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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Author: search.filters.author.Wickremasinghe, R.

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    Chemoprophylaxis for malaria: A costly approach to prevent re-establishment of malaria in Sri Lanka
    (Sri Lanka Medical Association, 2021) Muzrif, M.M.; Mendis, K.N.; Weerasekera, C.J.; Karunaratna, S.; Wickremasinghe, R.; Ranaweera, K.D.N.P.; Fernando, S.D.
    Introduction and Objectives As a measure to prevent the re-establishment of malaria in the country, the Anti Malaria Campaign (AMC) provides antimalarial chemoprophylactic medicines for up to six months free-of-charge to anyone travelling to malaria endemic countries. The objective of this study was to identify the trends of chemoprophylaxis prescription by the AMC and the costs involved. Methods Data were extracted from the national malaria database regarding the number of travellers issued with antimalarial chemoprophylactic medicines during the years 2017-2019. The amount spent for purchase of antimalarial chemoprophylactic medicines was determined. Results Over the three year period the overall number of individuals issued with antimalarial chemoprophylaxis increased (1714 in 2017, 2600 in 2018 and 3053 in 2019). The number of travellers obtaining chemoprophylaxis for malaria when travelling to African countries reduced, while the number travelling to India increased. The cost incurred to the Government of Sri Lanka to purchase mefloquine and doxycycline for prophylaxis was USD 45,755, while the cost to purchase CQ over the three year period for prophylaxis alone was USD 310,714. The total cost incurred to purchase the prophylactic antimalarials have also increased significantly over the three year period, the cost being eleven times higher in 2019 than in 2017. Conclusion Chemoprophylaxis against malaria remains an important strategy to sustain the malaria elimination status in Sri Lanka, and the cost of this intervention is considerable and increasing over time. The local production of anti malarials might be warranted if it will reduce the cost of chemoprophylaxis.
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    Screening for risk of obstructive sleep apnoea - results of an island wide survey in Sri Lanka
    (Journal of the Ceylon College of Physicians, 2019) Undugodage, C.; Amarasiri, L.; Kamalanathan, M.; Gunasinghe, W.; Sadikeen, A.; Fernando, A.; Wickremasinghe, R.; Gunasekera, K.
    INTRODUCTION: Obstructive sleep apnoea (OSA) is the commonest sleep related breathing disorder worldwide, but there is only limited community level data on the risk of OSA from South Asian countries. AIMS AND OBJECTIVES: This study assessed the community prevalence of persons at high-risk for OSA among Sri Lankan adults. METHODS: A randomly selected sample of adults from 7 (out of 9) provinces of Sri Lanka was screened using the Berlin Questionnaire (BQ). BQ has 3 categories related to snoring severity (category 1), excessive day time somnolence (category 2) and history of hypertension or obesity (category 3). Individuals were classified as high or low risk according to the category score. RESULTS: One thousand six hundred and eight adults (46.2% male) were screened, and 270 were classified as high risk for OSA {16.8%; 95% Cl 14.9 %-18.6% (15.1% in males; 18.3% in females, p >0.05)}. Of the high-risk individuals, 239 (88.5%) were category 1 positive, 142 (52.6%) category 2 positive and 202 (74.8%) category 3 positive. 49/577 (8.5%) among persons = or <40 years and 221/ 1031 (21.4%) among those >40 years were at high risk. 10.3% of the adults had a BMI ≥30 (5.7% of males, 14% of females p<0.001). Snoring was reported by 573 (35.6%) individuals; 120 of them (20.9%) had apneas during sleep. CONCLUSION: The prevalence of high risk for OSA in this Sri Lankan community survey is lower than that reported from Western countries and did not show a gender-related difference.
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    Work related musculoskeletal disorders among garment workers in South Asia: A systematic review
    (Sri Lanka Medical Association., 2019) Dissanayake, L.; Abhayasinghe, K.; Helliwell, T.; Corp, N.; Babatunde, O.; Sumathipaka, A.; Wickremasinghe, R.
