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 Comparison of urban diabetics with optimal and suboptimal control(British Medical Association, London, 2011) Pinidiyapathirage, M.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekera, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.Introduction The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. Methods A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. Results There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. Conclusions Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.Item Estimating the treatment cost of selected diseases in three state sector hospitals(College of the Community Physicians of Sri Lanka, 2007) Kasturiratne, A.; Sugimoto, T.; de Silva, A.INTRODUCTION: Costing disease management is useful for appropriate resource allocation and improving accountability in the health system. Protocol based disease management is helpful in cost analysis, but well developed and accepted protocols to cover the entire disease spectrum are yet being developed in the Sri Lankan context. OBJECTIVE: To estimate treatment cost of acute severe asthma and Lower Segment Caesarean Section (LSCS) in three state sector hospitals. METHODS: This descriptive cross sectional study was conducted in Teaching Hospital, Kurunegala (THK), Base Hospital, Kuliyapitiya (BHK) and Colombo North Teaching Hospital, Ragama (CNTH), from September to December 2006. The study populations were Bed Head Tickets (BHTS) in BHK and THK, and patients in CNTH. All study populations fulfilled the same criteria. A time study was conducted at CNTH using direct observation of Clinical management. Results of the step down method, the time study and the data extracted from BHTS were used for estimating direct, para-medical and accommodation costs. RESULTS: The total sample consisted of 240 subjects. The average duration of hospital stay for patients with acute severe asthma was approximately 4 days in THK and BHK, and 7 days in CNTH. The total cost of management ranged from Rs.2520 (THK) to Rs.4933 (CNTH). The cost of a LSCS ranged from Rs.8268 (CNTH) to Rs.9429 (THK). The average duration of hospital stay was 7-8 days. Operation theatre overheads accounted for 20-40% of the total cost. The cost of the time Spent by Medical Officers in the theatre was about 10% of the total cost. For both conditions, the cost of accommodation was the largest contributor to the total cost. CONCLUSION: in the absence of disease management protocols, there is variation in the disease management cost between different levels of hospitals. This may be due to differences in resource availability, utilisation pattern and accepted practices.Item Epidemiology of hypertension in an urban Sri Lankan population(BMJ Publishing Group, 2011) Kasturiratne, A.; Warnakulasuriya, T.; Pinidiyapathirage, J.; Kato, N.; Wickremasinghe, A.R.; Pathmeswaran, A.INTRODUCTION: Hypertension is a common risk factor for cardiovascular disease. In Sri Lanka, despite the existence of a universal free health system, services are not available for routine screening of hypertension in the general population. This paper aims to describe the epidemiology of hypertension in 35–64 year old residents in Ragama Medical Officer of Health area in the Gampaha district, Sri Lanka. METHODS: An age-stratified random sample of 4400 adults between 35 and 64 years of age drawn from the population based electoral list, was invited for a screening programme on cardiovascular risk factors. Socio-demographic and risk factor related data and anthropometric and blood pressure measurements were obtained by trained research assistants. Blood was obtained for relevant biochemical investigations. RESULTS: The prevalence of hypertension (systolic >139 mm Hg and/or diastolic >89 mm Hg) in 2986 subjects (Males 45%), was 30.4% (27.8% in males; 32.5% in females). 31.8% (n=288) were previously undetected. Of the known hypertensives, 19.5% were not on anti-hypertensive medication and only 32.1% were controlled (defined by systolic <140 mm Hg and diastolic <90 mm Hg). Factors associated with hypertension in both males and females were body mass index, waist circumference, fasting blood glucose and serum triglycerides. CONCLUSIONS: The prevalence observed is comparable to the prevalences of developed countries with relatively older populations. A considerable proportion of known hypertensives are not on treatment and the observed poor control indicates problems in drug compliance. Interventions targeting lifestyle modification and drug compliance are essential to control adverse outcomes of hypertension.Item Comparison of urban diabetics with optimal and suboptimal control(BMJ Publishing Group, 2011) Pinidiyapathirage, J.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.INTRODUCTION: The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. METHODS: A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. RESULTS: There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. CONCLUSIONS: Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.Item Age, sex and hyperlipidemia: Is it a simple association?