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 Adherence to good pharmacy practices of community pharmacies in the Gampaha District, Sri Lanka(Sri Lanka Medical Association, 2023) Basnayaka, B.M.T.D.D.; Ashara, S.F.; Ashik, K.J.M.; Bandara, B.M.M.P.; Bandara, H.M.A.C.; Basnayake, B.M.M.S.M.; Mettananda, K.C.D.INTRODUCTION: The guidelines for good pharmacy practices (GPP) were introduced in 2019 in Sri Lanka but their adherence is not studied. We studied the adherence to GPP of community pharmacies in the Gampaha district of Sri Lanka. OBJECTIVES: To determine the adherence to good pharmacy practices (GPP) of community pharmacies in the Gampaha district, Sri Lanka. METHODS: We did a descriptive cross-sectional study of all community pharmacies in the Gampaha district from 18th January to 8th February 2023. Data were collected using a self-administered online questionnaire developed using the guideline of GPP-2019 issued by the National Medicine Regulatory Authority (NMRA). The questionnaire comprised of 50-questions covering five broad areas of GPP; characteristics of the pharmacists, services and facilities provided, medicine storage, data management, and dispensing/distribution of medicines. Each question was given a mark and the final score was converted to a percentage. RESULTS: We received responses from 194 pharmacies. The mean adherence score was 68.8 (SD 12.8, range 24-97) %. 53.1% of the pharmacies had a score of more than 70% and 79.4% of pharmacies were aware of the GPP guideline by NMRA. 75% of pharmacies had a licensed pharmacist constantly. 92.3% of pharmacies were equipped with air conditioners, and 96.9% were equipped with a refrigerator. However, only 34% of pharmacies had a facade, “pharmacy” written in all three languages (Sinhala, Tamil, English) and 23.71% of pharmacies dispensed antibiotics without a prescription. CONCLUSIONS: Only half of the community pharmacies in the Gampaha district were adherent to GPP.Item Identification of type 2 diabetes patients with non-alcoholic fatty liver disease who are at increased risk of significant hepatic fibrosis: a cross-sectional study(Sri Lanka Medical Association, 2023) Mettananda, K.C.D.; Egodage, T.; Dantanarayana, C.; Solangarachchi, M.B.; Fernando, R.; Ranaweera, L.; Siriwardhena, S.; Ranawaka, C.K.; Kottahachchi, D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Annual screening of patients with diabetes for fatty liver, and identifying those with significant hepatic fibrosis using the FIB-4 score and vibration-controlled transient elastography (VCTE) has been recommended to detect patients who may progress to advanced hepatic fibrosis/cirrhosis. However, VCTE is not freely available in resource-limited settings. OBJECTIVES: To identify clinical and biochemical predictors of significant liver fibrosis in diabetics with fatty liver. METHODS: We conducted a cross-sectional study among all consenting adults with T2DM and non-alcoholic fatty liver disease (NAFLD) attending the Colombo North Teaching Hospital, Ragama, Sri Lanka from November 2021 to November 2022. FIB-4 scores were calculated and patients with a score ≥1.3 underwent VCTE. Risk associations for liver fibrosis were identified by comparing patients with significant fibrosis (LSM ≥8 kPa) with those without significant fibrosis (FIB-4<1.3). RESULTS: A total of 363 persons were investigated. Of these, 243 had a score of FIB-4 <1.3. Of the 120 with a FIB-4 ≥1.3, 76 had LSM ≥8 kPa. Significant fibrosis was individually associated with age (OR 1.01, p<0.0001), duration of diabetes (OR 1.02, p=0.006), family history of liver disease (OR 1.42, p=0.035), waist (OR 1.04, p=0.035), and FIB-4 (OR 2.08, p<0.0001). However, on adjusted analysis, significant fibrosis was only associated with a family history of liver disease (OR 2.69, p=0.044) and FIB-4 (OR 1.43, p<0.001). CONCLUSION: In patients with T2DM and fatty liver, advancing age, increased duration of diabetes, a family history of liver disease, waist circumference