    INTRODUCTION & OBJECTIVES: Work-related Musculoskeletal Disorders (WMSDs) are considered one of the central occupational health problems in both developed and developing countries. Localised pain, swelling, and discomfort in the affected area are the commonest symptoms. Aim of this systematic review was to estimate the burden of WMSDs among garment workers in South Asian countries. METHODS: The protocol and search strategy were registered with PROSPERO [CRD 42018089638]. 15 electronic databases, and 4 grey literature sources were searched. Reference lists of selected articles and two academic search engines were used to find any missing articles. Studies in English language focusing on garment workers of South Asia were included, irrespective of the type and date of publication. Joanna Briggs critical appraisal tools were used for quality assessment. RESULTS: 2534 studies were identified. Following screening and assessing eligibility, 45 journal articles and 5 theses from India, Bangladesh, Nepal, Pakistan and Sri Lanka were included. 43 descriptive cross-sectional studies had sample sizes ranging from 20 — 1 191, reported age ranging from 16 — 62 years and the overall prevalence of WMSDs among garment workers between 15.5% - 92%. Twenty-five studies reported neck pain [1% - 91%], and low back pain [6.2% - 90%] was reported by twenty-nine studies. Thirty-six studies identified pain as the most common symptom. Static work posture, long working hours, and low job satisfaction were main contributing factors. Nordic Musculoskeletal Questionnaire was the most used instrument. CONCLUSION: Burden of WMSDs among garment workers in South Asia is high. There may be opportunities to intervene and minimize WMSDs based on identified factors.
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    Relationship between objectively measured physical activity, sedentary behaviour and body mass index among 11-13 year-old adolescents in Colombo
    (Sri Lanka Medical Association., 2019) Dabare, H.P.M.; Waidyatilaka, P.H.I.U.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Jayawardena, R.; Hills, A.P.; Lanerolle, P.; Wickramasinghe, V.P.
    INTRODUCTION & OBJECTIVES: Inadequate physical activity (PA) and sedentary behaviour (SB) are attributed to the high prevalence of adolescent obesity in the world. This study aimed to identify the relationship between PA intensity, SB and body mass index (BMI) among I I -13 year-old adolescents in Colombo, Sri Lanka. METHODS: A purposive sample of 95 adolescent school girls and boys were recruited from the Colombo Municipal Council Area. Time spent on moderate-to-vigorous PA (MVPA) and SB were determined by accelerometers (Actigraph-WGT3X-BT) worn on the waist for 10 consecutive days. Height and weight were measured using the standard methodology and BMI was calculated. RESULTS: The sample consisted of 51.6 % of boys (n=49). Mean BMI of the boys was 17.2 ± 3.2 kgm-2 and girls was 17.2 ± 3.2 kgm-2. A significantly (p< 0.05) lower SB (487.4 ± 101.4 min/day vs. 596.4 ± 83.8 min/day) and a significantly higher time spent on MVPA (31.8 ± 15.1 min/day vs. 15 ± 6.7 min/day) were observed among normal weight (NW) girls compared to overweight (OW) girls. Similarly, compared to the OW boys, NW boys had a significantly (p< 0.05) lower SB (578.5 ± 94.1 min/day vs. 696.4 ± 87.4 min/day) and a significantly higher time spent in MVPA (52.9 ± 19.3 min/day vs. 23.4 ± 6.3 min/day). CONCLUSION: Effective strategies should be implemented to reduce SB and increase PA in order to correct the obsogenic behaviour among the adolescents.
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    Introduction of Recombinase Polymerase Amplification assay based mobile suitcase laboratory as a point of need tool to diagnose cutaneous leishmaniasis in Sri Lanka
    (Sri Lanka Medical Association, 2018) Gunaratna, G.P.S.; Ranasinghe, P. H. K. I. S.; Manamperi, A.; Pathirana, N.; Pathirana, H.; Wickremasinghe, R.; de Silva, N.R.; Sooriyarachchi, M.; Ahmed, A.E.W.