(College of Community Physicians of Sri Lanka, 2009) Pathmeswaran, A.; Pinidiyapathirage, J.; Kasturiratne, A.; Wickremasinghe, A.R.INTRODUCTION: Hyperlipidemia is a known cardiovascular disease risk factor. There are effective lifestyle, dietary and pharmacological interventions to treat hyperlipidemia. It is important to target testing for hyperlidemia for the most appropriate age sex groups to optimize resource utilization. Identifying such groups is not easy when there is an interaction between age and sex. OBJECTIVE: To describe the association between age, sex and hyperlipidemia among 35 to 64 year old residents of Ragama. METHODS: Residents aged 35-64 years in the Ragama MOH area were randomly sampled from the voters list after stratification into 10 year age groups. Blood for lipid profile was collected after a 14 hour overnight fast for analysis. Bivariate and multiple logistic regression were performed using Stata 8.2. Results are expressed as odds ratios and relevant 95% confidence intervals (OR; 95% Cl). RESULTS: Total sample analysed was 2987; 45% (n=1338) were males, 17% (n=515), 38% (n=1140) and 45% (n=1332) were in the age groups of 35-44, 45-54 and 55-64 years respectively. The prevalence of hyperlipidemia was 36%. In bivariate analysis, females (OR 1.3; 95% Cl 1.1-1.5) and the age groups of 45-54 (OR 1.7; 95% Cl 1.3-2.1) and 55-64 years (OR 1.5; 95% Cl 1.2-1.9) when compared to 35-44 years were at a higher risk of hyperl[pidaemia . In multiple logistic regression too females (OR 1.2; 95% Cl 1.1-1.4) and the same age groups ( 45-55 [OR 1.7; 95% Cl: 1.3-2.1] and 55 to 64 years OR 1.5; 95%CI: 1.2-1.9) respectively) had higher risk of hyperlipideamia. When an age sex interaction term was added to the above model, 35-44 year old females had the lowest risk. In comparison to the latter, the OR (95%CI) of females of 45-54 and 55-64 years were 2.4(1.8-3.4) and 2.8(2.1-3.9) respectively. The same for males of 35-44, 45-54, and 55-64 years were 2.0(1.3-2.9), 2.3(1.6-3.2) and 1.5(1.1-2.1) respectively. CONCLUSION: The risk of hyperlipidemia increased with increasing age among females but among males the lowest risk was in the 55-64 year age group. Attempts to portray a simple picture are likely to obscure important details and may even be misleading.Item Comparison of number of dog Rabies diagnosed at the Medical Research Institute before and after stray dog elimination cessation policy(College of the Community Physicians of Sri Lanka, 2013) Balasubramaniam, R.; Kasturiratne, A.; Wimalaratne, O.; Wickremasinghe, A.R.INTRODUCTION: In Sri Lanka, elimination of stray dogs was completely halted in 2007 and has been replaced by animal birth control methods. Incidence of human Rabies is steadily declining even after this transition in Rabies control activities. However, effect of it on other Rabies related statistics remains undocumented. OBJECTIVES: To compare the number of confirmed cases of dog Rabies at the Medical Research Institute (MRI) before and after implementation of stray dog elimination cessation policy. METHODS: This cross sectional descriptive study analysed the data on dog brains sent to the MRI for Rabies virus diagnosis and found positive (confirmed cases of dog Rabies (CCDR)) for a period of 10 years from 2002-2011. The required information was extracted manually from the records maintained in the MRI, computerized and subjected to further analysis. RESULTS: Annual mean of 964.2 (SD±192.7) brain specimens from suspected cases of dog Rabies (SCDR) have been received at the MRI during the study period. Although the number has increased by 80% from 541 in 2002 to 975 in 2011, it was steadily declining from 2008 onwards. Despite this drop, the annual mean of SCDR was higher after (1094±86.9) stray dog elimination has been halted than 2007 and before (877.67±199.5). Of these SCDR, approximately two-thirds were confirmed by laboratory testing. This led to an annual mean of 577.3 (SD±111.19) CCDR during the study period. Similar to the trend seen with SCDR, although the number has increased by 40.1% from 391 in 2002 to 548 in 2011, it was steadily declining from 2009 onwards. Despite this drop, the annual mean of CCDR was higher after (629.25±77.8) stray dog elimination has been halted than 2007 and before (542.67±122.6). The percentage increase in SCDR (24.6%) during the study period was slightly higher than the percentage increase in CCDR (16%). CONCLUSIONS AND RECOMMENDATIONS: Annual mean of SCDR and CCDR at the MRJ has not grossly increasedItem King coconut water, tender coconut water, Gatorade and ORS: which rehydrates athletes best?(Sri lanka Medical Association, 2015) Athauda, L.K.; Kasturiratne, A.; de Silva, A.P.