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 Prevalence and correlates of cognitive impairment among patients with schizophrenia attending psychiatry outpatient clinics at Teaching hospital – Karapitiya(Sri Lanka Medical Association, 2021) Goonathilake, Y.L.A.; Ruben, R.; Ediriweera, D.S.; Isuru, L.L.A.INTRODUCTION AND OBJECTIVES: Cognitive impairment is considered a core feature of schizophrenia. This study was designed to estimate the prevalence of cognitive impairment among patients with schizophrenia, to assess the degree of impairment in individual cognitive domains and to identify its sociodemographic and clinical correlates in a Sri Lankan setting. METHODS: A sample of 140 diagnosed patients with schizophrenia was selected from the psychiatry outpatient clinics at Teaching Hospital, Karapitiya. Their cognitive functions were assessed using Addenbrooke’s Cognitive Examination – III Sinhala version (ACE-III-S). Participants who scored below 85.5 in ACE-III-S were categorized as having significant cognitive impairment. Multiple linear regression analysis was conducted to assess correlates with level of significance measured at p = 0.05. RESULTS: In this sample, 89.3% of the participants scored below ACE-III-S cut-off (95% CI [84.09,94.47]). Statistical comparison of proportions of the sample which had impairment in each cognitive domain (attention 60%, memory 65.7%, fluency 55%, language 61.4%, and visuospatial skills 63.6%) did not show a significant difference. The final model of regression analysis showed that patients with shorter duration of formal education (p = <0.001), longer duration of illness (p = <0.001) and higher dose of antipsychotics (p = 0.034) had higher cognitive impairment. CONCLUSION: Nearly nine out of ten people with schizophrenia suffer from significant cognitive dysfunction. The evaluated cognitive domains have been affected equally. The results of this study emphasize the importance of introducing routine cognitive assessment protocols, improving facilities available for cognitive rehabilitation and more frequent review of antipsychotic medications.Item A multicentre study on pattern of fetal anomalies detected in Sri Lanka(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P. M.; Dias, T.D.; Ediriweera, D.S.; Mendis, B.M.I.U.OBJECTIVE: Prenatal diagnosis is a rapidly evolving specialty in modern medicine. The mid-trimester scan has been an important practice in safe antenatal care which predicts birth defects of the developing fetus. This scan performed during 18-23 weeks of pregnancy detects both internal and external abnormalities of the fetus. The objective of this study was to present the pattern of fetal anomalies detected in Sri Lankan pregnant women who were referred for the anomaly scan.METHODS: A multi centre retrospective study was carried out in all the fetal medicine referral centers conducted in the Island including Colombo, Ragama, Galle and Kurunegala between July 2013 and March 2017. Patient information and the ultrasound scan findings were obtained from the purpose built database maintained by the authors. RESULTS: A total of 7370 referrals were reviewed and 6704 singleton pregnancies were selected. The mean maternal age and the mean gestational age at which the anomaly scan was performed were 31 years (SD=4.9) and 23 weeks (SD= 4.5) respectively. Congenital Heart Disease (CHD) was the commonest abnormality detected in the study group 149 (2.2%). Thirty-one (0.5%) fetuses had Atrioventricular Septal Defect which predicts Down syndrome at the mid-trimester scan. Majority (8.3%) of the CHD were referred from the Uva province. Of the 7370 referrals 63 (0.9%) and 27 (0.4%) had Neural Tube Defects (NTDs) and cleft lip/palate respectively. Highest percentage (4.4%) of NTDs were referred from the North Central province and cleft lip/palate referrals were commonest in Sabaragamuwa (0.9%) province. Abdominal wall defects and cystic renal disease were detected in 33 (0.5%) and 38 (0.6%) fetuses correspondingly. Referrals received from the Uva (1.9%) province reached the highest number of abdominal wall defects and cystic renal disease referrals were peaked in the Uva (7.4%) province. Forty-eight (0.7%) referrals had Congenital Talipes Equino Varus deformity and highest number of referrals was from the Eastern (2.4%) province. CONCLUSION: Referrals received from the Uva province had highest number of fetal anomalies (20%) either as a major or minor birth defect. Of the total referrals congenital heart defect was the commonest congenital abnormality detected in the study group.Item Prevalence of chronic kidney disease and associations among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke,W.A.N.V; Ediriweera, D.