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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Author: search.filters.author.Kottahachchi, D.C.Has files: Yes

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    Thyroid gland and male reproductive anomalies among fuel handlers in Gampaha district, Sri Lanka
    (Endocrine Society, 2021) Kottahachchi, D.C.; Warnakularuriya, T.; de Silva, D.; Madagoda, K.; Wadasinghe, D.; Dayanath, B.K.T.P.I.; Siyambalapitiya, S.; Devanarayana, N.
    Introduction:Fuel handlers at petrol stations are continuously exposed to organic solvents from fuel and vehicle emissions. Endocrine disrupting chemicals (EDC) are present in fuel, which are harmful to endocrine organs. Thyroiditis and hypogonadism are reported among fuel handlers. Thyroid gland and male reproductive function anomalies were investigated among fuel handlers in the Gampaha district of Sri Lanka. Method: 43 were recruited from 6 fuel stations in the Gampaha district for the study and 28 age matched male workers who were not exposed to fuel in an occupational setting were recruited as controls. Thyroid gland was examined clinically and TSH, free T4, FSH, LH and Testosterone were done on all the participants. TPO antibody and a thyroid scan was done on the fuel handlers. Results: Median (IQR) age was 38 years (27-46 years). The mean TSH value was 1.62 IU/mL (1.15-2.35) vs 1.33 IU/mL (0.83-1.79) respectively in study and control populations with significantly higher levels in the study population (p=0.023). The median (IQR) TSH value above the reference range was identified in 7% of fuel handlers and all controls were within the normal range, while 16.9% of fuel handlers had a derangement in the TPO levels. On examination, only one control had a small goiter but his T4 and TSH levels were normal. On ultrasound thyroid scans, benign nodules were seen in 2 fuel handlers. TPO levels did not correlate with the TSH levels among the fuel handlers (r=-0.078, p=0.652). Inability to sustain an erection was reported by 35.5% fuel handlers which was significantly higher than controls who reported 5.6% (p=0.019). Premature ejaculation was reported by 27.9% of fuel handlers which was significantly higher than controls (p=0.023). The testosterone levels were significantly higher among fuel handlers compared to controls (p=0.048). The FSH and LH levels positively correlated with each other as expected in each subgroup and the total population (p<0.005). The TSH levels significantly negatively correlated with the testosterone levels among the fuel handlers. (r=- 0.338, p=.0.023). When the fuel handlers with premature ejaculation was considered the FSH, LH, Testosterone levels were not significantly different between the two groups, however the duration of employment was significantly longer among those reporting premature ejaculation. (p=0.024). Conclusion: There are thyroid and reproductive abnormalities among those exposed to fuel in an occupational setting. Disturbances to sexual functions may also be related to alteration of autonomic functions. Limiting exposure to fuel vapor will eliminate these detrimental effects and we propose self-service fuel pumps to be the best alternative to avoid occupational health hazards among fuel handlers.
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    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.
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    One hour fast for liquids prior to endoscopy is safe, effective and results in minimum patient discomfort
    (American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2006) de Silva, A.P.; Amarasiri, L.; Kottahachchi, D.C.; Sabhapathige, R.D.; Dassanayake, A.S.; de Silva, H.J.
    INTRODUCTION: Current guidelines for endoscopy advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. This is claimed to ensure safety and a clear endoscopic view. However, prolonged fasting may result in patient discomfort. Also due to practical delays the fasting period for endoscopy may be much longer, thus causing even more discomfort to patients. Several anaesthesia societies now recommend a 2-h pre-operative fast for clear fluids and a 6-h fast for solids in most elective patients. A pilot study done by us showed the time for a clear liquid (tea) or water to empty from the stomach using real-time ultrasonography was one hour. AIMS: To determine whether a one-hour fast prior to endoscopy was safe, effective and resulted in less patient discomfort. METHODS: 63 patients referred for endoscopy, without alarm symptoms or clinically obvious motility problems, were recruited. Patients were given a standard meal 6 hours before endoscopy. They were then randomized to either nil by mouth for 6 hours (group A, n = 31) or allowed to take clear fluids up to one hour prior to endoscopy (group B, n = 32). Just prior to endoscopy patients indicated discomfort due to fasting on a visual analog scale (0-no discomfort to 10-severe discomfort). Investigators were blinded to the period of fasting. Presence of fluid in the gastric fundus was noted, and endoscopic vision was graded as good, average or poor. Patients were followed one week after the procedure for the presence of any late complications. RESULTS: Discomfort was significantly lower in group B than group A (median visual analog score 0.3 vs. 5.1; p < 0.0001, Wilcoxon two-sample test). Endoscopic vision was good in all 31 patients in group A and 30 in group B, and average in 2 patients in group B. None were graded as poor. Fluid in the gastric fundus was noted in 7 patients in group A and 10 in group B. There were no complications in either group. CONCLUSIONS: A one-hour fast for clear liquids seems safe and effective and has minimum discomfort for the patient. However, a larger study should be done before the current endoscopic guidelines are revised.
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    One hour fast for liquids prior to upper gastrointestinal endoscopy seems safe, effective and results in minimum patient discomfort
    (Sri Lanka Medical Association, 2006) de Silva, A.P.; Amarasiri, L.; Kottahachchi, D.C.; Dassanayake, A.; de Silva, H.J.
    INTRODUCTION: Current guidelines for upper gastrointestinal endoscopy advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. Studies have shown that is uncomfortable and probably unnecessary. A study was done by us using real-time ultrasonography on 10 patients established the minimal time for clearing non-opaque liquids was one hour. Aims: To determine the effects of allowing clear liquids one hour prior to endoscopy. METHODS: 40 patients referred for video endoscopy, without alarm symptoms or clinically obvious motility problems, were recruited. Patients were given a standard meal 6 hours before endoscopy. They were then randomized to either fasting for 6 hours (group A, n=20) or allowed to take clear fluids up to one hour prior to endoscopy (group B, n=20). Just prior to endoscopy patients indicated discomfort due to fasting on a visual analog scale (0-no discomfort to 10-severe discomfort). All endoscopies were done by a single investigator blinded to the period of fasting. Presence of fluid in the gastric fundus was noted, and endoscopic vision was graded as good, average or poor. RESULTS: Discomfort was significantly lower in group B than group A (mean visual analog score 0.3 vs. 4.4; p<0.001, Wilcoxon two-sample test). Endoscopic vision was good in all 20 patients in group A and 18 in group B, and average in 2 in group B. None were graded as poor. Fluid in the gastric fundus was noted in 6 patients in group A and 7 in group B. CONCLUSIONS: Allowing clear liquids for up to one hour prior to endoscopy seems acceptable, and causes minimum discomfort to patients. However, a larger study should be performed before revision of current guidelines can be made.