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 Assessing liver fibrosis in patients with transfusion dependent beta thalassaemia - a predictive model(Sri Lanka Medical Association, 2021) Padeniya, A.G.P.M.; Ediriweera, D.; de Silva, A.; Niriella, M.A.; Premawardhena, A.P.Introduction and Objectives Liver fibrosis in β-thalassaemia major is mainly due to transfusion-related iron overload. Transient elastography (TE) is an imaging modality which measures liver stiffness/fibrosis non-invasively. TE is simple, safe and efficient. However, inaccessibility and high-cost hinders its routine use. We designed a predictive model to evaluate liver fibrosis using demographic, anthropometric, biochemical and imaging data. Methods Sixteen patients with transfusion dependent beta thalassaemia were recruited to the study. FBC, LFT, serum ferritin and Transient Elastography (TE) and FerriScan measurements were recorded at the baseline and after two years follow up. Multiple regression model was developed to predict liver fibrosis using demographic, anthropometric, biochemical and imaging data. [age, gender, body mass index (BMI), steatosis score, liver iron content, mean pre-Hb over the last year, no of blood transfusions (lifetime), amount of blood ingested over the last year(ml/kg), amount of elemental iron by transfusions over last year(mg/ kg), serum ferritin, SGOT, SGPT and compliance with iron chelation].Results Of 16, 8 (50%) were females, mean (SD) age, BMI and fibrosis scores were 21(4.3) years, 18.8 (2.8) kgm-2 and 9.7(5.7) kPa respectively. Gender, BMI, SGOT, SGPT, compliance, number of transfusions taken lifetime showed significant association with liver fibrosis. The final model showed a coefficient of determination (R2) of 0.859. According to the model, predicted liver fibrosis is given by;-26.18 - 4.38*male+1.01*BMI - 0.11*SGPT+0.32*SGOT+2.78*compliance (rps)+0.04*no. of transfusions. ConclusionThe suggested model is a reliable tool to predict liver fibrosis in transfusion-dependent β-thalassaemia major patients in resource poor settings.Item Pharmacist counselling: A new practice for improving out-patient management of diabetes in Sri Lanka(Sri Lanka Medical Association, 2018) Mamunuwa, A.M.G.N.; Coombes, J.; Lynch, C. B.; de Silva, A.; Wickramasinghe, N.D.D.; Jayamanne, S.F.INTRODUCTION AND OBJECTIVES: Our study assessed the effectiveness of pharmacist counselling on outpatient management of diabetes. Though this is new to Sri Lanka, many countries include this practice to achieve target treatment outcomes of patients with diabetes.METHODS: 800 participants with diabetes attending outpatient clinics of two Sri Lankan hospitals were assigned either intervention group (IG) or control group (CG). IG received pharmacist counseling for four consecutive monthly visits in addition to standard care. CG received standard care only Glycaemic control was assessed using Glycosylated haemoglobin (HbAlc) post-intervention Adherence and patient-knowledge were assessed using questionnaires at baseline and post-intervention. RESULTS: A Wilcoxon signed-rank test showed that the 4-month intervention made a statistically significant improvement in adherence in the IG. The IG had median adherence score of 5 out of 8 (IQR 6-3 3) at baseline which increased to 7 (IQR 8-6) post-intervention There was no significant change in adherence in the CG.The IG had median HbAlc of7.2% (IQR 1.5%) post-intervention whereas CG had median of7.7% (IQR 1.95%). This difference was statistically significant.The IG had a median score of 36. l 5% (IQR 48% - 24.07%) for the medication related knowledge domain which increased to 65% (IQR 76.4% - 50.4%) post-intervention (P value< 0 001). The CG did not have a significant change in the same at baseline and post-intervention (P = 0 15). CONCLUSION: Pharmacist counselling improved medication adherence, glycaemic control and patients' knowledge. Thus, it can effectively be used for improving the outpatient management of diabetes in Sri Lanka.Item The role of pharmacist counselling in the control of diabetes(Sri Lanka Medical Association, 2017) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; de Silva, A.; Lynch, C.B.; Wickramasinghe, N.D.D.INTRODUCTION & OBJECTIVES: Diabetes is a global health burden. Data in international literature prove the success