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Chronic kidney disease is a major non communicable disease in Sri Lanka with a rising prevalence. We studied the prevalence and associations of chronic kidney disease among patients with hypertension in a rural Sri Lankan population. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults with hypertension were investigated with serum creatinine, urine albumin creatinine ratio and eGFR. Socio-demographic and anthropometric data was obtained as well. RESULTS: Total of798 hypertensive patients (546 females and 252 males) were included in the study. 383 (48.7%, 95% CI: 45.2% - 54.0%) had proteinuria .486 (61.I %, 95% CI: 57.7% - 64.5%) of them had stage III or advanced CKD among which 241 had proteinuria. 618 (78.7%, 95% CI: 75.9% - 81.6%) showed either eGFR<60ml/min/l.73m2 or proteinuria. Advancing age (p<0.01), female gender (p<0.01) and raised LDL levels (p=0.01) were significantly associated with CKD.CONCLUSION: Prevalence of CKD is high in this rural hypertensive adult cohort. A significant proportion had non protienuric CKD. It may be justifiable to assess renal functions of all patients with hypertension to establish an early diagnosis of CKD to prevent complications. Considering the very high prevalence, community screening for CKD can be recommended in this populationItem Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change(Sri Lanka Medical Association, 2018) Ediriweera, D.S.; Diggle, P.J.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Isbister, J.K.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. METHODS: A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165,665 individuals living in 44,136 households and recorded all recalled snakebite events that had occurred during the preceding year Log-linear models were fitted to describe the expected number of snakebites occurring in each month taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and due to recall bias amongst survey respondents RESULTS: Snakebite events showed a clear seasonal variation. Typically, snakebite incidence was highest during November to December followed by March to May and August, but this varied between years due to variations in relative humidity, which is also a risk-factor. Low relative humidity levels was associated with high snakebite incidence. If current climate change projections are correct, this could lead to an increase in the annual snakebite of burden of 35,086 (95% CI: 4 202 a€" 69,232) during the next 25 to 50 years. CONCLUSION: Snakebite in Sri Lanka shows seasonal variation Additionally, more snakebites can be expected during periods of lower than expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.Item A multicentre study on pattern of fetal anomalies detected in Sri Lanka(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P.M.; Dias, T.D.; Ediriweera, D.S.; Mendis, B.M.I.U.OBJECTIVE: Prenatal diagnosis is a rapidly evolving specialty in modern medicine. The mid-trimester scan has been an important practice in safe antenatal care which predicts birth defects of the developing fetus. This scan performed during 18-23 weeks of pregnancy detects both internal and external abnormalities of the fetus. The objective of this study was to present the pattern of fetal anomalies detected in Sri Lankan pregnant women who were referred for the anomaly scan. METHOD: A multi centre retrospective study was carried out in all the fetal medicine referral centers conducted in the Island including Colombo, Ragama, Galle and Kurunegala between July 2013 and March 2017. Patient information and the ultrasound scan findings were obtained from the purpose built database maintained by the authors. RESULTS: A total of 7370 referrals were reviewed and 6704 singleton pregnancies were selected. The mean maternal age and the mean gestational age at which the anomaly scan was performed were 31 years (SD=4.9) and 23 weeks (SD= 4.5) respectively. Congenital Heart Disease (CHD) was the commonest abnormality detected in the study group 149 (2.2%). Thirty-one (0.5%) fetuses had Atrioventricular Septal Defect which predicts Down syndrome at the mid-trimester scan. Majority (8.3%) of the CHD were referred from the Uva province. Of the 7370 referrals 63 (0.9%) and 27 (0.4%) had Neural Tube Defects (NTDs) and cleft lip/palate respectively. Highest percentage (4.4%) of NTDs were referred from the North Central province and cleft lip/palate referrals were commonest in Sabaragamuwa (0.9%) province. Abdominal wall defects and cystic renal disease were detected in 33 (0.5%) and 38 (0.6%) fetuses correspondingly. Referrals received from the Uva (1.9%) province reached the highest number of abdominal wall defects and cystic renal disease referrals were peaked in the Uva (7.4%) province. Forty-eight (0.7%) referrals had Congenital Talipes Equino Varus deformity and highest number of referrals was from the Eastern (2.4%) province. CONCLUSION: Referrals received from the Uva province had highest number of fetal anomalies (20%) either as a major or minor birth defect. Of the total referrals congenital heart defect was the commonest congenital abnormality detected in the study group.Item Prevalence of hypertension in a rural district of Sri Lanka(Sri Lanka Medical Association, 2017) Luke, W.A.N.V.; Ediriweera, D.S.; de Silva, K.C.; Balasooriya, E.R.