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 Is hyperkalaemia associated with the development of heart blocks in patients with acute yellow oleander poisoning?(Sri Lanka Medical Association, 2023) Eriyawa, W.M.A.B.W.; Jayamanne, S.F.; Lokunarangoda, N.; Francis, G.R.; andakumari, G.V.N.; Jayawardane, P.INTRODUCTION: Yellow oleander (Thevetia peruviana) contains cardiac glycosides which result in arrhythmias, heart blocks and electrolyte imbalances. OBJECTIVES: The objective of the study was to find whether the development of hyperkalaemia within the first 24 hours of admission predicts the development of heart blocks. METHODS: A prospective cohort study was carried out at Teaching Hospital Batticaloa, Sri Lanka, from 1st July 2022 to 28th February 2023 among patients admitted with acute yellow oleander poisoning. Patients were recruited if any of the following signs were present: bradycardia (<60bpm), systolic blood pressure <80mmHg, nausea, vomiting, abdominal pain, diarrhoea, xanthopsia, within 2 hours of admission. Serum potassium level was assessed at recruitment and 6 hourly, serial electrocardiograms were done at recruitment and 4 hourly, for 24 hours. The association between hyperkalemia (serum potassium >5.5mmol/L) and the development of heart blocks were calculated using the chi-squared test. Ethical Clearance was granted by the Ethics Review Committee of the Faculty of Medical Sciences, University of Sri Jayewardenepura. RESULTS: Among 120 consenting symptomatic patients recruited, 26.67%(n=32) patients developed hyperkalemia while 7.5%(n=9), 10.0%(n=12) and 3.33%(n=4) patients developed 1st, 2nd, and 3rd degree heart blocks respectively. Temporary cardiac pacing (TCP) was done in 9.16%(n=11) patients and 2.5%(n=3) died due to cardiac arrest. Hyperkalemia within 24 hours of admission was associated with the development of heart block (X2(1, N=120)=12.9689, p=0.0003). CONCLUSION: Patients who developed hyperkalemia within 24 hours of admission following acute yellow oleander poisoning should be closely monitored for the development of heart blocks and managed at centres where facilities for TCP are available.Item Should ‘Drug Related Problems’ remain unnoticed among patients with chronic kidney disease of uncertain aetiology?(Sri Lanka Medical Association, 2023) Wickramasinghe, N.D.D.; Lynch, C.B.; Coombes, J.; Jayamanne, S.F.; de Silva, S.T.INTRODUCTION: Chronic kidney disease of uncertain aetiology (CKDu) is a major public health concern in Sri Lanka. CKDu patients often consume 10-12 drugs per day, which can result in drug-related problems (DRPs). However, emerging economies such as Sri Lanka have few safeguards in place to detect and report DRPs. OBJECTIVES: The objective of this study was to introduce clinic-based pharmacy services to detect, address and report DRPs that occurred in CKDu out-patients. METHODS: A randomized controlled clinical trial was conducted in pre-dialysis CKDu stages 4 and 5 patients at outpatient renal clinics in Teaching Hospital, Anuradhapura, Sri Lanka. DRPs were identified in both groups at baseline. The control group received usual clinic care while the intervention group received medication counseling by a clinic-based pharmacist. DRPs were identified in both groups after 12 months. RESULTS: At baseline, there were 123 and 126 patients in the control and intervention groups, respectively. 133 and 147 DRPs were identified from 80 and 79 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 1 (1-2) (p=0.458) for both groups. After 12 months, there were 101 and 98 patients in the control and intervention groups, respectively. 137 and 59 DRPs were identified from 57 and 33 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 2 (1-3) and 1 (1-2) (p=0.029) in control and intervention groups, respectively. CONCLUSION: A “clinic-based pharmacist” counselling is a beneficial additional service for identifying and addressing DRPs occurring in patients with CKDu.Item Changes in biochemical markers of outcomes in haemodialysis patients following a clinical pharmacy intervention.