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 Prevalence of chronic kidney disease and associations among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke,W.A.N.V; Ediriweera, D.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Chronic kidney disease is a major non communicable disease in Sri Lanka with a rising prevalence. We studied the prevalence and associations of chronic kidney disease among patients with hypertension in a rural Sri Lankan population. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults with hypertension were investigated with serum creatinine, urine albumin creatinine ratio and eGFR. Socio-demographic and anthropometric data was obtained as well. RESULTS: Total of798 hypertensive patients (546 females and 252 males) were included in the study. 383 (48.7%, 95% CI: 45.2% - 54.0%) had proteinuria .486 (61.I %, 95% CI: 57.7% - 64.5%) of them had stage III or advanced CKD among which 241 had proteinuria. 618 (78.7%, 95% CI: 75.9% - 81.6%) showed either eGFR<60ml/min/l.73m2 or proteinuria. Advancing age (p<0.01), female gender (p<0.01) and raised LDL levels (p=0.01) were significantly associated with CKD.CONCLUSION: Prevalence of CKD is high in this rural hypertensive adult cohort. A significant proportion had non protienuric CKD. It may be justifiable to assess renal functions of all patients with hypertension to establish an early diagnosis of CKD to prevent complications. Considering the very high prevalence, community screening for CKD can be recommended in this populationItem Prevalence and patterns of dyslipidaemia among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke, W.A.N.V.; Ediriweera, N.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Dyslipidaemia and hypertension are major risk factors for cardiovascular disease. Data on prevalence and patterns of dyslipidaemia in rural settings of Sri Lanka are limited. We conducted a study to determine the prevalence of dyslipidaemia among hypertensive adults over 40 years of age in the Puttalam district. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Socio-demographic data were obtained from adult hypertensive and basic investigations were carried out. RESULTS: Total of 798 hypertensive patients (546 females and 252 males) were included in the study. Median (Interquartile range) levels of total cholesterol, HDL, LDL and TG of the patients were 205 (173 - 238), 55 (48 - 63), 125 (96 - 155), 109 (85 - 143) respectively. Elevated levels of total cholesterol, LDL, TG and non HDL were reported in 192 (24. %), 371(46.4%), 173 (21.6%) and 527 (66%) respectively and low HDL was observed among 40 (5%) patients. High non HDL cholesterol was associated with female gender (P=0.03) and advancing age showed a negative association (P<0.01). CONCLUSION: Prevalence of dyslipidaemia is high in this hypertensive adult cohort. Suboptimal level of modifiable risk factor control is observed in this population which should be addressed to further reduce cardiovascular morbidity and mortalityItem Prevalence of hypertension in a rural district of Sri Lanka(Sri Lanka Medical Association, 2017) Luke, W.A.N.V.; Ediriweera, D.S.; de Silva, K.C.; Balasooriya, E.R.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION & OBJECTIVES: Hypertension is a leading cause of cardiovascular morbidity and mortality. Data on prevalence of hypertension in rural settings of Sri Lanka is limited. We conducted a study to determine the prevalence of hypertension among adults over 40 years of age in the Puttalam district.METHODS: A community-based prevalence study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults over 40 years of age living in consecutive households were screened by trained research assistants using digital blood pressure (BP) meters. Basic demographic data were obtained using an intervieweradministered questionnaire. Previously undiagnosed adults with persistent elevation of BP (SBP > 140 and /or DBP > 90 mmHg on two readings) and those already on treatment for hypertension were identified. RESULTS: A total of 2289 were screened. The mean (SD) of SBP and DBP were 134.5(21.3) and 82.1 (13.5) mmHg respectively. The overall hypertension prevalence was 458.5 (95% CI 438.1– 478.8) per 1000 population. 16.3% were newly diagnosed. Prevalence of uncontrolled hypertension among those on treatment was 516.2 (95% CI 479.4–552.9) per 1000. 