayake, A.; Gunetileke, M.G.; Niriella, M.A.; Sirigampola, C.; Upasena, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES:Hepato-cellular carcinoma (HCC) is the sixth commonest cancer worldwide. We studied 105 consecutive patients with HCC in a single tertiary care centre. METHODS: North Colombo Liver Unit maintains a prospective database of HCC since September 2011. There were 105 entries by February 2013. Decision on the best form of treatment was taken at a multidisciplinary meeting. RESULTS: The median age at presentation was 63 years (range 12-79). Patients were predominantly male 93 (87%). Alcohol consumption above the safe limit was reported in 47 (45%). Hepatitis B surface antigen or C antibody was not detected in any of the patients. Background liver cirrhosis was evident in 59 (79%). Forty two (46%) patients had single nodular tumours while in 20 (21%) it was diffusely infiltrating. Portal vein invasion was seen in 22 (20 %). Median alpha-feto protein (AFP) level was 57.25 mg/ml (1.16- 94120 ng/ml; n=72). Twenty four (33%) patients had AFP level > 400u/l. Surgery was performed in 20 (19%), liver transplant in 2 (1.9%), radiofrequency ablation or alcohol ablation in 8 (7.6%), trans arterial chemo embolization (TACE) in 44 (41.9%) and sorafinib was prescribed .in four patients. Overall mean survival was 15 months. In the 'no treatment' group, mean survival was 4 months. Surgery group had a mean survival of 20 months. CONCLUSION: Hepatitis B is not a risk factor for HCC in Sri Lankans. Median survival without treatment is 4 months.Item Incidence and risk factors for Non-Alcoholic Fatty Liver Disease in an urban, adult Sri Lankan population – a community cohort follow-up study(Sage Publishing, 2015) Niriella, M.; Kasturiratne, A.; de Silva, S.; Perera, R.; Subasinghe, C.; Kodisinghe, K.; Priyantha, C.; Rishikeshavan, V.; Dassanayake, A.; de Silva, A.; Pathmeswaran, A.; Kato, N.; de Silva, H.J.INTRODUCTION: We previously reported a community prevalence of 33% for NAFLD in an urban, adult Sri Lankan population. We also found a significant association between patatin-like phospholipase domain containing 3 (PNPLA3) gene rs738409 polymorphism, and susceptibility to NAFLD in the same population, after testing 10 selected single nucleotide polymorphisms (SNPs) in a case control study. AIMS & METHODS: The aim of this study was to assess the incidence and risk factors for NAFLD in this population after seven years of follow-up. The study population consisted of 42-71-year-old adults, originally selected by age stratified random sampling from electoral lists from Ragama, Sri Lanka. The target population was screened initially in 2007 and subsequently invited back for re-evaluation in 2014. On both occasions they were assessed using a structured interview, clinical and anthropometric measurements, liver ultrasound, and biochemical and serological tests. NAFLD was diagnosed on established ultrasound criteria for fatty liver (two out of three criteria: increased echogenecity of the liver compared to kidney and spleen, obliteration of the vascular architecture of the liver and deep attenuation of the ultrasonic signal), safe alcohol consumption (Asian standards: 514 units/week for men, 57 units/week for females) and absence of hepatitis B and C markers. Non-NAFLD controls were defined as subjects who did not have any of the ultrasound criteria for NAFLD. We also performed an updated case-control study to investigate associations of selected genetic variants with incident NAFLD [SNPs: PNPLA3 (rs738409), LYPLAL1 (rs12137855), GCKR (rs780094), PPP1R3B (rs4240624) and NCAN (rs2228603), APOC3 (rs2854117 and rs2854116), ADIPOR2 (rs767870) and STAT3 (rs6503695 and rs9891119)]. RESULTS: Of the 2985 original study participants, 2155 (72.2%) (1244 women and 911 men; mean age 59.2 years [SD, 7.7]) participated in the follow-up assessment. 