    INTRODUCTION AND OBJECTIVES: Cutaneous leishmaniasis (CL) caused by the vector-borne protozoan parasite is now endemic in Sri Lanka. Microscopy of Giemsa stained slit skin smears (SSS), lesion aspirates or scrapings for the presence of amastigotes, is widely used for laboratory confirmation of CL, although the reported sensitivity is low. Facilities for more sensitive culture and molecular techniques are available only in reference laboratories. A newly developed, Recombinase Polymerase Amplification (RPA) assay based Mobile Suitcase Laboratory (MSL) is a promising, molecular point of care test with high sensitivity and specificity for diagnosis of both post-kala• azar dermal leishmaniasis and visceral leishmaniasis. Objective was to assess RPA based MSL as a point of need tool to diagnose CL in Sri Lanka.METHODS: Twenty seven army personnel at Mullaitivu Army camp clinically suspected of having CL were recruited for this pilot study. Two slit skin smears and two punch biopsy specimens were obtained from each of them. Slit skin smears were stained with Giemsa in the field and examined for the presence of amastigotes and RPA was carried out at the point of collection. PCR was performed at the Parasitology Department, Sri Jayewardenepura University. RESULTS: Fifteen patients were confirmed by PCR as having CL and 14 of them were also positive by RPA based MSL conducted in the field (93.33% sensitivity). Only 3/15 were positive with microscopy of SSS (20% sensitivity). CONCLUSION: This pilot study shows RPA based MSL as a promising tool to diagnose CL at point of need.
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    Relationship between physical activity, sedentary behaviour and body composition among 11-13 year-old adolescent girls in Colombo
    (Sri Lanka Medical Association, 2018) Dabare, H. P. M.; Waidyatilaka, P.H.I.U.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Jayawardena, R.; Hills, A.P.; Lanerolle, P.; Wickremasinghe, V.P.
    INTRODUCTION AND OBJECTIVES: Physical activity (PA) is essential in reducing the risk of obesity. This study aimed to identify the relationship between the intensity of PA and body composition among 11-13 year-old adolescent girls from Colombo, Sri Lanka. METHODS: This is part of a larger study. A purposive sample of 46 adolescent school girls were recruited from the Colombo Municipal Council area. Time spent on light (LPA), moderate (MPA), vigorous (VPA), moderate-to• vigorous (MVPA) PA and sedentary behaviour were determined by waist-worn accelerometers (Actigraph• WGT3X-BT). Deuterium dilution (gold standard) was used with Fourier Transform Infrared (Agilent 4500®) spectroscopy to assess fat mass (FM) and fat-free mass. The% FM cut-off of 33.7% for Sri Lankan children was used to categorize the sample into high fat (HF) and normal fat (NF) groups. RESULTS: The mean age was 12.3 ± 1 year. %FM was significantly correlated with sedentary behaviour (r = 0.65, p < 0.001) and negatively correlated with'Mvf'A duration (r = -0.4, p < 0.01). Time spent on VPA (15.8 ± 6.7 min/day vs. 7.6 ± 3.2 min/day) and MVPA (33.9 ± 13.3 min/da vs. 15.5 ± 7.5 min/day) were significantly (p <0.01) higher among the NF group compared to the HF group. The NF group had significantly (p < 0.01) lower sedentary behaviour (379.7 ± 135 min/day vs. 622.7 ± 105.3 min/day) compared to the HF group. CONCLUSION: %FM was higher among the adolescent girls who spent more time in sedentary behaviours and among those who spent less time engaged in MVPA
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    Perceived travel constraints of older people and people with disabilities in the Colombo district: A qualitative research study
    (Sri Lanka Medical Association, 2018) Thennakoon, V.; Peiris-John, R.; Wickremasinghe, R.; Amerathunga, S.
    INTRODUCTION AND OBJECTIVES: Supportive transport systems allow people to maintain quality of life and meaningful participation in the society. Risks for safe transportation for vulnerable road users such as older people and people with disabilities affect their health and well-being. This study explored perceived risks relating to road safety and challenges for safe transportation among older people and people with disabilities in the Colombo district. METHODS: The community-based qualitative research study involved eight focus group discussions conducted older people (60 years and above) and disabled people (physical, sensory, learning impairment; 12 years and above). Transcribed discussions were coded thematically using NVivo 11. RESULTS: The transport challenges perceived by participants included poor road infrastructure, lack of disability-friendly transport services, negative attitudes of people, psycho-social factors and lack of opportunities to voice transport challenges. Suggestions for mitigating perceived risks included improved infrastructure facilities and user-friendly services, awareness programs for service providers and public, greater visibility of these groups in policy frameworks and effective law enforcement. CONCLUSION: The travel experiences of older people and people with disabilities indicated the need for improved road engineering designs, age-and disability- friendly transport modes and rigorous legislative enforcement. To ensure equitable opportunities and well-being of older people and people with disabilities, it is also imperative to foster meaningful relationships and positive societal attitudes towards them.