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: A randomized controlled, crossover trial was conducted to assess the rehydrating ability of exclusive consumption of king coconut water (KC) tender coconut water (TCW), Gatorade (G) and ORS as rehydration fluid. METHOD: Purposively selected 15 (M=13, F=2) middle distance runners with a mean age of 26.46 (+3.95) years with a BMI of 18.77(+1.53) were recruited from the National pool. Each fluid was given ad libitum during one hour training session and two hours of recovery on four different days with a wash out period >72 hours. Total fluid consumption and urine out¬put over three hours was assessed. Following parameters were assessed at baseline and two hours post-recovery: venous blood gas (VBG) and urine full report. A self-administered questionnaire assessed perception on each fluid. Differences between VBG findings (2 hours post recovery - baseline) were analyzed to compare different fluids using one-way AN OVA. RESULTS: KC was the most consumed fluid (mean 3325+769.77ml; p=0.016). Urine output was highest with Gatorade (mean365.77+246.49ml; p=0.16). There were significant differences in blood phi haematocrit (Hct), Sodium, Potassium Glucose, Lactate, BEecf, and urine pH, between baseline and post recovery among the four fluids. ORS at 2 hours post recovery had the largest decrease in Lactate (~0.353mmol/L) and Hct (-2.266) and highest increase in Sodium 2.46mmol/L and glucose 8.8mmol/L from baseline. Compared to other groups, the decrease in urine pH was significantly greater in Gatorade (-0.346; p<0.01). CONCLUSION: Although athletes' preference for rehydration was KC, biochemical markers indicate that ORS is the most suitable fluid for rehydration of athletes compared to the other three.Item Aetiological factors of oral cancer in Sri Lanka(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Ariyaratne, M.A.Y.; Wickremasinghe, A.R.OBJECTIVE: To determine aetiological factors of oral cancer in three provinces in Sri Lanka DESIGN, SETTING AND METHODS: A matched case-control study on incident cases of oral cancer and age-sex matched neighbourhood controls was conducted in three provinces of Sri Lanka. Risk factors were analysed using matched pair analyses and conditional logistic regression. RESULTS: Among 658 subjects (329 pairs) [males= 82.1%, mean age = 61.6 (30=12.2) years], a higher monthly income, regular betel chewing, age at starting chewing, duration of a chew, retaining the quid in the mouth at night, regular smoking, duration of smoking, amount smoked daily, type of smoke used, regular alcohol consumption and amount of illicit liquor consumed daily were significantly associated with oral cancer on bivariate analysis. Past history of cancer, family history of cancer and family history of cancer of head and neck were also associated with oral cancer. A higher income (OR=0.65; 95% CI 0.44-0.96) and high consumption of raw fruits (OR=0.64; 95% CI 0.46-0.89) were protective. Regular betel chewing (OR=1.94; 95% CI 1.23-3.07), retaining the quid in the mouth at night (OR=20.45; 95% CI 7.23-57.89), consumption of illicit liquor (OR=4,65; 95% CI 2.49-8.71) and the amount smoked per day (OR=1.04 95% CI 1.01-1.07) were significantly associated with oral cancer on multivariate analysis. CONCLUSIONS: Betel chewing is the most important determinant of oral cancer. Retaining the quid in the mouth should be discouraged. The importance of family history demands for preventive programmes for family members of patients.Item Epidemiology of non- alcoholic fatty liver disease (NAFLD) in an urban Sri Lankan population(Sri Lanka Medical Association, 2008) Dassanayake, A.S.; Rajindrajith, S.; Kasturiratne, A.; Kalubowila, U.; de Silva, A.P.; Mizoue, T.; Makaya, M.; de Silva, H.J.BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is increasing in the Asia-Pacific region. NAFLD can progress from simple steatosis, through steatohepatitis to advanced hepatic fibrosis, cirrhosis and hepatoma. Its prevalence in Sri Lanka is not known. Objective: To investigate community prevalence and risk factors associated with NAFLD among adults in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: The sample consisted of 2985 randomly selected subjects, 35-65 years old, resident in the Ragama Medical Officer of Health area. NAFLD was diagnosed on ultrasound criteria (presence of 2 out of 3: increased hepatic echogenicity compared to spleen or kidney, blurring of hepatic vasculature, deep attenuation of ultrasound signal), and when alcohol intake was <14 units/week for males and <7 units/week for females. Anthropometric and blood pressure (BP) measurements were made; fasting blood glucose, lipid profile and serum alanine transaminase (ALT) were estimated (normal cutoff values were based on revised ATP III criteria of metabolic syndrome for Asians). RESULTS: 974(35%) individuals had NAFLD [mean age 52.8 years (SD 7.3), 605 (62.1%) females]. On multivariate analysis, central obesity (BMI>25kg/m2 and/or waist circumference >90cm for males, >80cm females), elevated fasting plasma glucose (>100mg/dl), elevated diastolic BP (>85mmHg), elevated plasma triglycerides (>150mg/dl), elevated ALT (>twice the upper limit of normal), and low high density lipoprotein cholesterol (<40mg/dl for men, <50mg/dl for women) were significantly associated with NAFLD. CONCLUSIONS: The prevalence of NAFLD among adults in this urban Sri Lankan community is as high as in western populations. NAFLD is associated with factors that constitute the metabolic syndrome.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.