Conference Papers

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Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study
(Ceylon College of Physicians, 2020) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chackrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.P.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: There are no cardiovascular(CV)-risk prediction models specifically for Sri Lankans. Different risk prediction models not validated among Sri Lankans are being used to predict CV-risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected participants between 40-64 years, by stratified random sampling of the Ragama Medical Officer of Health area in 2007 and followed them up for 10-years. Risk predictions for 10-years were calculated using WHO/ISH (SEAR-B) charts with- and without-cholesterol in 2007. We identified all new-onset cardiovascular events(CVE) from 2007-2017 by interviewing participants and perusing medical-records/death-certificates in 2017. We validated the risk predictions against observed CVEs. RESULTS: Baseline cohort consisted of 2517 participants (males 1132 (45%), mean age 53.7 (SD: 6.7 years). We observed 215 (8.6%) CVEs over 10-years. WHO/ISH (SEAR B) charts with and without-cholesterol predicted 9.3% (235/2517) and 4.2% (106/2517) to be of high CV-risk ≥20%), respectively. Risk predictions of both WHO/ISH (SEAR B) charts with- and without-cholesterol were in agreement in 2033/2517 (80.3%). Risk predictions of WHO/ISH (SEAR B) charts with and with out-cholesterol were in agreement with observed CVE percentages among all except in high risk females predicted by WHO/ISH (SEAR B) chart with-cholesterol (observed risk 15.3% (95% Cl 12.5 - 18.2%) and predicted risk 2::20%). CONCLUSIONS: WHO/ISH (SEAR B) risk charts provide good 10-year CV-risk predictions for Sri Lankans. The predictions of the two charts, with and without-cholesterol, appear to be in agreement but the chart with-cholesterol seems to be more predictive than the chart without-cholesterol. Risk charts are more predictive in males than in females. The predictive accuracy was best when stratified into two categories; low (<20%) and high (≥20%) risk.
Role of dipsticks in diagnosis of urinary tract infection in children: is it accurate enough
(Sri Lanka College of Paediatricians, 2015) Fernando, C.M.P.; Galappaththi, A.G.A.R.; Punchihewa, P.M.G.; Karunaratne, G.K.D.; Warnakulasuriya, D.T.D.
BACKGROUND:Urinary tract infection (UTI) is a common problem in childhood. Urine culture is the Gold standard for diagnosis. Dipstick tests for leucocyte esterase reaction (LE) and nitrites (N) are bedside tests useful in the diagnosis of UTI. Accuracy of above tests have been extensively investigated in other countries. No published data is available from Sri Lankan children up to date.OBJECTIVES:To study the diagnostic accuracy of dipstick tests in diagnosis of UTI in Sri Lankan children.DESIGN, SETTING AND METHOD:Descriptive, cross sectional study was conducted in a medical ward at Lady Ridgeway Hospital for Children. 300 children less than 12 years, clinically suspected of UTI were recruited. Dipstick tests (LE and N) and urine culture were performed.RESULTS:Of the 300 children, 118 (39.3%) had positive cultures (pure growth of bacteria >105 cfu/ml), 16 (54%) had negative cultures and 20 (6.7%) had mixed growth. Cultures with mixed growths were excluded and remaining 280 were analyzed. Mean age of the participants was 49 months (SD 41.3), 148 (53%) being males.Accuracy of dipsticks tests (LE and N) in detecting UTI was as follows. LE and N in combination had a sensitivity of 97.5%, specificity of 77.2%, positive predictive value (PPV) of 75.6% and negative predictive value (NPV) of 97.6%. LE alone showed a sensitivity of 96.6% specificity of 77.7%, PPV of 76% and NPV of 96.9%. Corresponding values for N alone were 78.8%, of 97.5%, 95.8% and 86.3% respectively.CONCLUSIONS:Leucocyte esterase reaction and nitrite test in combination showed promising results to detect UTI in children. LE was more sensitive and N was more specific.
Ultrasonographic parameters of the liver, spleen and kidneys among a cohort of school children in the Gampaha district
(Sri lanka Medical Association, 2015) Warnakulasuriya, D.T.D.; Peries, P.P.U.C.; Rathnasekara, Y.A.C.; Jayawardena, K.A.T.M.; Upasena, A.P.
INTRODUCTION AND OBJECTIVES: Liver, spleen and kidney dimensions on uitrasonography vary with age, weight and ethnicity. Reference standards for these parameters in normal Sri Lankan children are not available. Our objective was to establish normative data for the longitudinal length of the liver, spleen and kidneys in healthy children living in the Gampaha District. METHOD: A total of 357 children between the ages of 5 to 12 years were selected from two randomly selected schools in the Gampaha District. A questionnaire was administered to the parents after obtaining informed written consent. Participants were screened for risk factors for organomegaly and were examined by a medical officer. Ultrasonographic assessment was done using a high resolution real-time scanner with a 3.5MHz convex transducer by a trained medical officer. Children with abnormalities in the Ultrasonographic appearance of organs were excluded. RESULTS: The study comprised 332 children (176 girls, 53%). There was no difference in organ dimensions between the two genders (p > 0.05). Body weight showed the best correlation with liver, spleen and kidney dimensions. Age significantly correlated with the longitudinal length of the liver and height significantly correlated with spleen length. Percentile graphs for the longitudinal length of the liver, spleen, right and left kidneys were developed in relation to body weight.

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