1322 [mean age 58.9 years (SD, 7.6), 483 (53.0%) men and 839 (67.4%) women] had NAFLD. Out of 795 [466 (58.6%) women] participants who did not have NAFLD in the original study, 365 [226 (61.9%) women, mean age 58.6 years (SD, 7.9)] had developed NAFLD after 7 years, giving an annual incidence rate 6.6%. On multivariate analysis, increased waist circumference [OR 1.96(1.30 – 2.97), p=0.001], BMI4 23 kg/m2 [OR 2.93(1.99 – 4.30), p50.001] and raised plasma triglycerides (TG) [OR 1.49(1.03 – 2.13), p=0.03] were independently predictive of incident NAFLD in this cohort, while raised BP and reduced HDL, were not. In the updated association study involving 1310 cases and 427 controls, we found borderline association with NAFLD at two of the 10 candidate loci: rs4240624 at PPP1R3B and rs738409 at PNPLA3 (one-tailed P=0.044 and 0.033, respectively). CONCLUSION: In this community cohort follow-up study in an urban, adult population in Sri Lanka, the annual incidence of NAFLD was 6.6%. Incident NAFLD was associated with features of the metabolic syndrome, and showed tendency of association at PNPLA3 and PPP1R3B gene polymorphisms. Disclosure of Interest: None declaredItem One hour fast for liquids prior to upper gastrointestinal endoscopy seems safe, effective and results in minimum patient discomfort(Sri Lanka Medical Association, 2006) de Silva, A.P.; Amarasiri, L.; Kottahachchi, D.C.; Dassanayake, A.; de Silva, H.J.INTRODUCTION: Current guidelines for upper gastrointestinal endoscopy advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. Studies have shown that is uncomfortable and probably unnecessary. A study was done by us using real-time ultrasonography on 10 patients established the minimal time for clearing non-opaque liquids was one hour. Aims: To determine the effects of allowing clear liquids one hour prior to endoscopy. METHODS: 40 patients referred for video endoscopy, without alarm symptoms or clinically obvious motility problems, were recruited. Patients were given a standard meal 6 hours before endoscopy. They were then randomized to either fasting for 6 hours (group A, n=20) or allowed to take clear fluids up to one hour prior to endoscopy (group B, n=20). Just prior to endoscopy patients indicated discomfort due to fasting on a visual analog scale (0-no discomfort to 10-severe discomfort). All endoscopies were done by a single investigator blinded to the period of fasting. Presence of fluid in the gastric fundus was noted, and endoscopic vision was graded as good, average or poor. RESULTS: Discomfort was significantly lower in group B than group A (mean visual analog score 0.3 vs. 4.4; p<0.001, Wilcoxon two-sample test). Endoscopic vision was good in all 20 patients in group A and 18 in group B, and average in 2 in group B. None were graded as poor. Fluid in the gastric fundus was noted in 6 patients in group A and 7 in group B. CONCLUSIONS: Allowing clear liquids for up to one hour prior to endoscopy seems acceptable, and causes minimum discomfort to patients. However, a larger study should be performed before revision of current guidelines can be made.Item Inflammatory bowel disease (IBB) in a tertiary referral centre in Sri Lanka(Sri Lanka Medical Association, 2005) de Silva, A.P.; Mettananda, K.C.D.; Dassanayake, A.; Ariyaratne, S.; Deen, K.I.; de Silva, H.J.AIMS: To study disease patterns of IBD in a tertiary referral centre in Sri Lanka, METHODS: We analysed the database of outpatients with IBD maintained since 1995, reviewing records with regard to history, clinical findings, colonoscopy, histology, medical treatment, surgery, and outcome. RESULTS: Records of 108 patients with IBD were analysed [Male: Female = 68:40, mean age 38.3 years (SD 17.5), 96.5% Sinhalese]. 78 (72.2%) had ulcerative colitis (UC), 23 (20.3%) Crohn's disease (CD) and 7 (6.5%) had indeterminate colitis. The main clinical features for UC were bloody diarrhoea (95 %), tenesmus (84%), and left sided abdominal pain (74%), and for CD were watery diarrhoea (59%), tenesmus (53%) and right sided abdominal pain (47%). The main extra-intestinal manifestations were: polyarthritis - UC (18%), CD (12%), and iritis - UC (4%), CD (6%). Among UC patients 44.8% had multiple relapses and 43.5% had moderate to severe disease; in CD cases 43.5% had multiple relapses and 56.5% had moderate to severe disease, A family history was recorded in 3% of UC cases and 6% of CD. There were no intestinal complications among UC patients. Two with CD developed strictures. Proctocolectomy was performed in 13 (16.6%) patients with UC (12 had ileal pouch procedures). Five patients with CD underwent surgery; 2 right hemicolectomy, 2 fistulectomy, and 1 colectomy with ileo-rectal anastomosis. CONCLUSION: The pattern of IBD among our patients was comparable to what is described in the western literature, with the exceptions of a low frequency of family history, extra-intestinal manifestations and intestinal complications.