and a high FIB-4 score increase the risk of significant hepatic fibrosis. Targeted interventions in this group may help prevent progression to advanced hepatic fibrosis/cirrhosis.Item Impact of COVID-19 on stroke admissions in a Sri Lankan tertiary care hospital:Data from the Ragama stroke registry(Ceylon College of Physicians, 2021) Deelaka, A.G.S.; Dep WDC, W.D.C.; Nanayakkara, Y.P.; Chandrasiri, H.M.J.; Mettananda, K.C.D.; Pathmeswaran, A.; Ranawaka, U.K.Introduction and Objectives The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous impact on stroke care globally. We investigated the impact of the pandemic on stroke admissions in a Sri Lankan tertiary care hospital. Methods We studied the number of admissions to the Stroke Unit and the University Medical Unit, Colombo North Teaching Hospital (CNTH) over four years, and delays in seeking medical care of patients admitted to the Stroke Unit. We compared data during a calendar year of COVID pandemic (01.04.2020 - 31.03.2021) with the preceding 3 pre-COVID years (01.04.2017 一 31.03.2020). Data regarding COVID year was compared with pre-COVID years using independent-samples t-test and nonparametric test. Results Mean number of stroke admissions per month during the pandemic was significantly lower compared to that of pre-COVID years: Stroke Unit (monthly mean admissions, COVID year vs pre-COVID years; 11 ± 3.5 vs 20 ± 3.1; pv0.01); University Medical Unit (12 ± .2 vs 18 ± 3.4; p<0.01). The lowest number of admissions was reported during the period with the highest COVID caseload in Sri Lanka. However, there was no significant difference in the median delays to seeking medical care between the COVID pandemic and pre-COVID years: delay to first medical contact: 2.0 h vs 2.4 h, p=0.208; first hospital admission: 3.0 h vs 3.0 h; p=0.993, admission to CNTH: 3.4 h vs 5.0 h; p=0.174. Conclusions Stroke admissions were significantly lower during the COVID pandemic, but there was no difference in the delays in seeking medical care during the same period.Item Spontaneous intracerebral haemorrhages from a Sri Lankan tertiary care center: 5-year data(Ceylon College of Physicians, 2021) Dep, W.D.C.; Deelaka, A.G.S.; Somaratne, K.G.S.K.; Meegahapola, H.; Premadasa, H.M.S.D.; Kurukulasuriya, S.A.F.; Mettananda, K.C.D.; Ranawaka, U.K.Introduction and Objectives Epidemiological data on spontaneous intracerebral haemorrhage (sICH) is limited from South Asia. We sought to describe epidemiology of sICH in a Sri Lankan cohort. Methods We studied all patients with stroke admitted to the Stroke Unit, Colombo North Teaching Hospital over five years. Data from sICH patients regarding treatment seeking delays, clinical char-jcteristics, risk factors, stroke severity and functional outcome were compared with ischa-mic stroke (IS) patients. Resists 984 patients (mean age 58.7 years; 62.1% males) were studied: sICH 15.0% (147 patients), IS 85.0%. sICH patients: mean age 58.0 years; 67.3% males. sICH patients presented to hospital earlier (<3h sICH 70.6%, IS 37.2%, p<0.001) and had more severe strokes (NIHSS>15) (sICH 21.3%, IS 12.2%; p<0.001). Hypertension was commoner in sICH group (sICH 72.6%, IS 63.5%; p=0.034), whereas diabetes (sICH 39.0%, IS 51.6%; p=0.005) and smoking (sICH 16.6%, IS 25.5%; p=0.021) were less common. Altered consciousness (sICH 30.3%, IS 18.3%; p=0.001), dysphagia (sICH 55.9%, IS 34.4%; p<0.001), bladder involvement (sICH 56.6%, IS 28.7%; p<0.001), and seizures (sICH 4.1%, IS 1.5%; p=0.029) were commoner among sICH patients. sICH patients had more severe disability on discharge (Barthel index 0-60: sICH 71.1%, IS 45.2%; p<0.001; modified Rankin scale (mRS) 3-6: sICH 76.7%, IS 52.1%; p<0.001). sICH location (lobar vs. deep) and presence of intraventricular haemorrhage was not associated with stroke severity. Lobar ICHs had more severe disability on discharge (Barthel index <60: p=0.037; mRS>3: p=0.020). On logistic regression, sICH was independently associated with early presentation to hospital (OR 1.79; p=0.039), and severe disability on discharge (Barthel index <60: OR 2.42, p=0.028; mRS>3: OR 2.70, p=0.012). Conclusions sICH patients sought medical attention early and had different clinical profiles, more severe strokes and more severe disabilities.Item Standards of care of management of diabetes among rural cohort in Sri Lanka - a descriptive study(Sri Lanka College of Internal Medicine, 2021) Chathuranga, P.A.D.U.; Meegodawidanage, N.; Rathnayaka, T.M.; Luke, W.A.N.V.; Mettananda, K.C.D.Introduction: Type 2 Diabetes mellitus (T2DM) is a challenge to health care leading to increase in morbidity and mortality. Objective: We conducted a descriptive study in rural Sri Lanka to assess the standards of care and disease control among patients with diabetes to identify areas for improvement. Methods: A retrospective follow-up study was conducted in five hospitals in Anuradhapura district. All type 2 diabetic patients, diagnosed and started on oral hypoglycemic drugs 24 months prior to recruitment, who attended the above clinics during the study period were enrolled to the study. Data on demographics, medications and blood sugar control were collected using an interviewer-administered questionnaire and perusing medical records. Drug compliance was studied using a self-administered questionnaire. Results: Control of Diabetes and other cardiovascular risk factors 2 years following initiation of oral hypoglycaemic drugs in 421 patients (19.2% male, mean age 58.3±10.4 years) were studied. Even after 2 years of medications, 48.2% were overweight, 34.0% obese and 53.9% were physically inactive. Prevalence of medication use among them were, metformin 96.7%, statins 64.1 % and anti-hypertensives 49.4%. Their mean Fasting Blood Sugar(FBS) was 139±54.3 mg/dl and Body Mass Index(BMI) was 26.5±4.5kgm-2. Poor compliance to medication was found in 60.3%. Sub-optimal risk factor control, FBS >130mg/dl, blood pressure >130/80mmHg, and LDL >100mg/dl were seen in 45.1.%, 19.94% and 16.1%, respectively. Conclusion: Even though majority were started on necessary medicines, FBS control was poor in this rural population. The reasons behind poor FBS control need to be studied and addressed to improve care of patients with diabetes in rural Sri Lanka.Item Statin use in primary prevention of cardiovascular diseases among an urban Sri Lankan cohort of patients with cardiovascular risk factors(Sri Lanka College of Internal Medicine, 2019) Mettananda, K.C.D.; Silva, S.B.K.; Thampoe, R.S.; Batagoda, B.M.S.M.BACKGROUND: Guidelines on statin prescription for primary prevention of cardiovascular diseases (CVD) have changed. However, there is limited data on use of statin in primary prevention among Sri Lankans. OBJECTIVES: We aimed to describe statin use in primary prevention of CVD in relation to 2018 AHA guidelines among an urban Sri Lankan cohort of patients with cardiovascular risk factors. METHODS: All patients without previous CVD but having vascular risk factors attending a follow-up medical clinic of a community surveys of urban Sri Lanka were studied from March 2018-2019. Data were collected using an interviewer administered questionnaire. Patients' 10-year CV risk was calculated using WHO/ISH charts (SEAR B). LDL targets were defined as <70 mg/dl - high risk, <100 mg/dl - intermediate risk and <130mg/dl - low risk patients on AACE 2017 Guidelines. Data were analysed using SPSS-version22. RESULTS: Total of 170 subjects (mean age 66.0±6.70years) were studied and of them 137(80.6%) were females. 129(75.9%), 26(15.3%), 15(8.8%) were at low, intermediate and high risk of CVD respectively. Prevalence of CV risk factors; diabetes mellitus, hypertension and smoking were 80 (47.1%), 114(67.5%), 4(2.4%) respectively. 152(89.4%) were on statins and 110(72.4%) had LDL controlled to target. 