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 Premorbid blood pressure control of incident transient ischaemic attacks and strokes; prevalence and determinants; Analysis of individual patient data over 10 Years(Lippincott Williams & Wilkins, 2017) Mettananda, C.; Li, L.; Lau, G.; Wharton, R.; Bull, L.; McCulloch, E.; Welch, S.; Mehta, Z.; Silver, L.; Rothwell, P.; Oxford Vascular StudyBACKGROUND: Uncontrolled blood pressure is the most important modifiable risk factor for strokes. AIMS AND METHODS: We determined the prevalence and determinants of blood pressure control in patients with incident transient ischaemic attacks(TIA) and strokes from 2002-2012 in a population-based cohort(Oxford Vascular Study). Controlled blood pressure(BP) was defined as having BP<140/90mmHg and was studied in different cardiovascular risk groups according to the Framingham 10-year general cardiovascular risk(CV-Risk) predicted at time of event and 10years pre-event; low(≤ 10%), moderate(11-19%) and high(≥ 20%) risk. We also studied the associations of controlled BP adjusted for age and sex. RESULTS: Among 1741 patients with incident TIA/strokes, 1051 (60.4%) had known hypertension, of which 891 (84.8%) were on anti-hypertensive treatment. However, only 698 (40.1%) of all and 306 (29.1%) of treated patients had controlled BP. On predicted 10-year CV-Risk at event, 861 (72.5%) of 1188 (77.0%) in high risk group had known hypertension, of which 758 (88.0%) were on treatment. However, only 346 (29.1%) of all in high-risk group and 190 (25.1%) of treated high risk patients had controlled BP. In contrast, 120 (88.2%) of 136 (8.8%) in low risk group had controlled BP. Risk stratification without scoring for BP showed consistent results except the number in high-risk group dropped to 863 (55.9%). Analysis with CV-risk 10years pre-event also showed similar trends. Age(adjusted OR=0.97, 95%CI=0.97-0.98, p<0.001), high CV-risk at event/10years pre-event (0.97, 0.95-0.99, p<0.013, 0.95-0.99, p=0.008), being treated for hypertension(0.43, 0.35-0.52, p<0.001), BMI≥ 30Kg/m2(0.72, 0.55-0.92, p=0.010) and high total cholesterol(0.91, 0.84-0.99, p<0.026) were negatively associated with controlled BP. However history of atrial fibrillation(1.35, 1.03-1.77, p=0.030) and physical dependency(modified-Rankin-Scale>2; 1.54, 1.15-2.06, p<0.001) were positively associated with controlled BP. CONCLUSIONS: Premorbid blood pressure control in patients with incident TIA/strokes was inadequate especially in high-risk patients. Controlling BP to targets in elderly and high CV-risk patients would be important in reducing incident TIA/strokes.Item Epidemiology of stroke subtypes and aetiology among Sri Lankan stroke patients(Sage Publishing, 2020) Mettananda, C.; Wettasinghe, L,; Eshani, M.D.P.; Ranawaka, U.BACKGROUND AND AIMS: Prevalence of stroke is on the rise in south Asia and the epidemiology is different to western countries. However, prevalence of stroke subtypes and aetiology is not reported of Sri Lanka. Therefore, we aimed to describe the same of Sri Lanka. METHODS: We analyzed all the acute stroke admissions to a stroke unit of a tertiary care hospital in Sri Lanka over 5 year from October 2013 to 2018. Data were collected prospectively using an interviewer administered questionnaire by interviewing patients and perusing medical records. Ischaemic strokes were classified on OCSP (Oxfordshire Community Stroke Project) and TOAST(Trial of Org 10172 in Acute Stroke Treatment) classifications RESULTS: 891 patients were admitted to stroke unit over 5 years; 765(85.5%) ischaemic strokes, 129 (14.5%) intracerebral haemorrhages (ICH), and 0(0%) sub-arachnoid haemorrhages (SAH). Of the ischemic strokes 16(1.8%) were total anterior circulation, 253(29.0%) partial anterior circulation, 543(62.3%) lacunar, 59(6.8%) posterior circulation infarcts on OCSP classification. 542 of ischaemic stroke patients who had complete investigations for TOAST classification were studied for aetiology of stroke. Atrial fibrillation was reported in only 14(2.7%) and more than 50% carotid stenosis was seen in 22(4.1%) ischaemic stroke patients. 17(3.1%) were of large artery atherosclerosis, 369(68.1%) small vessel occlusion, 11(2.0%) cardioembolic and 145(26.8%) undermined aetiology. CONCLUSIONS: Prevalence of ischaemic strokes, ICH and SAH were not different to western statistics in this Sri Lankan cohort of stroke patients. However, cardio-embolic and large artery strokes were less common compared to west and lacunar strokes were the commonest of ischemic strokes.Item Incidence and time trends in prevalence of stroke and vascular risk factors in an urban Sri Lankan population: A population- based cohort study(Asia Pacific Stroke Organization, Hong Kong Stroke Society and Jiangsu Stroke Association & karger publishing, 2017) Mettananda, C.; Wickramarathna, B.; Pathmeswaran, A.; Ranawaka, U.BACKGROUND AND RATIONALE: Prevalence of stroke is increasing in developing countries. However, population data on time trends in prevalence of stroke in Sri Lanka not. METHODS: We screened a population-based cohort 35–64 year selected by stratified random sampling from an urban health administrative area in 2007 evaluated them again in 2014. Identified possible stroke patients were independently reviewed by a Neurologist and a Physician with regard to diagnosis and vascular risk factors. Incidence and time trends in prevalence of stroke and vascular risk factors in 50–65-year age group were compared between 2007 and 2014. RESULTS: Of 2985 baseline study population in 2007 (females 54.5%, mean age 52.4 ± 7.8 years), 2204 attended follow-up in 2014. Of them, 45 have had a stroke/TIA, (female 51.1%, mean age 52.9 ± 5.4 years). 