98.7 (95% CI 86.6–110.9) per 1000 had blood pressure >160/110 mmHg. There was an increasing trend in blood pressure with increasing age (OR=1.07, 95% CI 1.06–1.08, p<0.01) but not with the male sex. CONCLUSION: Prevalence of hypertension is high in this rural adult cohort. Previously undetected hypertension and uncontrolled hypertension among those already on treatment are common. Community-based approaches targeting screening and BP control are essential to reduce adverse outcomes of hypertension.Item A Composite symptom score using frequency and severity correlates better to an objective measure of Gastro-Oesophageal Reflux Disease (GERD) than one scoring frequency of symptoms alone(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2008) Amarasiri, L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, H.J.INTRODUCTION: The prevalence of GERD is increasing. Community prevalence in Sri Lanka is unknown. There is lack of a practical screening instrument to use in an epidemiological setting. OBJECTIVE : To develop a practical clinical score to screen for GERD in the community and assess whether a score using both symptom frequency and severity correlated better with an objective measure of GERD than one using only symptom frequency. METHODOLOGY: A cross-sectional validity study was performed in 100 GERD patients and 150 healthy controls comparable in age and gender. Ethical clearance was granted. GERD was diagnosed by upper gastro-intestinal endoscopy, including patients with all grades of oesophagitis. All subjects faced a GERD-specific interviewer-administered questionnaire with seven upper gastro-intestinal symptoms (heartburn, acid regurgitation, chest/abdominal pain, abdominal distension, dysphagia, cough, belching). Each symptom was graded using a 5-item Likert scale for frequency (never, monthly, 2-4 times per week, weekly, daily) and a 4-item scale for severity (no effect, mild, moderate, severe) and two scores generated. Score 1 being the sum of frequency of symptoms while score 2 was the sum of products of frequency and severity of each symptom. All GERD patients underwent 24h ambulatory pH monitoring. Face and content validity were assessed by expert consultation and literature review, internal consistency by Cronbach alpha statistics, reliability by intra class correlation coefficient estimation and concurrent validity by comparison of scores with 24 hour pH monitoring values as the gold standard. Cut-off values were determined by constructing receiver-operating characteristic curves. RESULTS: For both scores, mean scores of cases were significantly higher than controls (p<0.001) Cut-off score for score 1 was ≥ 10.50 (sensitivity 92.0%; specificity 78.7%; area under the curve 0.937 respectively). Cut-off score for score 2 was ≥ 12.50 (sensitivity 90.0%; specificity 78.0%; area under the curve 0.929 respectively). Intra class correlation coefficient for score 1 and 2 were 0.94 and 0.82 respectively. There was good correlation between both symptom scores and 24-h pH metry parameters (Spearman rank correlation, p=0.01), but score 2 showed a significantly better correlation (correlation of Total reflux time pH<4 with score 1 and score 2 was 0.491 and 0.651; p=0.001, and of Demeester score with score 1 and score 1 was 0.590 and 0.747; p<0.001). CONCLUSION: Our GERD questionnaire is valid, reliable and showed better correlation with an objective test when both severity and frequency of symptoms were scored rather than frequency of symptoms alone.Item The Prevalence of reflux oesophagitis in adult asthmatics(Wiley- Blackwell, 2009) Amarasiri, L.; Ranasinha, C.D.; de Silva, H.J.BACKGROUND/PURPOSE: Asthma and gastro-oesophageal reflux disease are known to be associated. The severity of asthma is related to the degree of reflux. This relationship has been little studied in South Asia. METHODS: Thirty asthmatics underwent a reflux symptom assessment using a validated questionnaire assessing 7 upper gastro-intestinal (UGI) symptoms graded on a 5-point Likert scale (Amarasiri LD 2009). They further underwent UGI endoscopy. RESULTS: All asthmatics had mild stable asthma. 20 of the 30 asthmatics had apositive GORD symptom score. 27 asthmatics consented to UGI endoscopy. The grade of oesophagitis was classified using Savary Miller criteria. 