87% (70) of diabetics were on statins and 68%.,48) had LDL 190mg/dl were on statins. CONCLUSIONS: Even though statin prescription in primary prevention is satisfactory, a significant proportion has not met the treatment goals in this Sri Lank.an cohort.Item Patient perspectives on barriers to participate in cardiac rehabilitation(Sri Lanka College of Internal Medicine, 2019) Ismail, M.I.M.; Mettananda, K.C.D.BACKGROUND: Despite proven benefits of cardiac rehabilitation (CR), patients' attendance at cardiac rehabilitation program (CRP) is poor at National hospital of Sri Lanka (NHSL). OBJECTIVES: To identify patient perspectives of barriers to participate in cardiac rehabilitation program at NHSL. METHODS: A cross sectional study was conducted at cardiothoracic outpatient clinics of the National Hospital of Sri Lanka from May to July 2019. Post cardiac surgery patients who were referred to CRP but not attending them were studied. Data were collected using an interviewer administrated questionnaire and was analyzed with SPSS-version20. RESULTS: A total of 80 patients not attending CRP (male 41 (51.3%), mean age 59±11.7years, range 29-78 years) were studied. 87.5% of them were married, 46.3% had an income below Rs. 30,000/month, 51(63.7%) had studied up to grade- I 0 and 48(60%) were travelling from more than 50km.28(35%) patients were unaware of them being referred to CRP and its detail while 32(40%) were unaware of benefit of participation in CRP. The main reasons pointed by patients for not participating in CRP were difficulty in attending clinics due to distance and transportation issues 29(36.3%), other co-morbid medical issues 9(11.3%), non-availability of CRP nearby-29(36.3%) and not having proper guidance/advice at discharge-17(21.5%). CONCLUSION: Limited availability of CRP and unsatisfactory education of patients on the importance of CR at discharge following cardiac surgery were the main factors for poor attendance at CRP. Therefore, in cooperating a 'Patient education program' in the cardiac surgery protocol of and establishing new CRP in peripheries need priority to maximize the use of cardiac rehabilitation in Sri Lanka.Item Prevalence of antiplatelet use for primary prevention of cardiovascular diseases and its' justification among an urban Sri Lankan cohort of patients with cardiovascular risk factors(Sri Lanka College of Internal Medicine, 2019) Mettananda, K.C.D.; Silva, S.B.K.; Thampoe, R.S.; Batagoda, B.M.S.M.BACKGROUND: Guidelines on aspirin for primary prevention of cardiovascular diseases (CVD) has changed. There are no data on aspirin use for primary prevention from Sri Lanka or South Asia. OBJECTIVES: We aimed to describe antiplatelet use in primary prevention and its' justification in relation to latest guidelines in a cohort of patients with CV risk factors attending a follow-up medical clinic since 2007 of a community surveys of urban Sri Lanka. METHODS: A descriptive study was conducted of all patients with CV risk factors but without previous CVDs attending the above clinic from March 2018 -March 2019. Data were collected using an interviewer administered questionnaire. Patients' 10-year CV risk was calculated with WHO charts (SEAR B). Data were analyzed using SPSS-version 22. RESULTS: 170(137(80.6%) female, mean age 66.0± (6.70) years) were studied. Prevalence of CV risk factors; diabetes-mellitus, hypertension, hyperlipidemia and smoking were 80(47.1%), 114(67.5%), 150(89.3. %), 4(2.4%) respectively. 24(14.1%) were on antiplatelet for primary prevention. All were on aspirin. Aspirin prescription was justifiable in 4(25.0%) who were 50-69 years and had a 10-year CV risk of more than 10% according to US preventive task force recommendations. However, 7(16.3%) patients aged 70-years or more were on antiplatelet without justification. None of the patients have had serious adverse effects with aspirin. However, 50% had symptoms of gastritis. CONCLUSIONS: Even though antiplatelet use for primary prevention is not common in this cohort of urban Sri Lankans, a significant proportion of elderly were on antiplatelet without justification. Further, half of the patients experienced symptoms related to antiplatelet