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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The association between negative experiences during childhood and social anxiety disorder: A cross-sectional study among Sri Lankan university students
(Sri Lanka Medical Association, 2023) de Silva, B.G.R.; De Zoysa, P.T.; Pathmeswaran, A.; Williams, S.S.
INTRODUCTION: Social Anxiety Disorder (SAD) demonstrates early-onset, chronic course, and impairment in all social spheres. OBJECTIVES: The study objective was to explore the association between negative childhood experiences among a university student sample that indicated a high prevalence of SAD. METHODS: A cross-sectional study was conducted among 1137 students from five state universities. The Liebowitz Social Anxiety Scale – Sinhala version, and a correlates questionnaire including a culturally adapted Adverse Childhood Events Questionnaire and contextually appropriate parenting-related questions, were used as instruments. The analysis included chi-square tests for independence, spearman’s r correlations, and binary logistic regressions. RESULTS: Within the sample, 52.2% were female, and 66% were between 21-23 years. All faculties were represented with 27.5% from engineering. 32.2% of participants were first years. Bivariate analyses identified that being an eyewitness towards violence towards mother, feeling unsafe, feeling mistreated by family, experiencing physical abuse, experiencing sexual abuse, experiencing emotional abuse, experiencing parental dissatisfaction, and parental overcontrol to be significantly (p<0.05) associated with SAD. Continuous variables of Parent dissatisfaction (AOR=1.07, 95% CI 1.01-1.13, p<0.05), parent overcontrol (AOR=1.08, 95% CI 1.02-1.15, p<0.01) and experiences of emotional abuse (AOR=1.31, 95%CI 1.11-1.54, p=0.001) remained independently associated with SAD on regression analysis. CONCLUSIONS: Findings from this study corroborate the literature on the association between childhood experiences and parenting-related factors and SAD. The findings also highlight for the first time that Sri Lankan university students are no exception. An urgent need for awareness and prevention of adverse experiences within the family context, and early intervention to prevent the development of SAD are crucial.
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.
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.
Development of size charts of symphysis pubis height measurement for Sri Lankan Population
(Wiley-Blackwell, 2015) Dias, T.; Pathmeswaran, A.; Abeykoon, S.; Gunawardena, C.; Pragasan, G.; Padeniya, T.
INTRODUCTION Fetal growth restriction is responsible for majority of explained and unexplained intrauterine deaths. Screening and diagnosis of fetal growth restriction is one of the main objectives of the antenatal care. Symphysis pubis height measurement (SFH) is routinely measured to assess the fetal growth during antenatal period. Use of SFH charts made elsewhere may either under or overestimate the fetal size in our population. The aim of this study was to construct new size charts for SFH for Sri Lankan population. METHODS This was a prospective, cross-sectional study carried out at the District General Hospital Ampara. In order to increase generalisability 1220 women with normal nutritional and health status and minimal environmental constraints on fetal growth were enrolled during first trimester. Fetal crown–rump length measurement between 11+0 and 13+6 was considered for gestational age assessment in all patients. Each mother considered only once for measurement of SFH for the purpose of this study at gestations between 24 and 41 weeks. SFH was measured using non-elastic, blinded tape using standard technique. For SFH measurement separate regression model was fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived from this mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age. RESULTS A total of 387 mothers had their SFH measured directly. New charts were created for SFH. 10th, 50th and 90th centile values for SFH at 40 weeks are 34, 37 and 41 cm. CONCLUSIONS We have constructed new size chart for SFH. This chart can now be used to assess the fetal size of Sri Lankan population.
Seven–minute neurocognitive test battery: A reliable test for dementia
(Elsevier, Inc. (2020-Wiley), 2006) de Silva, A.; Pathmeswaran, A.; de-Jager, C.; Kuruppuarachi, L.A.
BACKGROUND: The increasing prevalence of Alzheimer’s disease (AD) suggests that there is an increasing need for accurate and easily administered screening instruments to assess cognitive function. OBJECTIVE(S): To examine the reliability of the 7-minute screen as a cognitive screening instrument for AD in a Sri Lankan population. METHODS: 53 patients with mild-moderate AD, 34 with other dementias, 36 with mild cognitive impairment (MCI) referred to a memory clinic, and 60 patients with depression with no evidence of dementia and 56 healthy volunteers (controls) were recruited to the study after informed consent. All were community-dwelling and aged _60 years. Patients with severe dementia, receptive aphasia, visual and motor impairment, and severe depression were excluded. All diagnoses were made according to established criteria and the diagnosis of depression was confirmed after psychiatric evaluation. All subjects underwent cognitive assessment with the Mini Mental State Examination (MMSE) and the 7-minute screen. This screen consists of four components (enhanced cued recall, temporal orientation, verbal fluency, and clock drawing) that assess memory, orientation to time, fluency of expression, and executive function, cognitive functions typically compromised in AD. RESULTS: Baseline characteristics did not differ significantly in the five groups. (see the table). CONCLUSIONS: The 7-minute neurocognitive screen is a highly sensitive instrument to screen for AD and was more reliable than the MMSE to detect AD, MCI, and other dementias in this Sri Lankan population. However, the accuracy of the screen may be confounded by the presence of depression.
Development and validation of a reintegration index to assess the status of reintegration among returnee Middle-East Migrant workers in Kurunegala District
(College of Community Physicians of Sri Lanka, 2021) Wijeratne, P.D.; Pathmeswaran, A.