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    Incidence and predictors of metabolic syndrome among urban, adult Sri Lankans: a community cohort, 7-year follow-up study
    (European Association for the Study of Diabetes, 2017) de Silva, S.T.; Niriella, M.A.; Kasturiratne, A.; Kottahachchi, D.; Ranawaka, U.K.; Dassanayake, A.; de Silva, A.P.; Pathmeswaran, P.; Wickremasinghe, R.; Kato, N.; de Silva, H.J.
    BACKGROUND AND AIMS In 2007, we reported a 38.9% prevalence of metabolic syndrome (MetS) in an urban, adult population. Published data on incident MetS from South Asia is lacking. This study investigated the incidence and risk factors for MetS after a 7-year follow-up of the initial cohort. MATERIALS AND METHODS: The study population (selected by age-stratified random sampling from the Ragama MOH area) was screened in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions, structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests were performed. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Total body fat (TBF) and visceral fat percentage (VFP) were measured in 2014, using impedance. Abnormal TBF was defined as >32% for females and >25% for males. Abnormal VFP was defined as >10% for both sexes. Non-alcoholic fatty liver disease (NAFLD) was diagnosed on established ultrasound criteria, safe alcohol consumption (Asian standards: <14 units/week for men, <7 units/week for women) and absence of hepatitis B and C markers. RESULTS: 2137/2967 (72.0%) of the initial cohort attended follow-up [1229 (57.5%) women; mean-age 52.4 (SD-7.7) years]. 1000/2137 [548 (54.8%) women; mean age 57.5 years (SD-7.74)] had MetS (prevalence-46.8%). Out of 1246 individuals who initially did not have MetS in 2007, 318 [225 (70.8%) women; mean age 57.5 (SD 7.7) years] had developed incident MetS after 7 years (annual incidence-2.13%). Comparison of incident MetS with those with no MetS in 2014 is shown in Table 1. On logistic regression, female sex (OR 3.6, p<0.001), central obesity [OR 4.58, p<0.001], BMI >23kg/m2 [OR 4.84, p<0.001], increase in weight 2%-5% [OR 2.02, p<0.001], increase in weight >5% [OR 5.3, p<0.001), increase in waist circumference (WC) 5-10-cm [OR 3.68, p<0.001], increase in WC >10cm [OR 10.34, p<0.001] and NAFLD (OR 2.44, p<0.001) in 2007 were independently predictive of incident MetS in 2014. Abnormal VFP [OR 4.23, p<0.001] and abnormal TBF [OR 5.25, p<0.001] were also associated with incident MetS. CONCLUSION: In this prospective community study, the annual incidence of MetS was 2.13%. Female gender, increase in weight and WC from baseline and the presence of NAFLD predicted the development of incident MetS. Obesity at baseline was the only defining individual component of MetS that predicted future MetS.
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    Correlates of serum homocysteine in a Sri Lankan population
    (American Association For Clinical Chemistry, 2010) Chackrewarthy, S.; Wijayasinghe, Y.S.; Gunasekera, D.; Wickremasinghe, R.; Kato, N.