of involving pharmacists to achieve glycaemic control. This is the first study in Sri Lanka on the impact of pharmacist counselling among outpatients with diabetes. The objective was to assess the impact of pharmacist counselling on glycaemic control of outpatients with diabetes. METHODS: A total of 400 consecutive patients with diabetes mellitus attending the outpatient diabetes clinics at Base Hospital, Dambadeniya, were randomized into either the intervention group (IG) or the control group (CG). IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to the standard care at the clinic, while the CG received standard care only. Glycaemic control was assessed for both groups with HbA1c measured at the end of the four monthly visits.RESULTS: Mean age of participants was 57.14±10.15 years and 67.5% were females. Non parametric tests were performed as data did not follow the normal distribution. On analysis of HbA1c data, the IG had a median of 7.2% (IQR: 8.2%-6.5%) whereas the CG had a median of 7.7% (IQR: 8.8%-6.9%). The IG patients had statistically lower HbA1c levels compared to the CG patients, according to the Mann-Whitney U test (p<0.05). HbA1c levels <8.00% indicate good/fair glycaemic control. 73.9% of the IG, but only 58% of the CG subjects had levels <8.00%. However, 9.1% of the IG and 10% of the CG had very poor glycaemic control (HbA1c level >10.00%). CONCLUSION: Pharmacist counselling in the outpatient clinics can improve the glycaemic control of patients with diabetes.Item Contribution of physical activity and sedentary behaviour to glycaemic status in urban women(Sri Lanka Medical Assosiation, 2012) Waidyatilaka, P.H.I.U.; de Silva, A.; Lanerolle, P.; Wickremasinghe, R.; Somasundaram, N.; Atukorala, S.INTRODUCTION: Physical activity plays a significant role in the development of Type 2 diabetes mellitus and the role of sedentary behaviour is gaining importance. This association may exist even in persons meeting exercise guidelines. AIMS: To assess percentage fat mass (FM%), waist circumference (WC), physical activity (PA) and sedentary behaviour (sitting time) in relation to glycaemic status in urban women. METHODS: Newly diagnosed diabetic and non diabetic urban women (30-45 years) were recruited in a community based cross sectional study following screening using fasting blood sugar (n-425). HbAlc was used to categorise "worn en as normoglycaemic (n=182) or dysglycaemic (n=243). PA and sitting time were assessed by the International Physical Activity Questionnaire (IPAQ). WC was measured and FM% was determined by Bio-impedance analysis. Means were used to describe variables and Spearman correlation coefficients and multiple linear regression analysis were used to test for associations. Results: Mean age of women was 37.7+4.0 years. Compared with normoglycemics, dysglycaemics had significantly higher WC(70.7±7.1 vs 80.7±7.5cm), FM% (32.0±5.6 vs 37.0±4.7%), and sitting time (144±66 vs 311±120 minutes/day)(p<0.001 for each variable). PA (7252±2935 vs 2769±1762METminutes/week) was significantly lower (p<0.001) in dysglycemics. WC(rs=0.575, p<0.001), sitting time (rs=0.712, p<0.001) were significantly correlated with HbAlc. PA (rs=- 0.719, p<0.001) was negatively correlated with HbAlc. WC and sitting time were significantly associated with glycaemic status (F=69.3, p<0.001) after adjusting for PA. CONCLUSIONS: WC, sitting time and PA are significantly associated with glycaemic status. Independent of PA, WC and sedentary behaviour are associated with dysglycaemia.Item Knowledge, attitudes and practices regarding type 2 diabetes mellitus, nutrition and lifestyle in urban Sri Lankan women(Sri Lanka Medical Association, 2013) Waidyatilaka, P.H.I.U.; de Silva, A.; Atukorala, S.; Somasundaram, N.; Lanerolle, P.; Wickramasinghe, R.AIMS: Data on population specific patterns of knowledge, attitudes and practices (KAP) is essential for the design of effective intervention strategies. The aim of this study was to assess KAP regarding type 2 diabetes mellitus (T2DM), nutrition and lifestyle in Sri Lankan urban women who were unaware of their glycaemic status. Methods: 2800 apparently healthy urban women (30 - 45 years) were screened for dysglycaemia and 345 normoglcaemics and 272 dysglycaemics were selected from Coiombo Municipal Council area by random cluster sampling