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 Hepatocellular carcinoma in Sri Lanka: Where do we stand?(Sri Lanka Medical Association, 2013) Siriwardana, R.C.; Liyanage, C.A.H.L.; Jayatunge, D.S.P.; Dassanayaka, A.; Gunetileke, M.G.; Niriella, M.A.; Sirigampola, C.; Upasena, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES:Hepato-cellular carcinoma (HCC) is the sixth commonest cancer worldwide. We studied 105 consecutive patients with HCC in a single tertiary care centre. METHODS: North Colombo Liver Unit maintains a prospective database of HCC since September 2011. There were 105 entries by February 2013. Decision on the best form of treatment was taken at a multidisciplinary meeting. RESULTS: The median age at presentation was 63 years (range 12-79). Patients were predominantly male 93 (87%). Alcohol consumption above the safe limit was reported in 47 (45%). Hepatitis B surface antigen or C antibody was not detected in any of the patients. Background liver cirrhosis was evident in 59 (79%). Forty two (46%) patients had single nodular tumours while in 20 (21%) it was diffusely infiltrating. Portal vein invasion was seen in 22 (20 %). Median alpha-feto protein (AFP) level was 57.25 mg/ml (1.16- 94120 ng/ml; n=72). Twenty four (33%) patients had AFP level > 400u/l. Surgery was performed in 20 (19%), liver transplant in 2 (1.9%), radio frequency ablation or alcohol ablation in 8 (7.6%), trans arterial chemo embolization (TACE) in 44 (41.9%) and sorafmib was prescribed in four patients. Overall mean survival was 15 months. In the ‘no treatment’ group, mean survival was 4 months. Surgery group had a mean survival of 20 months. CONCLUSION: Hepatitis B is not a risk factor for HCC in Sri Lankans. Median survival without treatment is 4 months.Item Assessing liver fibrosis in patients with transfusion dependent beta thalassaemia - a predictive model(Sri Lanka Medical Association, 2021) Padeniya, A.G.P.M.; Ediriweera, D.; de Silva, A.; Niriella, M.A.; Premawardhena, A.P.Introduction and Objectives Liver fibrosis in β-thalassaemia major is mainly due to transfusion-related iron overload. Transient elastography (TE) is an imaging modality which measures liver stiffness/fibrosis non-invasively. TE is simple, safe and efficient. However, inaccessibility and high-cost hinders its routine use. We designed a predictive model to evaluate liver fibrosis using demographic, anthropometric, biochemical and imaging data. Methods Sixteen patients with transfusion dependent beta thalassaemia were recruited to the study. FBC, LFT, serum ferritin and Transient Elastography (TE) and FerriScan measurements were recorded at the baseline and after two years follow up. Multiple regression model was developed to predict liver fibrosis using demographic, anthropometric, biochemical and imaging data. [age, gender, body mass index (BMI), steatosis score, liver iron content, mean pre-Hb over the last year, no of blood transfusions (lifetime), amount of blood ingested over the last year(ml/kg), amount of elemental iron by transfusions over last year(mg/ kg), serum ferritin, SGOT, SGPT and compliance with iron chelation].Results Of 16, 8 (50%) were females, mean (SD) age, BMI and fibrosis scores were 21(4.3) years, 18.8 (2.8) kgm-2 and 9.7(5.7) kPa respectively. Gender, BMI, SGOT, SGPT, compliance, number of transfusions taken lifetime showed significant association with liver fibrosis. The final model showed a coefficient of determination (R2) of 0.859. According to the model, predicted liver fibrosis is given by;-26.18 - 4.38*male+1.01*BMI - 0.11*SGPT+0.32*SGOT+2.78*compliance (rps)+0.04*no. of transfusions. ConclusionThe suggested model is a reliable tool to predict liver fibrosis in transfusion-dependent β-thalassaemia major patients in resource poor settings.Item Prevalence, predictors and outcome of chronic kidney disease in a cohort of aging urban, adult Sri Lankans(Sri Lanka Medical Association, 2021) de Silva, S.T.; Ediriweera, D.D.; Niriella, M.A.; Kasturiratne, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.Introduction and Objectives Chronic kidney disease (CKD) affects 700 million people worldwide. In 2017, deaths due to CKD accounted for 4.6% of mortality globally. Prevalence of CKD is increasing worldwide, with increasing diabetes and hypertension in aging populations. Our objective was to determine prevalence of CKD in an urban, adult cohort, since such data is scarce in Sri Lanka. Methods The study population was selected by stratified random sampling from Ragama MOH area initially in 2007 (aged 35-64 years) and re-assessed in 2014. On both occasions, participants were assessed by structured interview, anthropometric measurements and biochemical tests. CKD was assessed in 2014. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI formula. CKD was defined as eGFR<60ml/min/1.72m2, using KDIGO/KDOQI classification. The cohort was further followed up in 2017 when all-cause and cardiovascular (CV) mortality and CV morbidity were also assessed. Results Of 2985 individuals recruited in 2007, 2148(71.6%) attended follow-up in 2014. 2032/2148 (94.6%) had CKD data [57.0% women, mean age 52.3(SD 7.7) years]. Age adjusted prevalence of CKD was 3.03(1.98–4.11) per 100 population in 2014; 41/61(67.2%) were in CKD Stage-3A, 14/61(23%) in Stage-3B, 6/61(9.8%) in Stage-4 and none in end-stage. Independent predictors of CKD in 2014 were older age (p<0.001), male gender (P<0.05) and presence of diabetes (p<0.001) and hypertension (p<0,001) in 2007. CKD was not associated with all-cause mortality, CV mortality or morbidity (p>0.05) in 2017.Conclusion Diabetes and hypertension were associated with CKD. Most with CKD were in Stage 3, where early recognition and better control of co-morbidities retard progression of CKD.Item Post hepatectomy adjuvant trans-arterial chemotherapy- A pilot study(College of Surgeons of Sri Lanka, 2015) Ekanayake, C.S.; Bandara, L.M.P.M.; Liyanage, C.A.H.; Niriella, M.A.; Dassanayake, A.S.; Siriwardena, R.C.INTRODUCTION: Hepatic micro metastases lead to early recurrence after surgery for hepatocellular carcinoma (HCC). Trans arterial therapy (TAT) without selective embolization may be an effective treatment that induces tumour necrosis. This potential has not been investigated before. This study looks in to the tolerability of TAT in patients after major hepatectomy. MATERIAL AND METHODS: Consented patients were offered trans arterial chemotherapy after normalization of liver functions following surgery. Through the femoral artery, right and left hepatic arteries were selectively cannulated. Doxorubicin 50mg was mixed with 10ml of Lipidol and injected. Post procedure biochemistry and complications were assessed at day 3, 7 and 14 intervals. RESULTS: 11 Patients consented (81% males, median age 61y [range 47y-76y]. There were 7(63.6%) cirrhotics. Four (36.3%) were extended right or left hepatectomies while others were bisegmentectomies. The median time period from surgery to chemotherapy was 25 weeks (range 4-60weeks). Post procedure, 1 (9%) had right hypochondrial pain, 2 (18.1%) had fever, 4(36.3%) had nausea, 2(18.1%) had vomiting within 48 hours. All were discharged at 48 hours. One patient developed a transient bradycardia during procedure. There was no clinical evidence of liver failure. Two patients had three-FOLD rise in transaminase levels at day3 and 7. All recovered by day 14. None of the patients had significant rise in prothrombin time or bilirubin levels. CONCLUSIONS: Post hepatectomy adjuvant trans –arterial chemotherapy is a well-tolerated procedure in the view of short term complications.Item Factors affecting Post- Embolization fever and liver failure after Trans- Arterial Chemo-Embolization in a cohort without background infective hepatitis- A prospective analysis.(College of Surgeons of Sri Lanka, 2015) Bandara, L.M.P.M.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Sirigampala, C.; Upasena, A.; de Silva, H.J.INTRODUCTION: Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC. MATERIAL AND METHODS: Of 290 patients with HCC(July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: post embolization fever(PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI). RESULTS: 84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63(34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions(n=77)] or B; ascites and portal vein invasion was present in 18(16.2%) and 15(13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28(25.2 %), NV 4(3.6%), abdominal pain 9(8.1%), infection 7(6.3%), AHD 13(11.7%), AKI 3(2.7%)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p=0.046) and low serum albumin (p=0.035) predicted PEF while low serum albumin (p=0.021) and low platelet counts (p=0.041) predicted AHD. In the multivariate model, factors with p 5 cm (p=0.049,OR=2.410)and elevated serum bilirubin (p=0.036,OR=1.517) predicted AHD. CONCLUSIONS: In NASH and alcoholic cirrhosis related HCC patients pre- procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5cm with elevated bilirubin predicted AHD post-TACE.Item The Health Effects of the Combined Use of Protein, Multivitamins and Electrolyte Dietary Supplements on Sri Lankan Athletes: A Pilot Study(Sri Lanka Medical Association, 2020) Fernando, P.N.J.; Pigera, S.; Rashani, S.A.N.; Niriella, M.A.; Jayawickreme, S.; de Silva, A.P.INTRODUCTION AND OBJECTIVES: The combine use of protein, multivitamins and electrolyte dietary supplements daily; multiple