10 of the 27 asthmatics had evidence of mucosal damage (see Table 1). There was no correlation between the grade of oesophagitis and the GORD score (r = 0.025; P = 0.896, Spearman Rank correlation). CONCLUSIONS: The prevalence of reflux oesophagitis in asthmatics was 37%. There was no association of severity of oesophagitis with symptoms. Both these findings are consistent with the global data, but have not previously been described in a South Asian population.Item The role of reflux in the genesis of respiratory symptoms in a cohort of adult asthmatics in Sri Lanka(Wiley-Blackwell, 2010) Amarasiri, L.; Ranasinha, C.D.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION: The oesophagus and airways have a common origin. Reflux related respiratory symptoms may be triggered by aspiration of gastric refluxate into airways or a vagally mediated oesophago-tracheo-bronchial. This association has not been reported previously in Sri Lanka. The aim of this study was to describe the association between gastro-oesophageal reflux (GOR) events and respiratory symptoms in a cohort of adult asthmatics in Sri Lanka. METHODS: Thirty stable, mild asthmatics (American Thoracic Society criteria) underwent dual-sensor ambulatory oesophageal pH monitoring. Respiratory symptoms (cough, wheeze, difficult breathing, chest tightness) during monitoring were recorded and correlated with reflux events. RESULTS: Both proximal and distal GOR parameters were significantly higher in asthmatics than controls (P < 0.050; Mann–Whitney U-test). However, there was no difference in any parameter between asthmatics with and without respiratory symptoms. Abnormal proximal acid reflux was documented in 66.7% and distal reflux in 73.3% of 30 asthmatics. Of 102 respiratory symptoms in all asthmatics, majority (72%) were cough episodes. In total, 93% of coughs, 81% of wheeze and all of chest tightness was reflux-associated, where in most, reflux events preceded respiratory symptoms. Of 15 asthmatics with respiratory symptoms, acid exposure was normal in 4 (26%), abnormally high in proximal oesophagus in 9 (60%) and abnormally high in the distal oesophagus in 11 (73%) and abnormal at both levels in 8 (53%). Most reflux events in asthmatics occurred in the upright position. CONCLUSION: Asthmatics have more GOR and associated respiratory symptoms than non-asthmatic volunteers, with reflux episodes preceding respiratory symptoms in most cases. Distal GOR and upright acid exposure was more prominent than proximal GOR.Item Management of yellow oleander poisoning (YOP) with multiple-dose activated charcoal: a randomized placebo controlled trial(Sri Lanka Medical Association, 2003) de Silva, H.A.; Fonseka, M.M.D.; Pathmeswaran, A.; Alahakone, D.G.S.; Ratnatilake, G.A.; Gunatilake, S.B.; Ranasinha, C.D.; Lalloo, D.G.; Aronson, J.K.; de Silva, H.J.Abstract AvailableItem An audit of fibre-optic bronchoscopy in a general hospital in sri lanka(Sri Lanka Medical Association, 2002) Ranasinha, C.D.; Tillekaratne, Y.INTRODUCTION: In managing respiratory disease the indications for fibre-optic bronchoscopy (FOB) are many and arise not only from abnormal radiographic appearances but also from respiratory symptoms alone. A FOB service was established in the University Medical Unit of the Colombo North Teaching Hospital, Ragama, in February 2001. OBJECTIVES AND DESIGN: A prospective database was begun at inception to follow patient outcomes. The primary end point was the number of patients in whom FOB changed management. Data were collected to follow patterns of referral, indications, bronchoscopic findings, diagnostic procedures and outcome for all patients referred to the service. RESULTS: 54 patients (42 male) were bronchoscoped in the first 8 months of the service (1 refusal of consent). All were in-patients. Most referrals were made by physicians (49/55). The indication in 54/55 cases was an abnormal chest radiograph in addition to clinical features. 