(Ceylon College of Physicians, 2021) Kalpani, A.G.S.; Mohamed, F.; Hough, J.E.; de Silva, D.N.N.; Chandrasena, W.M.H.N.M.; Jayamanne, S.F.Introduction and Objectives Common complications of End-Stage Renal Disease (ESRD) include cardiovascular disease, diabetes, anaemia and mineral and bone disease. Achieving an optimum level of biochemical markers of outcomes is crucial in managing ESRD. This study was conducted to assess the changes in selected biochemical parameters following a clinical pharmacy intervention (CPI) in this population. Method A randomized controlled trial was conducted at outpatient haemodialysis units in North Central Province, Sri Lanka. Serum phosphate, serum calcium, haemoglobin, lipid profile, eGFR and 'adequacy of dialysis* (AoD) (determined by urea reduction ratio (URR); calculated based on pre-post blood urea nitrogen measurements and Kt/V measurements) were measured in patients at baseline (BL) and after one year (PI). The Intervention Group (IG), n=143 patients received comprehensive pharmaceutical care by the clinical pharmacist on four consecutive occasions at recruitment, and 2, 6 and 10 months after recruitment. While the Control Group (CG), n=140, received standard care. Results At the baseline, there was no significant difference in the biochemical markers of outcomes between the two groups and AoD was within the acceptable range. However, there was a significant improvement in the mean serum phosphate levels (IG 4.04±1.19 vs CG 5.00±1.67, p<0.0001), mean serum calcium levels (IG 8.90±1.35 vs CG 7.11±2.07, p<0.0001), and mean haemoglobin levels (IG 10.5±1.25 vs CG 9.4±1.87, p<0.0001) in the IG compared to the CG at the end of one year. However, eGFR, lipid profiles did not change significantly (p>0.05). AoD was within the acceptable range in both groups at baseline and post intervention and did not change significantly (p>0.05) Conclusions Improvement in the selected biochemical markers of outcomes resulting from CPI suggests better patient management outcomes in the ESRD population.Item Opportunities for optimization of drug therapy and characterization of drug-related problems in ckd/ckdu patients undergoing hemodialysis in Sri Lanka(Ceylon College of Physicians, 2021) Kalpani, A.G.S.; Mohamed, F.; Hough, J.E.; de Silva, D.N.N.; Jayamanne, S.F.Introduction and objectives Drug-related problems (DRPs) in ESRD patients undergoing haemodialysis have not been investigated in Sri Lanka. The present study was conducted to identify and characterize the potential drug-related problems and identify opportunities to optimize drug therapy in ESRD patients undergoing haemodialysis. Method As part of RCT at ambulatory hemodialysis (HD) units of Teaching Hospital Anuradhapura (THA) and District General Hospital (DGH) Polonnaruwa, randomly selected ESRD patients undergoing hemodialysis were recruited for the study. DRPs were identified by reviewing the clinic drug charts, patient clinic records and structured interviews with patients or caregivers to identify the patients* actual drug-taking behaviour. Identified DRPs were categorized using a PCNE classification system V.08. Results A total of 1350 drug related problems were identified in 283 ambulatory HD patients during the study period. Patients were taking an average of 10.64 drugs and had 4.77 DRPs. Unnecessary drug treatment (30.3%), effect of the drug treatment not optimal (29.9%) followed by untreated symptom or indication (24.5%) were the most prevalent DRP categories according to the PCNE classification system. The major cause for the identified DRPs was a prescriber related (50.22%) followed by patient related (30.0%) and dispensing related (16.9%) causes in ESRD patients undergoing HD. Conclusions ESRD patients undergoing HD had a large number of medications which increases the risk of potential DRPs. Significant opportunities exist for pharmacists' input to improve the quality use of medicines by identifying and resolving the DRPs in ESRD patients undergoing haemodialysis in the current Sri Lankan government hospital setting as part of multidisciplinary teamItem Pharmacist counselling: A new practice for improving out-patient management of diabetes in Sri Lanka(Sri Lanka Medical Association, 2018) Mamunuwa, A.M.G.N.; Coombes, J.; Lynch, C. B.; de Silva, A.; Wickramasinghe, N.D.D.; Jayamanne, S.F.INTRODUCTION AND OBJECTIVES: Our study assessed the effectiveness of pharmacist counselling on outpatient management of diabetes. Though this is new to Sri Lanka, many