supplement (MS), is a common practice among Sri Lankan Athletes. The aim of this study was to determine the relative risk for developing adverse health effects from multiple supplements use. METHOD: A Retrospective Cohort, pilot study was conducted with 45 healthy athletes (23 males and 22 females), age between 22-31. Participants were composed of non-supplement users (n=19) and MS users for 2-5 months’ time (n=25). Their lipid, kidney, liver profiles, full blood count, fasting blood glucose, serum testosterone, urine full report and urine protein/creatinine were tested. Food frequency questionnaire was also filled from each athlete. RESULTS: Increase in total cholesterol and LDL cholesterol was significantly higher among multiple supplements users than non-users (P<0.05). Relative risk in increasing total cholesterol between 200-240 mg/dL was 8.7, increasing LDL cholesterol between 160-171 mg/dL was 2.9 and being overweight was 1.3, in MS users compared to non-users. Relative Risk in increasing total cholesterol was 2.9 in female and 7.1 in male while increasing LDL cholesterol was 2.3 in female and 4 in male. There were no statistically significant changes in the other parameters studied. CONCLUSION: Combined use of MS between 2-5 months, has a negative effect on the lipid profile of athletes. More pronounced in male. The clinical implication of this finding needs further study.Item Predictors of mortality in a cohort of adult Sri Lankans(Sri Lanka Medical Association., 2019) Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION & OBJECTIVES: There is limited knowledge on early predictors of mortality among Sri Lankans. We investigated predictors of mortality in the Ragama Health Study cohort 10 years after recruitment. METHODS: The study population (35-64-year-olds selected by age-stratified random sampling from the Ragama Medical Officer of Health area) was initially screened in 2007 for socio-demographic, lifestyle, anthropometric and clinical risk factors with informed written consent. Their vital status was assessed in 2017 and the causes of death of the deceased were retrieved from death certificates available with the next-of-kin or declaration of death records from the hospital where the death occurred. RESULTS: Of the 2986 enrolled in 2007, 169 [Males: 107 (63.3%)] had died over the 10-year period, giving an overall mortality rate of 5.7% (95% CI: 5.0 % - 6.4%). The number of deaths due to cardiovascular and cancer related causes were 73/169 and 31/169, respectively. On multivariate analysis using Cox's proportional hazards model, advancing age, male sex, lower educational level, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of all-cause mortality. Advancing age, male sex, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of cardiovascular mortality, while advancing age and unsafe alcohol consumption were the only independent predictors of cancer-related mortality. CONCLUSION: Unsafe alcohol consumption and the presence of metabolic syndrome were important modifiable risks for mortality in this population. Addressing these risks in early adulthood will help to improve longevity.Item Incidence and predictors of Diabetes Mellitus: A 7- year community cohort follow-up of urban, adult Sri Lankans(Sri Lanka Medical Association., 2019) de Silva, S.T.; Ediriweera, D.; Beddage, T.; Kasturiratne, A.; Niriella, M.A.; de Silva, A.P.; Dassanayake, A.S.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: There is limited data on incidence of type 2 diabetes mellitus (T2DM) from South Asia. We investigated incidence and predictors ofT2DM in an urban, adult population after seven-years of follow-up. METHODS: The study population (42-71 year-olds in 2014, selected by age-stratified random sampling from the Ragama MOH area) was initially screened in 2007 and re-evaluated in 2014 with informed written consent. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. RESULTS: Of the 2986 enrolled in 2007, 737 had established T2DM giving a baseline prevalence of 24.7% (95% CI: 23.1%-26.2%). 2148/2984 (71.6%) of the original cohort attended follow-up [1237 (57.5%) women; median (IQR) 60 (54-66) years]. 1650 participants who did not have T2DM in 2007 presented for follow up; 436 (27.6%) of them had developed new T2DM by 2014, giving an annual incidence of 3.9% (95% CI: 3.0%-4.9%). Of 525 participants with pre-diabetes (HbA1c 5.7-6.4%) in 2007, 364 attended follow up and 201/364 (55.1%) had developed T2DM by 2014, giving an annual conversion rate of pre-diabetes to T2DM of 7.9%. On logistic regression, pre-diabetes (OR:4.4;95%CI:3.3%-6.0%), central obesity (OR: 1.8;95%CI: 1.3%-2.4%), dyslipidemia (OR: l.5;95%CI: 1.1 %-2.1 %) and non-alcoholic fatty liver disease (NAFLD) (OR:1.5;95%CI: 1.1 %-2.1%) showed significant association with incident T2DM. CONCLUSION: In this urban cohort, the annual incidence of T2DM was 3.9% and the annual conversion rate of pre-diabetes to T2DM was 7.9%. Our findings emphasize the need for targeted and intensive lifestyle interventions for individuals with high metabolic risk to prevent T2DM.Item Development of a model for a resource limited setting, to predict the presence of oesophageal varices among newly diagnosed patients with cirrhosis.