for a cross sectional study. An interviewer administered questionnaire was used to obtain KAP, demographic information and family history. Chi square test and Student's t- tests were used for categorical variables and for group comparison respectively. RESULTS: KAP on T2DM, nutrition and healthy lifestyle were poor. Knowledge on pre-diabetes and prevention of T2DM was also poor. However majority wanted to improve their knowledge. Women with a family history had better knowledge (p< 0.001) and attitudes (p< 0.05), but lower practice scores (p< 0.05) compared to women without a family history of T2DM. A significant (p< 0.001) proportion of women with a family history of T2DM found it difficult to resist eating foods high in fat and sugar. CONCLUSIONS: Overall KAP was poor, especially about pre-diabetes and prevention. Willingness to learn can be used positively to direct future interventions. Poor practices despite better knowledge and attitudes among women with a family history of T2DM indicate a need for targeted intervention.Item Incidence and risk factors for Non-Alcoholic Fatty Liver Disease in an urban, adult Sri Lankan population – a community cohort follow-up study(Sage Publishing, 2015) Niriella, M.; Kasturiratne, A.; de Silva, S.; Perera, R.; Subasinghe, C.; Kodisinghe, K.; Priyantha, C.; Rishikeshavan, V.; Dassanayake, A.; de Silva, A.; Pathmeswaran, A.; Kato, N.; de Silva, H.J.INTRODUCTION: We previously reported a community prevalence of 33% for NAFLD in an urban, adult Sri Lankan population. We also found a significant association between patatin-like phospholipase domain containing 3 (PNPLA3) gene rs738409 polymorphism, and susceptibility to NAFLD in the same population, after testing 10 selected single nucleotide polymorphisms (SNPs) in a case control study. AIMS & METHODS: The aim of this study was to assess the incidence and risk factors for NAFLD in this population after seven years of follow-up. The study population consisted of 42-71-year-old adults, originally selected by age stratified random sampling from electoral lists from Ragama, Sri Lanka. The target population was screened initially in 2007 and subsequently invited back for re-evaluation in 2014. On both occasions they were assessed using a structured interview, clinical and anthropometric measurements, liver ultrasound, and biochemical and serological tests. NAFLD was diagnosed on established ultrasound criteria for fatty liver (two out of three criteria: increased echogenecity of the liver compared to kidney and spleen, obliteration of the vascular architecture of the liver and deep attenuation of the ultrasonic signal), safe alcohol consumption (Asian standards: 514 units/week for men, 57 units/week for females) and absence of hepatitis B and C markers. Non-NAFLD controls were defined as subjects who did not have any of the ultrasound criteria for NAFLD. We also performed an updated case-control study to investigate associations of selected genetic variants with incident NAFLD [SNPs: PNPLA3 (rs738409), LYPLAL1 (rs12137855), GCKR (rs780094), PPP1R3B (rs4240624) and NCAN (rs2228603), APOC3 (rs2854117 and rs2854116), ADIPOR2 (rs767870) and STAT3 (rs6503695 and rs9891119)]. RESULTS: Of the 2985 original study participants, 2155 (72.2%) (1244 women and 911 men; mean age 59.2 years [SD, 7.7]) participated in the follow-up assessment. 1322 [mean age 58.9 years (SD, 7.6), 483 (53.0%) men and 839 (67.4%) women] had NAFLD. Out of 795 [466 (58.6%) women] participants who did not have NAFLD in the original study, 365 [226 (61.9%) women, mean age 58.6 years (SD, 7.9)] had developed NAFLD after 7 years, giving an annual incidence rate 6.6%. On multivariate analysis, increased waist circumference [OR 1.96(1.30 – 2.97), p=0.001], BMI4 23 kg/m2 [OR 2.93(1.99 – 4.30), p50.001] and raised plasma triglycerides (TG) [OR 1.49(1.03 – 2.13), p=0.03] were independently predictive of incident NAFLD in this cohort, while raised BP and reduced HDL, were not. In the updated association study involving 1310 cases and 427 controls, we found borderline association with NAFLD at two of the 10 candidate loci: rs4240624 at PPP1R3B and rs738409 at PNPLA3 (one-tailed P=0.044 and 0.033, respectively). CONCLUSION: In this community cohort follow-up study in an urban, adult population in Sri Lanka, the annual incidence of NAFLD was 6.6%. Incident NAFLD was associated with features of the metabolic syndrome, and showed tendency of association at PNPLA3 and PPP1R3B gene polymorphisms. Disclosure of Interest: None declaredItem Therapeutic effects of domperidone on abdominal pain-predominant functional gastrointestinal disorders: randomized, double-blind, placebo- controlled trial.