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 Incidence and prevalence of stroke and time trends in vascular risk factors among urban/semi-urban Sri Lankans: A population-based cohort study(Ceylon College of Physicians, 2020) Mettananda, K.C.D.; Ranawaka, U.K.; Wickramarathna, K.B.; Kottahachchi, D.C.; Kurukulasuriya, S.A.F.; Matha, M.B.C.; Dassanayake, A.S.; Kasturiratne, K.T.A.A.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Incidence of stroke is declining in developed countries, but is increasing in developing countries. There is no data on incidence of stroke in Sri Lanka, and only limited data on prevalence of stroke. METHODS: We studied a population-based cohort (35-64 years) selected by stratified random sampling from an urban/semi-urban health administrative area (Ragama Health Study) in 2007, and evaluated them again in 2014 with regard to new onset stroke and prevalence of vascular risk factors. Possible stroke patients were independently reviewed by a neurologist and a physician with regard to the diagnosis of stroke. The prevalence of stroke (at baseline) was estimated. Prevalence of vascular risk factors in the population were compared between 2007 and 2014. RESULTS: The baseline cohort in 2007 consisted of 2985 individuals (females 54.5%, mean age 52.4 ± 7.8 years). Of them, 2204 attended follow-up in 2014 (female 57.6%, mean age 59.2±7.6 years). 19 had a history of strokes at enrolment (stroke prevalence 6.37/1000 population) and 24 episodes of strokes occurred over the 7 years (annual incidence of stroke 1.56/1000 population). Risk factor prevalence in 2007 and 2014 were; hypertension 48.7% and 64.3%; hyperlipidaemia 35.5% and 39.3%; diabetes mellitus 28.2% and 35.7%; and obesity 2.6% and 17.9%, respectively. CONCLUSION: Stroke incidence and prevalence rates of Sri Lanka lie between those of developed and developing countries. Prevalence of vascular risks have increased over time in this urban/semi urban Sri Lankan population.Item Mortality in an urban cohort in Ragama, Sri Lanka(BMJ Publishing Group, 2011) Vithanage, P.V.T.S.; Panapitiya, P.A.S.; Padmakumara, N.; Hemantha, S.; Kasturiratne, K.T.A.A.; Wickremasinghe, A.R.; Pathmeswaran, A.; Pinidiyapathirage, M.J.INTRODUCTION: The leading causes of mortality in Sri Lanka are due to chronic diseases. We describe the mortality patterns in a 35–64-year-old urban cohort resident in Ragama, Sri Lanka and followed over 3 years. METHODS: A follow-up study was conducted among 2986 35–64 year olds randomly selected from the Ragama Medical Officer of Health area, Sri Lanka. A baseline survey was conducted from January to September 2007 and a follow-up survey was conducted from March to November 2010. Mortality data were obtained from next of kin and cause of death was verified from death certificates. RESULTS: There were 49 deaths during 9186.46 person years of observations. Of the 49 deaths, 11 were due to myocardial infarctions, 5 were due to strokes, 5 were due to other ischaemic heart disease and the rest included 6 due to cancer and 2 due to train accidents. The increase in mortality in men occurs after 45 years and in females it is observed later on. Mortality among men was more than twice as much as females (RR 7.96 vs 3.17 per 1000 person years). All cause mortality was significantly higher in diabetics. Mortality was not associated with hypertension, dyslipidaemia, smoking, central obesity, obesity or physical activity. Conclusions Diabetes Mellitus was significantly associated with all cause mortality. Other associations may have not been significant due to the small number of deaths.Item A Descriptive study of deep vein thrombosis (DVT) in a tertiary care hospital(Sri Lanka Medical Association, 2008) Botheju, W.I.K.; Navaratne, A.C.R.; Somarathne, C.K.; Balasooriya, B.L.P.P.; Wijebandara, R.J.K.S.; Mandawala, M.B.S.N.; Ruwanpathirana, T.; Kasturiratne, K.T.A.A.; Hewawitharana, C.P.; Rathnasena, B.G.N.; Fernando, P.; Wijesinghe, P.S.; Premawardhena, A.OBJECTIVE: The incidence and risk factors for DVT are not well established for the Sri Lankan population. Though believed to be an effective screening tool for DVT, the Well's Clinical score is not widely used in Sri Lankan hospitals. DESIGN, SETTING AND METHODS: Over a period of 8 months, a total of 23274 patients who presented to four units (including one general medical, one general surgical, one Gynaecology & Obstetrics, and the Orthopedic ward) of the North Colombo (Teaching) Hospital were screened for asymmetrical limb swelling more than 2 cm. The latter group were subjected to risk assessment for DVT, Well's scoring and CDU (Colour Duplex Ultrasound). RESULTS: Of the 23274 patients, 93 (0.4%) had unilateral limb swelling of which 12 (12.9%) were CDU confirmed to have DVT (0.5 per 1000). Limb swelling for more man two weeks was significantly commoner among DVT patients when compared to those without DVT (75% Vs 25.9%: p=0.001). None of the patients had been evaluated with the Well's score as a guide to refer for CDU by the relevant clinical teams. In 55 (59.1%) subjects, Well's score was 0 or less (minimum probability of DVT) and there were no subjects with DVT in this group. All 12 patients with DVT had a moderate or high probability Wells score. CONCLUSIONS: Overall incidence of DVT in the study population was lower than in other comparable published studies from Asia. Well's score which was underused by the clinicians is a highly sensitive screening tool for DVT.