11/54 had normal FOB examinations. In 6 cases bronchogenic tumour was seen. 37 cases had inflammatory changes: with blood in 22 (excluding those with tumour) and muco-purulent secretions in 16 (both features in 12 cases). Diagnostic procedures were carried out in all but 4 cases: bronchial wash for microbiology in 36 cases, cytology 32 (both in 18) and endobronchial biopsy 10. OUTCOME: From 54 bronchoscopies, 6 cases of bronchial malignancy were confirmed by pathology (4 biopsy, 2 cytology) and 18 cases of tuberculosis were confirmed by Ziehl-Neelson staining of aspirate. CONCLUSIONS: Overall, FOB enabled a definitive on-site pathological diagnosis to be reached in 24 cases (44%), reducing the need for patient transfer.Item Alcohol consumption and tobacco smoking in an urban adult Sri Lankan population(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Pinidiyapathirage, M.J.; Perera, H.K.K.; Fernando, E.D.P.S.; Ranasinha, C.D.; Edirisinghe, P.A.S.; Makaya, M.; Kato, N.BACKGROUND: Data on the prevalence and patterns of alcohol consumption and smoking in the general population in Sri Lanka are scarce. Objective: To describe patterns of alcohol use and smoking in an urban adult population in Sri Lanka. DESIGN, SETTING AND METHODS: A random sample of the general population aged between 35-65 years, resident in the Ragama Medical Officer of Health area was interviewed to obtain drinking and smoking habits. RESULTS: Among 2985 subjects [males 45.5%; mean age 52.7 years (SD7.8)], 1156(39.7%) reported ever use of alcohol, and 892(29.7%) reported current use. 58.8% of males and 5.7% of females were current drinkers. 190(14%) males and 12(0.7%) females consumed alcohol above the weekly safe limit (>14 units for males, >7 units for females). The median duration of alcohol use among ever users was 18 years (interquartile range 10-25), and current users was 20 years (interquartile range 1,0-25). The commonest type of alcohol consumed was arrack (n=492), followed by beer (n=217). 60.2% of males and 2.1% of females reported ever smoking, 483(16.2%) were current smokers. 35.1% of males and 0.5% of females were current smokers. The median duration of smoking was 20 years among both ever smokers (interquartile range 10-27.3), and current smokers (interquartile range 15-30). Most (55.3%) smoked cigarettes, only 36(4.2%) smoked beedi. The median pack years of current smokers was 4,5 (interquartile range 2-10). CONCLUSION: Lifetime and current use of alcohol and smoking are high among males. Focused interventions are required to reduce current rates among males and to maintain low rates reported by females.Item Oesophageal dysfunction in asthmatics(Sri Lanka Medical Association, 2010) Amarasiri, W.A.D.L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, H.J.INTRODUCTION: Gastro-oesophageal reflux (GOR) predisposes to respiratory symptoms through reflex vagal activity. Asthmatics have oesophageal hypomotility and vagal hyperactivity. Whether this oesophageal hypomotility is primary or secondary to damage from GOR is unclear. METHODS: 30 mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory oesophageal pH monitoring, manometry, autonomic function testing and GORD symptom assessment and gastroscopy. A vagal score using 3 tests (valsalva manouvre, heart rate response to deep breathing and to standing from supine position) was correlated with oesophageal function parameters. Respiratory symptoms during pH monitoring were correlated with reflux events. RESULTS: Asthmatics (mean age 34,8y; 60% female) had more frequent GORD symptoms than controls (mean age 30.9y; 50% female). 10/27 asthmatics had oesophageal mucosal damage, 22/30 showed hypervagal response, none had a hyperadrenergic response. 14/30 asthmatics had ineffective oesophageal motility. Higher GOR-score asthmatics had significantly fewer peristaltic contractions and more simultaneous contractions than controls, and higher oesophageal.acid contact times than those with lower scores. All reflux parameters were significantly higher and acid clearance time prolonged in asthmatics than controls. There was no correlation of vagal function with oesophageal function parameters. 50% of the asthmatics complained of respiratory symptoms during pH monitoring, and reflux episodes usually preceded respiratory symptoms. CONCLUSION: Asthmatics have abnormal oesophageal motility and pathological GOR which usually precede respiratory symptoms. There was no vagal dysfunction, and the vagal function score did not correlate with oesophageal motility parameters. Peristaltic dysfunction may be secondary to damage due to gastro-oesophageal reflux.