(Lippincott Williams & Wilkins, 2015) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.; de Silva, A.INTRODUCTION: The therapeutic effect of domperidone on abdominal pain-predominant functional gastrointestinal diseases (AP-FGIDs) was assessed on children in 5-12 year age group at the Gastroenterology Research Laboratory of Faculty of Medicine, University of Kelaniya, Sri Lanka. METHODS: Children fulfilling Rome III criteria for AP-FGIDs were recruited from the out-patient clinic of the University Paediatric Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka, after obtaining parental consent. They were randomized in to 8 weeks of placebo or Domperidone (Motillium 10 mg, 3 times per day, before meals) groups, using computer generated random numbers. Placebo was a specially prepared dummy tablet without any active ingredients, had the same colour, size, shape and taste of domperidone tablet and were packaged similarly. Primary outcomes defined were cure (abdominal pain less than 25 mm on the visual analogue scale and no impact on daily activities) and improvement (pain relief and sense of improvement recorded on global assessment scale). Secondary outcomes were significant improvement in symptoms, gastric motility, quality of life (QoL) and family impact. Both patients and investigators who assessed primary and secondary outcomes before and after intervention were blind to inventions administered. Symptom severity was recorded on a validated 100 mm visual analogue scale. Translated and validated PedQL Generic Score Scale version 4.0 and Family Impact Module were used. Gastric motility was assessed using a validated ultrasound method. RESULTS: One hundred children were enrolled and 89 completed the trial [Placebo 42 (22 girls), Domperidone 47(33 girls)]. While comparing primary outcomes, domperidone group had significant improvement [37 (78.7%) vs. 25 (59.5%) in placebo group, p = 0.04], while no such difference was observed in cure. When assessing secondary outcomes, domperidone group reported significant reduction in abdominal pain severity (70.84% vs. 48.18% p = 0.03) and improvement in motility index (29.3% vs. 8.6% p = 0.04) after intervention. No such difference was seen in improvement of QoL and family impact (p > 0.05). CONCLUSIONS: Domperidone has a favorable therapeutic effect on improvement AP-FGIDs in children aged 5-12 years. It causes significant reduction in abdominal pain and improvement in motility of the gastric antrum. However, it has no significant effect on improvement of QoL and family impact.Item Effectiveness of a lifestyle modification programme in reducing cardiometabolic risk markers in urban Sri Lankan women with pre- diabetes(Sri Lanka Medical Association, 2015) Waidyatilaka, P.H.I.U.; de Silva, A.; Lanerolle, P.; Wickremasinghe, R.; Atukorala, S.INTRODUCTION AND OBJECTIVES: Prediabetes increases cardlometabolic risk. Our aim was to develop and assess the effectiveness of a lifestyle modification programme in reducing cardiometabolic risk markers in newly diagnosed prediabetic urban Sri Lankan women. METHOD: Women (n=1500) from Colombo Municipal Council area were screened and 130 newly diagnosed prediabetics recruited randomly to intervention and control groups. Participant involvement ensured development of a culturally relevant, four month intervention programme. Control group received initial advice and print material only. Intervention was developed with a goal based strategy of 5% weight loss and 150 minutes of physical activity (PA) per week using a predominantly group based approach with individual sessions.FPG, HbAic, serum lipids and hs-CRP were measured. RESULTS: The final sample was 101 women (intervention n=51, control n=50) with no significant difference in baseline parameters between groups or responders and non-responders. Following intervention, 52.9% achieved the weight loss goal compared to the control group (2%) and37.3% became normoglycaemic, compared to