25 (55.6%) of them were strokes within the 7 year follow up (annual incidence-1.66 per 1000 population). Prevalence of stroke in 50–65-year age group was of the 45 stroke patients reviewed in 2014, 28 (62.2%) had. Of 27 were definite strokes, 15 probable strokes and 3 TIAs. CONCLUSION: Prevalence has increased over time in urban Sri Lanka lie between developed and developing counties.Item Recent signals in pharmacovigilance(The Sri Lanka Association of Clinical Pharmacology and Therapeutics., 2020) Mettananda, C.Pharmacovigilance is the science and activities related to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem of already marketed drugs. The main goal of this is to promote safe and effective use of health products by providing timely information about the safety of health products to patients, health-care professional s, and the public. There are several bodies involved in this process. The World Health Organisation (WHO) established its Programme for International Drug Monitoring, in response to the thalidomide disaster detected in 1961. World Health Organization (WHO) Collaborating Centre for International Drug Monitoring, the Uppsala Monitoring Centre (UMC), promotes pharmacovigilance of the WHO member countries. At the end of 201 0, 134 countries were part of the WHO Pharmacovigilance Programme. The WHO defines a safety signal as a "Reported information on a possible causal relationship between an adverse event and a drug, the relationship being unknown or incompletely documented previously". Information received from patients and healthcare providers via pharmacovigilance agreements as well as other sources such as medical literature is considered in signal detection. Once it is decided that there is a plausible association between an adverse effect and a drug, U MC signals those to national pharmacovigilance centres via "VigiLyze" and the signals will be published in the publicly-available WHO Pharmaceuticals Newsletter (online) and the individual signals are sent to the appropriate pharmaceutical company when they can be identified as uniquely responsible for the drug concerned. Regulators in individual countries may investigate these further and will decide on continued use of the medicine. Confirmed associations will lead to changing the information for patients, providing a public warning or in the most serious situations, withdrawing a drug from the market. For example, pharmacovigilance finding of "Roficoxib" causing increased risk of heart attack and stroke on long term use in high doses Jed to voluntary withdrawal of the drug by manufacturer from the US market in 2004.Item Perception of Sri Lankan medical students about teaching methods in medical schools.(Yong Loo Lin School of Medicine., 2016) Mettananda, C.; Perera, S.; Jayakody, K.; Palihana, A.AIMS: Although English is a second language, Sri Lankan medical students are also taught using the same teaching methods used in developed countries where English is the 1st language because there are no data on Sri Lankan medical students' views and expectation about the teaching methods used in medical schools. Therefore, we aimed to evaluate Sri Lankan Medical students perception on teaching methods used in medical schools. METHODS: We evaluated views and expectations on teaching methods of 3rd and 4th year medical students of Faculty of Medicine, University of Kelaniya, Sri Lanka in an observational study using a self-administered questionnaire. RESULTS: 102 3rd-year (mean age 23.4 years, female 64.7%) and 96 4th-year (mean age 24.3 years, female 74.0%) medical students volunteered for the study. All students have had> 55/100 marks for English language at Ordinary level (O/L) (year 11) exam, but only 88% had > 55/100 marks for English language at Advanced level (NL) (year 13) exam. Majority of students were form not so rural areas; Gampaha - 33%, Kurunegala -15% and Colombo - 14%. Half of the students were from families where their parents have studied only up to O/L. 78% students preferred lectures while 10%, 7% and 6% liked problem based learning (PBL), practical sessions and tutorials respectively as the teaching method of choice, but there was no significant association with their English results. The main reasons why they liked lectures were that they can get expert knowledge (57%) by attending lectures and that the lecturer knows the subject well (12%) than when it is taught as a PBL by few non-experts. Majority preferred to have 45 minutes long (74%), multimedia assisted (89%), interactive (75%) lectures. More than 85% students liked if the lecturer highlights the important aspects and especially if they relate it to exam and to practice as a doctor, use simple language to explain the subject and if handouts were given at the end. However, only 52% and 57% students viewed respecting students and giving cognitive breaks in-between lectures are important. The main reasons for students to attend a particular lecture depended on if the lecturer is a good teacher (87%), importance of topic to exam (82%) and to carrier as a doctor (74%). But the decision to attend lecture was not much related to appearance of the lecturer (13%), how famous the lecturer is (29%), the fact that lecture handouts are not given (18%) or the lecture being compulsory (39%). CONCLUSION: Views and expectations of this sample Sri Lankan medical students on teaching methods used in medical schools are more or less similar to that of developed world.Item Viral characteristics and genomics of early onset, single organ specific presentations in dengue(Sri Lanka Medical Association, 2013) Premaratna, R.; Perera, H.K.K.; Chan, K.H.; Yeung, M.F.; Mettananda, C.; Peiris, J.S.M.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Early onset neurological, hepatic and cardiac complications of dengue are increasingly recognized. However, doubts exist as to whether such complications of dengue are consequences of dengue shock syndrome rather than direct organ involvement. We studied virus characteristics and their genomics in patients who presented with early onset single organ involvement due to dengue, without features of DSS. METHODS: Blood samples were collected at admission of seven patients, who presented to the Professorial Medical Unit, Colombo North Teaching Hospital Ragama during 2011-2012, confirmed as having acute dengue by PCR. Samples were analysed with single-tube, nested RT-PCR using type-specific primers. Viral RNA was extracted and sequencing was performed. The dengue virus sequences were aligned with other sequences that are available in the GenBank and maximum-likelihood (ML) tree was made. RESULTS: Early onset organ specific manifestations included; self-limiting fits and clouding of consciousness on the 2nd day, rise in AST (1337iu/L) and ALT (749iu/L) on the 4th day and T wave inversions in the ECG on the 3rd day. Seven Dengue 1 viruses were isolated, which were in close homology in all 7 patients, based on the maximum likelihood tree with 1000 boot-straps. CONCLUSIONS: All the strains detected were clustered within the Genotype I clade of dengue-1 and in close homology with the dengue-1 viruses detected in the country in the recent past. The significance of viral characteristics and genomics related to organ specific manifestations need further study.Item Knowledge and expectations of parents regarding the role of antibiotic treatment of upper respiratory tract infections - a survey among parents attending a tertiary care institution with a sick child(Sri Lanka Medical Association, 2006) Premaratna, R.; Rajindrajith, S.; Mettananda, C.; Balasooriya, H.; Fonseka, J.; Randeny, S.; de Silva, H.J.INTRODUCTION: Parents' knowledge and expectations regarding antibiotics contribute for antibiotic misuse inpaediatric practice. METHODS: Parents of children suffering from URTI, attending the OPD and Professorial Paediatric Unit of the Teaching Hospital, Ragama, were interviewed for knowledge, attitudes and practices during URTI pre-tested questionnaire by doctors from February to July 2005. Results: 235 parents (230 mothers) mean age 31.9 years (SD: 7.33) participated in the study. The level of education was; below grade 5:11 (4.7%), Grade 5-10: 142 (60.4%), grade 10-12:71 (30.2%) and higher education: 11 (4.7%). Of the 235,201 (85.1%) identified antibiotics as a component of treatment. However only 11 (4.7%) knew that antibiotics were against bacterial infections; 212 (90.3%), 189 (80.8%), 176 (75%), 165 (70.4%), 130(55,4%), 77 (32.8%) and55 (23.6%) identified them as treatment for cough, fever, phlegm, cold, sore throat, ear ache and headache either alone or combination. 116 (49.3%) and 119 (50.3%) thought that antibiotic treatment was important to cure the illness or for early recovery respectively. The expectation of being given an antibiotic for an URTI (always, 75%, 50% and 25% of the time and never) was 28 (12%), 39 (17%), 23 (10%), 119 (51%) and 23 (10%) respectively. Twenty (8.5%) had requested an antibiotic when it had not been prescribed; 12(60%) from apharmacy and 8 (40%) from the doctor. 172 (73%) claimed to complete the full course of treatment, while 18 (7.8%) kept the 'excess' antibiotics for future use. CONCLUSIONS: Knowledge, expectations, demand and self medication with antibiotics seems to be low among parents in our population.