countries include this practice to achieve target treatment outcomes of patients with diabetes.METHODS: 800 participants with diabetes attending outpatient clinics of two Sri Lankan hospitals were assigned either intervention group (IG) or control group (CG). IG received pharmacist counseling for four consecutive monthly visits in addition to standard care. CG received standard care only Glycaemic control was assessed using Glycosylated haemoglobin (HbAlc) post-intervention Adherence and patient-knowledge were assessed using questionnaires at baseline and post-intervention. RESULTS: A Wilcoxon signed-rank test showed that the 4-month intervention made a statistically significant improvement in adherence in the IG. The IG had median adherence score of 5 out of 8 (IQR 6-3 3) at baseline which increased to 7 (IQR 8-6) post-intervention There was no significant change in adherence in the CG.The IG had median HbAlc of7.2% (IQR 1.5%) post-intervention whereas CG had median of7.7% (IQR 1.95%). This difference was statistically significant.The IG had a median score of 36. l 5% (IQR 48% - 24.07%) for the medication related knowledge domain which increased to 65% (IQR 76.4% - 50.4%) post-intervention (P value< 0 001). The CG did not have a significant change in the same at baseline and post-intervention (P = 0 15). CONCLUSION: Pharmacist counselling improved medication adherence, glycaemic control and patients' knowledge. Thus, it can effectively be used for improving the outpatient management of diabetes in Sri Lanka.Item 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 The role of pharmacist counselling in the control of diabetes(Sri Lanka Medical Association, 2017) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; de Silva, A.; Lynch, C.B.; Wickramasinghe, N.D.D.INTRODUCTION & OBJECTIVES: Diabetes is a global health burden. Data in international literature prove the success of involving pharmacists to achieve glycaemic control. This is the first study in Sri Lanka on the impact of pharmacist counselling among outpatients with diabetes. The objective was to assess the impact of pharmacist counselling on glycaemic control of outpatients with diabetes. METHODS: A total of 400 consecutive patients with diabetes mellitus attending the outpatient diabetes clinics at Base Hospital, Dambadeniya, were randomized into either the intervention group (IG) or the control group (CG). IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to the standard care at the clinic, while the CG received standard care only. Glycaemic control was assessed for both groups with HbA1c measured at the end of the four monthly visits.RESULTS: Mean age of participants was 57.14±10.15 years and 67.5% were females. Non parametric tests were performed as data did not follow the normal distribution. On analysis of HbA1c data, the IG had a median of 7.2% (IQR: 8.2%-6.5%) whereas the CG had a median of 7.7% (IQR: 8.8%-6.9%). The IG patients had statistically lower HbA1c levels compared to the CG patients, according to the Mann-Whitney U test (p<0.05). HbA1c levels <8.00% indicate good/fair glycaemic control. 73.9% of the IG, but only 58% of the CG subjects had levels <8.00%. However, 9.1% of the IG and 10% of the CG had very poor glycaemic control (HbA1c level >10.00%). CONCLUSION: Pharmacist counselling in the outpatient clinics can improve the glycaemic control of patients with diabetes.Item Development of a Snakebite risk map for Sri Lanka(Sri Lanka Medical Association, 2016) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.K.; Dawson, A.; Giorgi, E.; Diggle, P.J.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION: Snakebite is a public health problem in Sri Lanka and about 37,000 patients are treated in government hospitals annually. At present, health care resources which are required to manage snakebite are distributed based on the administrative boundaries, rather than based on scientific risk assessment. OBJECTIVES: The aim of the study is to develop a snakebite risk map for Sri Lanka. METHOD: Epidemiological data was obtained from a community-based island-wide survey. The sample was distributed equally among the nine provinces. 