none among controls.In the intervention group, when compared to baseline, there was a significant (p<0.05) reduction in HbAlc (0.2±0.24%), FPG (20.6±11.6 mg/dl), total cholesterol (14.4±26.5 mg/dl) and triglycerides (13.2+30.7 mg/dl) and a significant (p<0.05) increase in HDL-cholesterol (3.2+5.9 mg/dl) post intervention with no significant change in hs-CRP. All differences were significant against the control group. Conclusions: A culturally sensitive intervention programme achieved improvement in markers of glycaemia, lipid profile and weight reduction with reversal of prediabetes in a majority.Item Assessment of thyroid volume in adult Sri Lankans(Sri Lanka Medical Association, 2010) Fernando, R.; Bandara, D.M.S.M.; de Silva, A.; Renuka, M.D.OBJECTIVE: The ultrasound is the most sensitive method to detect goitre. Goitre size varies with different populations. Clinical palpation has low sensitivity. It is dependant on the experience of the examiner. Development of reference values for different populations is required. Objective of this study was to assess thyroid volume of Sri Lankans. METHODS: Patients taking inward treatment in the university surgicai unit for problems other than thyroid disorders and patients' bystanders were enrolled. Pregnant women, lactating women, acute or chronically ill patients, age below 16 years, abnormal echotexture or nodules on ultrasound examination were excluded. Subjects were selected randomly. Thyroid scan was done by a Consultant Radiologist. Thyroid volume was assessed using ellipsoid formula RESULTS: 60 males with mean age of 33 years were assessed. Their mean thyroid volume was 8.628 ml (2.73) with range of 2.657-15.15. Thirty females with median age of 42 were assessed. Mean thyroid volume of females was 6.413ml (1.66) with range of 2.871-9.737. This difference was statistically significant (p<0.01) Overall thyroid volume was 7.889ml (2.745). There was no significant difference in volume of both lobes (p>0.01). There was no significant correlation with height weight or BMI. Reference ranges for males and females were 8.628 ± 5.46 ml and 6.413 ± 3.32 ml respectively. CONCLUSION: Mean thyroid volumes of study sample of adult Sri Lankans were 8,628 ml (2.73) and 6.413ml (1.66) for males and females respectively. Reference ranges for males and females were 8.628 ± 5.46 mi and 6.413 ± 3.32 ml respectively.Item Measures of body fat in diabetic and non-diabetic females(Sri Lanka Medical Association, 2011) Waidyatilaka, P.H.I.U.; de Silva, A.; Lanerolle, P.; Wickremasinghe, R.; Somasundaram, N.; Atukorala, S.INTRODUCTION AND OBJECTIVES: Increased body fat (BF) predisposes to obesity linked co-morbidities, including diabetes. Data on body fat percentage in Sri Lankan adult populations are limited. Aim of this study was to assess %BF, waist circumference (WC) and body mass index (BMI) in adult diabetic, pre-diabetic and normoglycaemic females. METHODS: Free living females (n=25) aged 30-45 years, without any known illness, and 19 females of similar age, social class and employment, recently diagnosed with DM and yet untreated, were recruited from primary health care centers in Colombo Municipality for a community based cross sectional study. Weight, height and WC were measured using standard protocols and BMI calculated. Bio-impedance analysis was used to determine % BF. HbAlc was estimated and women grouped into diabetic (HbAlc >6.5 %), pre-diabetic (HbAlc 5.7-6.4 %) or normoglycemic categories. Results: Mean age of women was 36.6±4.1 years. In the group without known illness, 9 were pre-diabetic and 16 were normoglycaemic. No significant differences were observed between diabetic, pre-diabetic and normoglycaemic women in age or weight. There was no significant difference in BMI between diabetic (25.3±3.3kg/m), pre-diabetic (26.8±2.5 kg/m2) or normoglycaemic (24.4±3.7 kg/m2) women. However, %BF was significantly higher (p < 0.01) among diabetic (37.3± 6.1} and pre-diabetic (33.9±5.5) than in normoglycaemic women (28.6±9.9). WC was also significantly higher (p < 0.01) among diabetic (83.5±7.9 cm.) and pre-diabetics (84.5±6.8) than normoglycaemic women (76.2±6.4 cm). CONCLUSIONS: In this population, although there was no difference in BMI, pre-diabetic and diabetic women had a higher %BF and WC than normogiycaemics. Funded by IAEA.