    Correlates of total serum homocysteine concentration in a Sri Lankan population BACKGROUND: Hyperhomocysteinemia, a possible risk factor for vascular disease occurs at a higher prevalence in South Asian countries. Serum homocysteine concentrations are influenced by genetic, nutritional and lifestyle factors. Correlates of total serum homocysteine concentration (tHcy) are not well characterized in the Sri Lankan population. Such information is important in developing therapeutic and preventative strategies. OBJECTIVE: To investigate the factors potentially associated with fasting levels of serum tHcy in a Sri Lankan population. METHODS: In a cross sectional study, 177 apparently healthy volunteers (91 men and 86 women) aged 38-65 years were selected from residents in an urban health administrative area. Individuals with a history of chronic disease and with any pharmacological treatment were excluded from the study. Information on diet, lifestyle factors and medical history were recorded. Anthropometric indices and blood pressure were measured according standard protocols. Fasting serum levels of tHcy, insulin, creatinine, folate and lipids were estimated using standard protocols. RESULTS: Fasting serum tHcy levels were higher in males than in females (geometric mean +/- SD, 13.75 mumol/l +/- 1.41 Vs. 9.58 mumol/l +/- 1.43, p<0.001) and were positively associated with age (r=0.204, p< 0.01) in both sexes. 32.3% of males and 10.3% of females had mild hyperhomocysteinemia (tHcy>15mumol/l). tHcy levels were significantly higher in smokers than in non-smokers (geometric mean +/- SD, 14.58 mumol/l +/- 1.44 Vs.12.71 mumol/l +/- 1.37, p<0.05) and in alcohol consumers than in non-consumers (geometric mean +/- SD, 14.53 mumol/l +/- 1.43 Vs.12.14 mumol/l +/- 1.32, p< 0.02). In males, tHcy levels were negatively related to serum insulin (r= -0.397, p<0.001) and BMI (r= -0.244, p <0.02) and positively related to serum creatinine (r=0.235, p<0.02). In females, there was a positive relationship between tHcy and systolic blood pressure (r= 0.239, p<0.02) but there was no significant correlation with serum insulin. In both sexes, serum tHcy levels strongly correlated with serum folate (r= -0.412, p<0.001). There were no significant associations between tHcy and serum lipids. Stepwise regression analysis confirmed the associations between tHcy and folate (p<0.001 in both sexes), insulin (p=0.026 in males) and creatinine (p=0.036 in males). CONCLUSION: Low intake of folate, alcohol consumption and smoking were associated with increased tHcy concentrations. Serum insulin and creatinine were independent correlates of tHcy in males, but not in females. Difference in tHcy levels between sexes may partly be attributed to differences in lean muscle mass and to a metabolic link between creatinine synthesis and homocysteine production. Insulin may regulate serum tHcy concentrations by homocysteine remethylation or by increasing homocysteine clearance.
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    Genetic Polymorphism in Pvmsp-3a. and Pvcs genes in Plasmodium vivax infections in Sri Lanka
    (Sri Lanka College of Microbiologists, 2008) Manamperi, A.; Fernando, D.; Mahawithanage, S.; Wickremasinghe, R*.; Bandara, A.; Wellawatta, C.; Hapuarachchi, C.; Abeyewickreme, W.; Wickremasinghe, R.
    INTRODUCTION: Plasmodim vivax malaria accounts for about 70% of all malaria infections in Sri Lanka. There is limited information on the genetic heterogeneity of P. vivax parasites in endemic areas of the country. OBJECTIVE: The objective of this study was to assess the potential of two P. vivax genes, Pvmsp-3v. and Pvcs. as genetic markers for their use in genotyping parasites collected from the field. METHOD: DNA was extracted from 12 Geimsa-stained P. vivax positive slides by phenol/chloroform method. A nested polymerase chain reaction (PCR) approach was adopted for both Pvmsp-3a and Pvcs genes. RFLP analysis ofPvmsp-la nested PCR products was carried out with Hha\ restriction enzyme. RESULTS AND DISCUSSION: Nested amplification of the marker genes resulted in 4 size variants for Pvcs (~ 600-750 bp) and 2 size variants for Pvmsp-3a (1.9 kb and 1.1 kb). Further, all PCR-RFLP products of Pvmsp-3a. Gene showed a major size polymorphism. Three samples showed evidence of infections with mixed genotypes and there was also evidence to identify a relapse infection. Analysis of these two genetic markers revealed 11 distinguishable variant types: 4 for Pvcs and 7 for Pvmsp-3a. CONCLUSIONS: The observed PCR and PCR-RFLP profiles of the Pvcs and Pvmsp-3& genes demonstrate that the P. vivax parasites in Sri Lanka were highly diverse despite the prevailing low transmission levels. It could be concluded that these two genes in combination could be considered suitable genetic markers to analyze P. vivax parasite dynamics in Sri Lanka.