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION & OBJECTIVES: Hypertension is a leading cause of cardiovascular morbidity and mortality. Data on prevalence of hypertension in rural settings of Sri Lanka is limited. We conducted a study to determine the prevalence of hypertension among adults over 40 years of age in the Puttalam district.METHODS: A community-based prevalence study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults over 40 years of age living in consecutive households were screened by trained research assistants using digital blood pressure (BP) meters. Basic demographic data were obtained using an intervieweradministered questionnaire. Previously undiagnosed adults with persistent elevation of BP (SBP > 140 and /or DBP > 90 mmHg on two readings) and those already on treatment for hypertension were identified. RESULTS: A total of 2289 were screened. The mean (SD) of SBP and DBP were 134.5(21.3) and 82.1 (13.5) mmHg respectively. The overall hypertension prevalence was 458.5 (95% CI 438.1– 478.8) per 1000 population. 16.3% were newly diagnosed. Prevalence of uncontrolled hypertension among those on treatment was 516.2 (95% CI 479.4–552.9) per 1000. 98.7 (95% CI 86.6–110.9) per 1000 had blood pressure >160/110 mmHg. There was an increasing trend in blood pressure with increasing age (OR=1.07, 95% CI 1.06–1.08, p<0.01) but not with the male sex. CONCLUSION: Prevalence of hypertension is high in this rural adult cohort. Previously undetected hypertension and uncontrolled hypertension among those already on treatment are common. Community-based approaches targeting screening and BP control are essential to reduce adverse outcomes of hypertension.Item Profile of spinal cord injuries among inward patients at the Rheumatology and Rehabilitation Hospital, Ragama(Sri Lanka Medical Association, 2017) Dilina, A.K.N.; Ediriweera, D.S.INTRODUCTION & OBJECTIVES: The global spinal cord injury (SCI) incidence is 40 to 80 per million. Data on SCI in Sri Lanka is sparse. This study describes the socio-demographic characteristics of SCI patients at the Rheumatology and Rehabilitation Hospital, Ragama (RRH). METHODS: All SCI patients admitted to the RRH during September to November 2015 were studied. An interviewer-administered questionnaire was used. Ethical clearance was obtained from the University of Kelaniya. ISCO-08 classification was used to classify the occupation category. RESULTS: There were 138 SCI patients. 124 (90%) of them were males, median age was 39 (IQR: 27 to 57) years and 11 (8%) were below 18 years. There were 50 (36%) elementary workers, 28 (20%) service and sales related workers, 10 (7%) machine operators and 26 (18%) were unemployed. Causes of spinal injury were as follows; 62 (45%) fall from a height, 35 (25%) road traffic accidents (RTA), 20 (14%) disease related, 5 (3.6%) each from assault, blunt trauma and spinal tumors. There were 63 (45.6%) thoracic, 57 (41.3%) cervical, 18 (13%) lumbar spinal injuries respectively. 90 (65%) were paraplegic and 48 (34%) were quadriplegic. 29% were bed bound, 58% could move in a wheelchair with support, 10% could move in a wheelchair without support and 2% could walk alone. CONCLUSION: SCI is common in young and middle aged adult male elementary workers. Common cause of injury was fall from a height followed by RTAs. Thoracic and cervical injuries were common and the majority were paraplegic patients. Health education programmes on safety measures to minimize SCI due to falls and RTAs in risk groups would be important in preventing the majority of SCI.Item Feeding in children with cerebral palsy: preliminary results from an ongoing study at the Rheumatology and Rehabilitation Hospital, Ragama(Sri Lanka Medical Association, 2017) Dilina, A.K.N.; Ediriweera, D.S.INTRODUCTION & OBJECTIVES: Malnutrition is a common problem in children with cerebral palsy (CP) and can be associated with growth failure. This study was done to assess feeding patterns and caregivers’ perception on feeding children with CP. METHODS: A total of 42 children with CP at the Rheumatology and Rehabilitation Hospital, Ragama (RRH) were studied from March 2016 to March 2017. An interviewer-administered questionnaire was used to collect data. RESULTS: Median (IQR) age of children was 65 (37-117) months and 69% were males. 