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 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 Psychological morbidity and illness perception among patients receiving treatment for tuberculosis in a tertiary care centre in Sri Lanka(Sri Lanka Medical Association, 2016) Galhenage, J.S.; Rupasinghe, J.P.; de Silva, A.P.; Williams, S.; Gunasena, B.INTRODUCTION AND OBJECTIVES: To describe the disease perception and prevalence of depression and anxiety among TB patients at National Hospital for Respiratory Diseases, Welisara, Sri Lanka. METHOD: A descriptive cross sectional study involving TB patients from both inward and outpatient clinic settings was conducted. All consecutive patients who gave informed consent were assessed using the self-administered validated Sinhala and Tamil translations of the Hospital Anxiety and Depression Scale (HADS) and the Brief Illness Perception Questionnaire (BIPQ). RESULTS: A total of 254 inward patients and 176 clinic patients participated. Of the clinic patients, 17.6% screened positive for anxiety and 8.5% screened positive for depression. Of the inward patients 25.2% had depression and 12.6% had anxiety. Mean BIPQ score was 27.44 for the whole population and for clinic and inward patients the mean scores were 23.84 and 29.91, respectively. Prevalence of depression was significantly higher among inward patients (p<0.0001), elderly age groups (p=0.007) and in patients with low education levels (p= 0.012). Previously treated TB patients and those on Category 2 treatment regime had a higher proportion of persons with depression (p=0.004 and p=0.002). Among the Inward patients, previously treated patients, patients with low education level, those with depression and anxiety had a higher BIPQ score (p=0.002, p=0.005, P<0.0001, p=0.001 and P<0.0001, respectively). CONCLUSIONS: Psychological morbidity is present among patients undergoing treatment for TB. Addressing this issue will improve treatment outcome and overall wellbeing of the patients.Item Cardiovascular risk profile of the estate population of Sri Lanka(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Chackrewarthy, S.; Perera, P.S.; Wijayasinghe, Y.S.; Williams, S.; Williams, S.S.; Kato, N.; Wickremasinghe, A.R.OBJECTIVES: To estimate the prevalence of biochemical and anthropometric risk markers of cardiovascular diseases in the estate population of Sri Lanka. METHODS: Using a cross sectional design, consenting adults aged 35-64 years resident in 3 selected estates in the Nuwara-Eliya District were recruited with the support of estate medical assistants and welfare officers. AH participants were subjected to an interview, blood pressure and anthropometric measurements and collection of fasting blood samples. RESULTS: Of the 401 participants recruited, 53% were females and 99% were cither Indian or Sri Lankan Tamils. The mean age of the participants was 50.3 years (SD 8.5). 47 (12%) participants had a BMI >25, 8 (2%) a BMI >30. 29 males (15%) and 29 females (14%) had a waist circumference [WC] >90cm and >80 cm, respectively. 151 (38%) participants had systolic blood pressure (SBP) > 140mmHg , 127 (32%) had diastolic blood pressure (DBF) > 90mmHg and 170 (42%) had either SBF > 140 or DBF > 90. 41(10%) participants had fasting blood glucose (FBG) >126mg/dL. In 197 (49%) participants, some form of dyslipidaemia was present. Males had a significantly higher mean BMI, FBG and triglyceride (TG) level and a significantly lower high density lipoprotein (HDL) level as compared to females. CONCLUSIONS: Obesity, as defined by BMI or WC, was low in this population as compared to other reported studies from different population groups in the country. But prevalence of hypertension and dyslipidaemia (especially high TG and low HDL levels in males) was high.Item The burden of diabetes mellitus in an urban population of Sri Lanka(Sri Lanka Medical Association, 2011) Pinidiyapathirage, M.J.; Kasturiratne, A.; Williams, S.; Wijekoon, N.; Pathmeswaran, A.; Ranawaka, U.K.; Warnakulasuriya, T.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: To describe the burden of diabetes in middle and old aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, in which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and 51ood pressure measured by trained personnel. Blood samples were taken after a 14 hour fast for measurement of glucose, HbAlc and lipids. The prevalence of diabetes (fasting plasma glucose [FPG] >7mmol/L) and impaired fasting glycaemia [IFG] (FPG=5.6-6.9mmol/L) and major predictors of diabetes in Sri Lanka were estimated from the population based data. RESULTS: In the whole sample two thirds of the participants were diagnosed as either people with diabetes (20%) or IFG (45%). Among the diabetics only 23.8% were optimally controlled. Through the present screening, 235 diabetics (7.9%) and 1257 (42.1%) participants with impaired fasting glucose levels