related side effects.Item 30-year cardiovascular risk prediction of medical undergraduates of university of Kelaniya, Sri Lanka(Sri Lanka College of Internal Medicine, 2019) Mettananda, K.C.D.; Gunarathna, M.R.T.A.; Gunasekara, M.D.S.D.; Gunasekara, P.; Gunasekara, T.N.A.S.; Gunasekara, W.S.M.T.M.; Thampoe, R.S.BACKGROUND: Medical students could be at high risk of cardiovascular diseases (CVDs) due to lack of exercises, increased mental stresses, unhealthy dietary practices. However, there are no reported data on this from Sri Lanka. OBJECTIVE: We aimed to predict 30-year CVD-risk of medical students of University of Kelaniya. METHODS: A cross-sectional study was conducted among medical students of Faculty of Medicine, University of Kelaniya during November 2018. 20 students from each batch were randomly selected. Data were collected using an interviewer administered questionnaire. 30-year risk of General-CVDs were calculated using Framingham 30- year CVD-risk calculator using sex, age, systolic blood pressure, use of antihypertensive medications, smoking, presence of diabetes mellitus and body mass index(BMI). Data was analysed using SPSSversion-22. RESULTS: 100 students (female 59(59%)) aged 21-29 years (mean 24.8 ± 1.8 years) were studied. Cardiovascular risk factor prevalences were; hypertension 1(I%), hyperlipidaemia 2(2%), diabetes mellitus I (I %), smoking 3(3%), overweight 37(37%) and obesity 2(2%). Mean 30-year hard-CVD risk was 2.13% (SD±l .63), mean 30-year general-CVD risk was 4.58% (SD±2.88). Majority (93%) were low-risk, and 7% were at moderate-risk and none were categorised high-risk. Of the moderate risk participants, 5(28.6%) were male (p=0.11), 6(87.7%) (p=0.043) were overweight but none were smokers nor had diabetes mellitus, hypertension or hyperlipidaemia. CONCLUSION: Majority of current medical students of University of Kelaniya e at low risk of future CVD events. The commonest risk factor seen among moderate risk students was being overweight. This emphasize the importance of adhering to healthy lifestyle.Item Caregivers knowledge on "aphasia" based on 'life participation approach to aphasia model; A Sri Lankan experience(Sri Lanka College of Internal Medicine, 2019) Jayarathna, T. V.; Rathnayake, S.; Mettananda, K.C.D.INTRODUCTION: Caregiver knowledge on 'aphasia' is very important in successful rehabilitation of aphasic patients. There are no published data on this from Sri Lanka. OBJECTIVES: We aimed to describe knowledge on aphasia of caregivers caring post-stroke aphasia patients based on 'life participation approach to aphasia (LPAA) model. METHODS: We studied knowledge on aphasia of caregivers caring post-stroke aphasic patients at 3 state sector speech and language therapy clinics of Gampaha district from March to April 2019.Data on language & related impairments and communication & language environment were collected using an interviewer administered questionnaire. Data were analyzed using SPSS version 22. RESULTS: 35 caregivers (male-13 (37.1%), mean age 50.4 ± 16.8) caring aphasia patients for more than 1year were interviewed. All were close relatives of the patients. 77% had studied only up to grade-10. 64.7% knew the primary medical diagnosis and 60% knew the organ involved. However, 68.6% had never heard the term "aphasia". Only 51.4% appreciated aphasia is a language problem. 57% thought it is a memory problem while 14% thought it is a psychiatry problem. Caregivers' knowledge about expressive language was good; 79%, 92%, 96% knew the correct levels of speech, reading and writing skills of patients compared that identified by speech & language therapists (SLT). However, knowledge about comprehensive language was not satisfactory; 88.6% thought their clients can't obey comprehensive commands but it was 42% according to SLTs. CONCLUSION: Knowledge on aphasia of caregivers of this Sri Lankan cohort is not satisfactory. Formal education of caregivers seems a way forward in successful rehabilitation programs.