Background: Reintegration is the least explored phase of the migration cycle. Yet, the reintegration process has a strong influence on the socio-economic and health-related outcomes of returnee migrant workers. The objective of this study was to develop and validate an Index of Reintegration to assess the status of reintegration among returnee Middle-East migrant workers in the Kurunegala District. Methods: A mixed-method consist of qualitative and quantitative approaches were followed for the tool development. In the first-phase primary pool of items was generated following a comprehensive literature review. Further, key informant interviews and Focus Group Discussions were conducted with experts, returnee migrant workers, and their family members to validate and to compliment the developing index. In the second phase, principal component analysis was performed on the collected dataset from a survey involving returnee Middle-East migrant workers(n=232). In the third phase, the constructed tool was evaluated and validated using multiple methods. The tool was tested for reliability. Results: The items and domains of the index demonstrated acceptable validity and reliability (25items, α=0.7). The finalized tool consisted of 25 items distinguished under eight (08) factors: economic self-sufficiency, belongingness, support networks, social adaptation, cultural acceptance, access to health services, physical-psychological distress, etc. and explained 60.1% of the total variance during the factor analysis. Conclusions: Reintegration Index is a reliable and valid tool to measure the status of reintegration of returnee migrant-workers. This tool could be applied for different occupational context returnees in determining socio-economic, migration-related, and health-related factors influencing their reintegration into the home-country.
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.
Carotid artery stenosis in patients with ischaemic stroke in a tertiary care centre: Prevalence and associated factors
(Ceylon College of Physicians, 2019) Ranawaka, U.K.; Mettananda, K.C.D.; Eshani, M.D.P.; Wettasinghe, L.M.; Somaratne, S.; Premadasa, H.M.S.D.; Sirigampola, C.; Upasena, A.; Sathkorala, W.; Pathmeswaran, A.
OBJECTIVES: Data on the prevalence of carotid artery stenosis (CAS) among Sri Lankan stroke patients is limited. We sought to determine the prevalence and associated factors of significant CAS in patients with ischaemic stroke admitted to a Sri Lankan stroke unit. METHODS: We prospectively studied all stroke patients admitted to a stroke unit in a tertiary care hospital over a five-year period. Presence and degree of CAS was evaluated by doppler ultrasonography (US). Degree of CAS was classified as low {<50%), moderate (50-69%), significant (70-99%) or total occlusion (100%) according to NASCET criteria. Factors associated with significant CAS were identified by stepwise multiple logistic regression analysis. RESULTS: Out of 867 stroke patients studied, 704 (81.2%) had ischaemic strokes (59.7% male, mean age 59.0 ± 10.3 years), and 550 (78.1%) of them had carotid doppler data available. 528 (96.0%) had low degree stenosis, 12 (2.2%) had moderate stenosis, 7 (1.3%) had significant stenosis and 3 (0.5%) had total occlusion. Older age was associated with significant CAS (OR 1.14, p=0.011) on stepwise multiple logistic regression analysis. Sex, smoking, BMI, total cholesterol, LDL cholesterol, history of diabetes mellitus, hypertension, hyperlipidemia or ischemic heart disease, and premorbid aspirin or statin use were not associated with significant CAS. CONCLUSIONS: Significant CAS is seen in only 1.8% of Sri Lankan patients with ischaemic stroke at this tertiary care centre. These figures are much lower compared to Western data. Our findings have implications for the use of management approaches such as thrombectomy and carotid endarterectomy in Sri Lankan patients. ACKNOWLEDGEMENTS: EMDP and WLM were supported by a research grant from the National Stroke Association of Sri Lanka.
Usefulness of berg balance scale, six-minute walk test and timed up and go test as fall risk predictors in post stroke adults attending rehabilitation hospital, Ragama
(Journal of the Ceylon College of Physicians, 2020) Bandara, K.M.T.; Pathmeswaran, A.; Ranawaka, U.K.
INTRODUCTION AND OBJECTIVES: Stroke is a major risk factor for falls. However, there are no established practices for predicting fall risk in Sri Lankan stroke care settings. We sought to determine the usefulness of three clinical tests: Berg Balance Scale (BBS), Six Minute Walk Test (6MWT) and Timed Up and Go test (TUG) as fall risk predictors in post stroke individuals and to introduce cut-off values. METHODS: Participants were recruited from the physiotherapy unit, Rehabilitation Hospital, Ragama. History of falls was recorded from patient's interview. Each participant underwent BBS, 6MWT and TUG test. Scores were compared with international cut-off values. Receiver Operating Characteristic (ROC) curves were constructed to describe sensitivity, specificity and predictive values. Optimum cut-off values for fall risk discrimination were determined. RESULTS: We studied 74 stroke patients (mean age 56.5±28.5, males 67.6%) and 17 (23%) had history of falls. There was no significant difference in the baseline characteristics between fallers' and non-fallers. Cut-off values for fall prediction were as follows; BBS < 45, AUC = 0.773, p=0.001; 6MWT < 193 meters, AUC = 0.686, p=0.020; TUG ⪀23s, AUC = 0.662, p=0. 044. CONCLUSION: All three scales were associated with risk of falls. The BBS performed better in predicting fall risk in stroke individuals than TUG and 6MWT. We recommend the use of physical performance tests such as BBS, 6MWT and TUG test to predict fall risk in stroke patients in Sri Lanka.
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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