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 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 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 Is Acanthosis Nigricans a useful clinical screening test for non-alcoholic fatty liver disease(NAFLD) in resource poor settings(Elsevier, 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.V.U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.BACKGROUND: Acanthosis nigricans (AN) is an easily detectable papillomatosis and hyperkeratosis of the skin associated with insulin resistance. Insulin resistance is widely accepted as the underlying cause of Non- Alcoholic Fatty Liver Disease (NAFLD). Ultrasonography is the currently accepted tool to screen for NAFLD in the community, but is expensive and needs expertise. OBJECTIVES: To investigate whether AN would be an useful screening test for NAFLD in an adult Sri Lankan population. METHODS: This study was part of a community based investigation −Ragama Health Study (RHS). The study population consisted of 35−64 year old adults, selected using stratified random sampling. Consenting adults were screened by a structured interview, clinical examination, liver ultrasound and collection of 10 ml venous blood. NAFLD was diagnosed based on established ultrasound criteria for fatty liver, safe alcohol consumption and absence of serum markers for Hepatitis B and C. AN was identified by the presence of dark, thick, velvety skin in the neck, body folds and creases. Results: 3012 subjects participated in the study. AN was present significantly more frequently among NAFLD patients than normal individuals in both males (37.9% vs. 4.8%, p <0.001) and females (39.8% vs. 5.8%,p<0.001). The sensitivity, specificity, and positive predictive value of AN for NAFLD was 37.9%, 95.2%, 78.0% for males and 39.8%, 94.2%, and 81.3% for females respectively. CONCLUSION: AN is significantly more common in NAFLD than normal individuals. Although AN has a high specificity, it is not an useful test to screen for NAFLD in the community.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.Item Prevalence of metabolic syndrome in a Sri Lankan community(Sri Lanka Medical Association, 2008) Chackrewarthy, S.; Gunasekera, D.; de Silva, L.D.R.; Pathmeswaran, A.; Wijekoon, C.N.; Ranawaka, U.K.; Mizoue, T.; Kato, N.OBJECTIVE: To estimate the prevalence of metabolic syndrome (MetS) in a Sri Lankan community. Limited information is available about MetS in Sri Lankans. DESIGN, SETTING AND METHODS: A total of 2948 individuals (1345 males and 1603 females) who participated in the Ragama Health Study comprised the study population. Prevalence of MetS was estimated using three widely used criteria: International Diabetes Federation (IDF), WHO and National Cholesterol Education Programme - Adult Treatment Panel III (NCEP-ATP III). RESULTS: Age and sex adjusted prevalence rates of MetS were 38.9%, 38.9% and 41.6% as defined by IDF, WHO and NCEP-ATP III respectively. Prevalence increased with age (for age groups 35-44, 45-54 and 55- 65 years respectively; IDF - 27.9%, 40,1%, 42.9% ; WHO - 28.7%, 43.2%, 52.6%; NCEP ATP III - 34.6%, 46.7%, 50.6%; P<0.001 in all). MetS was commoner in women (IDF - 45.8% Vs. 23.0%, P<0.001; WHO - 37.3% Vs. 40.5%, P>0.05; NCEP-ATP III - 49.8% Vs. 33.1%, P<0.001). Prevalence of central obesity (using Asian cutoff values) was higher in women. (70.8% Vs. 35.5%, P<0.001). CONCLUSION: Prevalence of MetS is high in this community. Preventive measures towards reducing trie risks associated with MetS should be promoted.Item Alcohol consumption and tobacco smoking in an urban adult Sri Lankan population(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Pinidiyapathirage, M.J.; Perera, H.K.K.; Fernando, E.D.P.S.; Ranasinha, C.D.; Edirisinghe, P.A.S.; Makaya, M.; Kato, N.BACKGROUND: Data on the prevalence and patterns of alcohol consumption and smoking in the general population in Sri Lanka are scarce. Objective: To describe patterns of alcohol use and smoking in an urban adult population in Sri Lanka. DESIGN, SETTING AND METHODS: A random sample of the general population aged between 35-65 years, resident in the Ragama Medical Officer of Health area was interviewed to obtain drinking and smoking habits. RESULTS: Among 2985 subjects [males 45.5%; mean age 52.7 years (SD7.8)], 1156(39.7%) reported ever use of alcohol, and 892(29.7%) reported current use. 58.8% of males and 5.7% of females were current drinkers. 