were newly identified. Old age (OR=5.1, 55-64 years vs. 35-44 years), male sex (OR=3.1), family history (OR- 2.7), central obesity (OR-1.8), and reduced physical activity (OR=1.3) were significantly associated with increased risk of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in the general population. Short and long term control strategies are required not only for optimal-therapy among those affected but also for nationwide primary prevention of pre-diabetes.Item Techniques for primary screening for haemoglobinpathies in Sri Lanka: a comparison of single tube osmotic fragility (STOP) and dye test {DCIP) vs full blood count (FBC)(Sri Lanka Medical Association, 2007) Premawardhena, A.P.; Williams, S.; Idirisinghe, A.; Allen, A.; Olivieri, N.F.; Weatherall, D.J.INTRODUCTION: Techniques best suited for haemoglobinopathy screening of the Sri Lankan population need to be determined. Full blood count is used to detect p thalassaemia trait but is affected by iron deficiency. Its ability to detect haemoglobin (Hb) E is less certain. Alternative tests for screening include single tube osmotic fragility (STOP) test (for [5 thalassaemia) and a dye test (DCIP) for HbE. However there is no consensus regarding their usage in population surveys. OBJECTIVES: To decide the validity of STOP and DCIP test as screening tests for haemoglobin disorders in Sri Lanka. DESIGN, SETTING AND METHODS: Blood samples of volunteers attending an educational campaign held at the Faculty of Medicine, Ragama were tested using STOP, DCIP and FBC, and the results compared with the "gold standard" HPLC (high performance liquid chromatography) Results: 1062 individuals participated. HPLC identified 27 p traits and 3 HbE carriers. A total of 508 subjects had either MCV < 80 or MCH <27 on FBC, which included 26 of the p traits and all with HbE. The rest were presumably iron deficient. Only 56 subjects had a positive STOF test including 26 with p trait. 34 had a positive DCIP test including all three HbE carriers. One person with HbA2 of 3.5% had a normal MCV, MCH, negative STOF and negative DCIP. STOF test had a sensitivity and specificity of 96% and 97% for p trait. The DCIP had a sensitivity and specificity of 100% and for the detection of Hb E. CONCLUSIONS: Both STOF and DCIP are excellent tests for primary screening. The STOF is a superior test for screening thalassaemias than FBC in populations with high prevalence of iron deficiency.Item A Case report of dengue and chikungunya co-infection in Sri Lanka(The Parasitology and Tropical Medicine Association of Thailand, 2008) Abeyewickreme, W.; Hapuarachchi, H.A.C.; Bandara, K.B.A.T.; Hapugoda, M.D.; Williams, S.Dengue fever and chikungunya are arboviral diseases transmitted by Aedes mosquitoes. Though dengue has been an important communicable disease in Sri Lanka for many years, chikungunya has not been reported in Sri Lanka since late 1960s. However, in November 2006, an outbreak suggestive of chikungunya erupted in the country. We report here the first laboratory confirmed case of dengue and chikungunya co-infection in Sri Lanka. The objective is to confirm the co-infection of dengue and chikungunya in a clinical case reported in November 2006. Clinical history of high fever, severe headache, nausea, loss of appetite, severe arthralgia and mild oedema of knees, small joints of hands and feet for 3 days suggested the possibility of dengue and chikungunya in a 70 year old male. There was no skin rash or bleeding manifestations. Laboratory investigations performed included total white blood corpuscle count/differential count (WBC/DC), platelet count (PLT), serum, haemoglobin (Hb%) and packed cell volume levels (PCV). Reverse Transcription- Polyrnerase Chain Reaction (RT-PCR) technology was used to confirm the presence of either dengue or chikungunya. Viral RNA was extracted from serum samples collected during the first five days of infection using QiAmp Viral RNA Kits and amplified products were visualized by 2% agarose gel electrophoresis and ethidium bromide staining. WBC/DC analysis showed a leucopaenia (WBC count 3.04 x 103 per μl) with relative lymphocytosis (51.0%). The total PLT was 115 x 103 per μl. Hb% was 14.3 g/dl with a PCV of 43.8%. The presence of both infections was confirmed by RT-PCR which amplified 225 bp and 354 bp products for dengue and chikungunya respectively. This was the first laboratory confirmed case of dengue and chikungunya co-infection, which was also the first confirmed report of chikungunya since 1969 in Sri Lanka. As clinical and biochemical manifestations of this patient suggested the probability of a mixed infection of dengue and chikungunya, the confirmation was achieved by a RT-PCR assay. This report highlights the importance of using molecular assays to confirm mixed viral infections during their early stages, especially infections such as dengue which can result in fatal complications.