(Sri Lanka Medical Association., 2019) Perera, K.; Kodisinghe, S.K.; Ediriweera, D.; Moratuwagama, H.M.D.; Williams, S.; Pathmeswaran, A.; Niriella, M.A.; de Silva, H.J.INTRODUCTION & OBJECTIVES: In cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV). UGIE is unavailable in most resource-limited settings. Therefore, we assessed prediction of presence OV using hematological parameters (HP) and Child-Turcott-Pugh (CTP) class. METHODS: A prospective study was carried out on consecutive, consenting, newly-diagnosed patients with cirrhosis, in the University Medical Unit, Colombo North Teaching Hospital, Ragama, from April 20 I 4-April 2016. All patients had UGIE to evaluate presence and degree of OV, prior to appropriate therapy. HP (FBC with indices using automated analyzer and peripheral blood smear using Leishmann stain) and CTP class were assessed. Linear logistic regression model was developed to predict OV using HP and CTP class. RESULTS: 54-patients with cirrhosis were included [14(26%), 24(44%) and 16(30%) belonged to CTP class A, B and C respectively]. 37 had varices [CTP-A 4/14(26.6%), CTP-B 19/24(79.2%), CTP-C 14/16(87.5%)] on UGIE. Generalized linear model fitting showed decreasing percentage of small platelets (%SP) (P=0.002), CTP-B (P=0.003) and CTP-C (P=0.003) compared to CTP-A had higher probability of having OV. The model predicts the log odds for having OV = - 0.189 - (0.046*%SP) + 2.9 [if CTP-B] + 3.7 [if CTP-C]. Based on ROC analysis, a model value >-0.19 was selected as the cutoff point to predict OV with 89%-sensitivity, 76%-specificity, 89% positive predictive value and 76%-negative predictive value. CONCLUSION: We constructed a model using %SP on peripheral blood smear and CTP class. This model can be used to predict the presence of OV, in newly diagnosed patients with cirrhosis, with high sensitivity and specificity, avoiding the need for initial UGIE.Item Prevalence of dyspeptic symptoms and associated lifestyle factors among 3rd-year undergraduates in the University of Kelaniya(Sri Lanka Medical Association, 2019) Jayasinghe, J.A.P.H.; Jayasinghe, J.A.G.K.; Jayasinghe, L.P.; Jayasinghe, J.A.M.P.; Jayasinghe, H.J.M.U.M.H.; Wangmo, D.; Niriella, M.A.INTRODUCTION & OBJECTIVES: Dyspepsia includes epigastric discomfort, bloating and post-prandial fullness/early-satiety. Dyspepsia affects daily activities and quality-of-life. We assessed prevalence and associated lifestyle factor of dyspepsia among undergraduates of University of Kelaniya (UoK). METHODS: A descriptive, cross-sectional study was conducted among 3rd-year undergraduates of following faculties of UoK: Commerce & Management (CM), Humanities, Medicine, Science and Social Science (SS). The participants were selected randomly by stratified-cluster-sampling. Demographic data, presence of dyspepsia (Short Form Leeds Questionnaire), dietary habits, smoking & alcohol use, and sleep (WHO STEPS report) and stress levels (Perceived Stress Scale) were collected suing a self-administered questionnaire. Ethical clearance was granted by the Ethics-Review-Committee of the Faculty of Medicine, UoK. RESULTS: 347 (64-CM, 70-Humanities, 70-Medicine, 73-Science and 70-SS) responded. Overall occurrence of dyspepsia was 45.2% (50%- CM, 51.4%-Humanities, 45.7%-Medicine, 26.0%-Science, 54.3%-SS). Dyspepsia was significantly less among Science undergraduates (p<0.05). On bivariate-analysis, Faculty (other than Science) (p<0.01), consumption of fatty foods (daily) (p<0.05), spicy foods (daily) (p<0.01), vegetables (daily) (p <0.05), sleep (<6 hours) (p<0.05), moderate to high stress level (p<0.001), missing breakfast (p<0.05), skipping meals (daily) (p<0.05) were associated with dyspepsia. There was no association of smoking or alcohol habits with dyspepsia. On multivariate-analysis, spicy food (daily) (p<0.05, OR 1.8), missing breakfast (p<0.01, OR 2.1), sleep <6 hours (p<0.05, OR 1.8) and moderate-high stress level (p<0.001, OR 5.6) were found to be independently associated with dyspepsia. CONCLUSION: 45% of undergraduates of UoK had dyspepsia. Daily consumption of spicy food, missing breakfast, sleep <6 hours, and moderate-high stress level were found to be independently associated dyspepsia.