190(14%) males and 12(0.7%) females consumed alcohol above the weekly safe limit (>14 units for males, >7 units for females). The median duration of alcohol use among ever users was 18 years (interquartile range 10-25), and current users was 20 years (interquartile range 1,0-25). The commonest type of alcohol consumed was arrack (n=492), followed by beer (n=217). 60.2% of males and 2.1% of females reported ever smoking, 483(16.2%) were current smokers. 35.1% of males and 0.5% of females were current smokers. The median duration of smoking was 20 years among both ever smokers (interquartile range 10-27.3), and current smokers (interquartile range 15-30). Most (55.3%) smoked cigarettes, only 36(4.2%) smoked beedi. The median pack years of current smokers was 4,5 (interquartile range 2-10). CONCLUSION: Lifetime and current use of alcohol and smoking are high among males. Focused interventions are required to reduce current rates among males and to maintain low rates reported by females.Item Cardiovascular risk in a Sri Lankan community(Sri Lanka Medical Association, 2008) Ranawaka, U.K.; Wijekoon, C.N.; Pathmeswaran, A.; de Silva, L.D.R.; Gunasekara, D.; Chackrewarthy, S.; Mizoue, T.; Kato, N.OBJECTIVE: Identifying the cardiovascular disease (CVD) [coronary heart disease (CHD) and stroke] risk in a community is important in planning preventive strategies, but such data are lacking from Sri Lanka. We sought to describe the CVD and CHD risk in a Sri Lankan community. DESIGN, SETTING AND METHODS: A community survey was conducted in the Ragama Medical Officer of Health area (Ragama Health Study) involving individuals aged 35-65 years, selected by stratified random sampling. Their 10-year CVD and CHD risks were estimated using three widely used risk stratification ALGORITHMS: Framingham score, NCEP-ATP III (National Cholesterol Education Program – Adult Treatment Panel III), and Systematic Coronary Risk Evaluation (SCORE). Results: In the study population (n=2985), 54.5% were females, and the mean age [SD] was 52.4 [7.8] years. According to the Framingham (CHD risk), NCEP-ATP III (CHD risk) and SCORE (total CVD mortality risk) criteria, 11.5%, 37.2% and 9.7% respectively were classified as 'moderate or high risk'. Risks were not significantly different between sexes, except with NCEP-ATP III criteria (M- 54.1%, F- 21%, p55y- 38%, p55y- 64.7%, p<0.001; SCORE: <55y- 9.0%, >55y- 14.6%, PItem Alanine Transaminase (ALT) levels in normal adult Sri Lankans(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.; Kalubowila, U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.BACKGROUND : Alanine transaminase (ALT) levels are widely used in screening for liver disease.The upper limit of normal (ULN) of ALT (males 30 IU/l, females 19 IU/l) have been definedfor western populations. Normal levels have not been established for Asian populations. OBJECTIVES: To establish levels of ALT for a normal, adult Sri Lankan population METHODS: This study was part of a community based investigation - Ragama Health Study (RHS). The study population consisted of 35-64 year old adults, selected using stratified random sampling. Consenting adults were screened by a structured interview, liver ultrasound and collection of 10 ml venous blood. The “normal” population was defined as those not using potentially hepatotoxic drugs, safe alcohol consumption (14 units/week for males, 7 units/week for females), absence of fatty liver, and being HBsAg and anti-HCVab negative. ALT levels were estimated by a kit using the Bergmeyer method. The 95th percentile of the ALT levels was taken as the ULN. RESULTS: 3012 subjects participated in the study. The ALT level (U/l) among 831 normal males (mean 36, median 30, SD 20, ULN 68) was significantly higher than that of the 885 normal females (mean 29, median 25, SD 13, ULN 53) (p<0.001,Student's t-test ). CONCLUSION: The ULN for ALT levels of a “normal” Sri Lankan population was higher than observed in western populations. The levels were higher in males. ULN for ALT may need to be redefined for different population groups.