64.3% had spastic quadriplegia. 90% of children’s main caregiver was the mother. 19% were able to self feed, 12% could self feed but was slow and messy, 7% could self feed with assistance and 62% were entirely fed by the caregivers. 79% tolerated adult food, 17% were on coarsely mashed purees and 4% required well mashed purees. Median (IQR) daily feeding time was 110 (72-205) minutes in spastic quadriplegic children compared to 80 (60-110) minutes in other types of CP (p=0.17). 31% of caregivers expressed that feeding was stressful. 57% of caregivers believed that their child was underweight, 2% as just below normal weight and 10% as overweight. CONCLUSION: A total of 62% of children were entirely fed by the caregivers. Twenty one percent needed special food preparations. Median feeding time was relatively higher in spastic quadriplegics compared to other types of CP. Nearly one third of caregivers expressed that feeding was stressful. More than half of the caregivers believed that their children were underweight.Item Nutritional status of patients with spinal cord injury admitted to the Rheumatology and Rehabilitation Hospital, Ragama(Sri Lanka Medical Association, 2017) Dilina, A.K.N.; Lakmali, A.K.S.; Ediriweera, D.S.INTRODUCTION & OBJECTIVES: Malnutrition is a common problem in hospitalized patients having chronic diseases with long periods of debilitation. There is limited data on the nutritional status of spinal cord injury (SCI) patients in Sri Lanka. METHODS: All the SCI patients admitted to the Rheumatology and Rehabilitation Hospital, Ragama (RRH) during September to November 2015 were studied. An interviewer-administered questionnaire was used. Mid upper arm circumference (MUAC) was measured to assess the body mass index (BMI) category and nutritional screening was done with the Malnutrition Universal Screening tool (MUST). RESULTS: There were 138 patients, median (IQR) age was 39 (27 to 57) years and 124 (90%) were males. The median (IQR) MUAC was 25 (22-27) cm and 23% were in the BMI category less than 20kg/m2 and 7% were in the BMI category more than 30kg/m2. 84 (61%) were at risk of undernutrition (MUST score 1 or more). 27 (19.5%) were at high risk of undernutrition (MUST score 2 or more), where the high risk was seen in 37.5% of bedbound patients compared to 12.27% in others (p<0.01). 44 (32%) of SCI patients had pressure ulcers and 38.6% of them were at high risk of undernutrition (MUST score 2 or more) compared to 10.6% in non-ulcer patients (p<0.01). CONCLUSION: Among SCI patients, 7% were obese and 23% were undernourished according to MUAC. According to the MUST score, more than half of the SCI patients were at risk of undernutrition and 19.5% were at high risk of undernutrition, where this was specifically seen in bedbound patients and patients with pressure sores.Item E-readiness among first year medical students at the Faculty of Medicine, University of Kelaniya(Sri Lanka Medical Association, 2017) Maduwanthi, A.A.H.; Hettige, S.; Ediriweera, D.S.INTRODUCTION & OBJECTIVES: E-readiness refers to the measurement of the degree of preparedness and willingness of a country to participate in the electronic world. In Sri Lanka there is a lack of research to measure the e-readiness among higher educational students. This study is done to assess the level of e-readiness among first year medical students at the Faculty of Medicine, University of Kelaniya. METHODS: A self-administered questionnaire was given to all first year students at the Faculty of Medicine, University of Kelaniya in 2017. RESULTS: Among 155 students, 42.6% were males. All have used computers previously and 72% owned a personal laptop. 68% have been using computers more than once a week and another 21% at least once a month. Students’ perceptions on their ability to use computers were as follows: 21% as good, 68% as average and 10% as poor. 68% had formal computer training and 54% had at least some paper qualifications related to the training which they had undergone, where 41% had learnt Information Technology (IT) as a subject during O/Ls, 22% had followed a certificate level course and 5% had diplomas. All could search the web and had e-mail accounts. 96.8% had used the office package. 38.7% and 20.6% could edit videos and images respectively. CONCLUSION: All had used computers and e-mail accounts. Majority had a formal training and were capable of handling the office package.