165,665 participants (0.8%of the country’s population) living in 1118 Grama Niladhari divisions were surveyed. Generalized linear and generalized additive models were used for exploratory data analysis. Model-based geostatistics was used to determine the geographical distribution of snakebites. Monte Carlo maximum likelihood method was used to obtain parameter estimates and plug-in spatial predictions were obtained. Probability contour maps (PCM) were developed to demonstrate the spatial variation in the probability that local incidence does or does not exceed national snakebite incidence. RESULTS: Individual point estimate snakebite incidence map and PCM were developed to demonstrate the national incidence of snakebite in Sri Lanka. Snakebite hotspots and cold spots were identified in relation to the national snakebite incidence rate. Risk maps showed a within-country spatial variation in snakebites. CONCLUSIONS: The developed risk maps provide useful information for healthcare decision makers to allocate resources to manage snakebite in Sri Lanka.Item Community incidence of snakebite in the Amiradhapura district(Sri Lanka Medical Association, 2013) Kasturiratne, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Pathmeswaran, A.; Isbister, G.; Dawson, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: The community incidence of snakebite in Sri Lanka is unknown. To investigate incidence of snakebite, we undertook a community study in the Anuradhapura district as part of an ongoing countrywide survey on snakebite. METHODS: The survey was designed to sample at least 1% of the population in each district Within the district, a Grama Niladhari (GN) division, was defined as a cluster for data collection. The number of clusters required to sample at least 1 % of the population was first determined, and clusters were then selected using simple random sampling. In each selected cluster 40 households were sampled consecutively from a random starting point. Population estimates of snakebite were constructed for the district. RESULTS: The Anuradhapura district has a total of 694 GN divisions, and 84 were surveyed. This included 3357 households and a population of 13,428 (1.6% of the district's population). Eightysix snakebites were reported within the last 12 months. Extrapolating this to the district (mid-year population=855,373), the estimated snakebites in Anuradhapura district was 5478. The crude community incidence of snakebite in the Anuradhapura district was 640.5 per 100, 000 population. CONCLUSIONS: The incidence of snakebite in the community is high in the Anuradhapura district, with one in 156 persons bitten annually.Item Acute poisoning in the paediatric age group in North-Central province of Sri Lanka(Sri Lanka Medical Association, 2013) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, Y.C.INTRODUCTION AND OBJECTIVES: There is little data on poisoning in the paediatric age group in the North Central Province (NCP) of Sri Lanka. Objective of this study was to identify characteristics, risk factors and outcome of poisoning in the paediatric age group in the NCP. METHODS: All children presenting with either accidental or deliberate poisoning, to all paediatric casualty units at the Anuradhapura and Polonnaruwa Teaching Hospitals, over a period of 8 months from March 2012 were studied. Information was obtained from clinical interviews, focus group discussions, clinical observation and clinical records. RESULTS: Of the 167 children, 53% were male and 91% were below six years of age. Parents were agricultural workers in 25% and 51% had been educated up to GCE O' Level. Poisoning was mainly accidental (97%). Commonest poison was kerosene oil (24.9%). Reasons for delay in seeking medical help included lack of transport (14%), poor knowledge (12%), lack of awareness regarding urgency (12%) and financial constraints (8%). Complications included acute liver injury (4.2%), chemical pneumonitis (3.6%), and convulsions (1.8%). There were no deaths. Inadequate supervision by parents 87.5%, improper storage of household chemicals 52% and medicines 40% were common risk factors. CONCLUSIONS: Acute poisoning in children mostly occurred due to inadequate supervision by parents and improper storage of chemicals and medicines. Community education and safe storage of chemicals and medicines will reduce the incidence of poisoning in the paediatric age group.