Conference Papers
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/6561
This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
Browse
4 results
Search Results
Item Assessing reversibility of liver fibrosis in patients with transfusion-dependent beta thalassaemia following intensive chelation(Sri Lanka Medical Association, 2023) Padeniya, A.G.P.M.; Ediriweera, D.; Niriella, M.A.; de Silva, A.; Premawardhena, A.P.INTRODUCTION: Transfusion-related iron overload is a leading cause of hepatic fibrosis in transfusion-dependent thalassaemia (TDT). OBJECTIVES: This study aimed to evaluate the reversibility of liver fibrosis with intensive chelation therapy in TDT. METHODS: Forty-five patients were included. Serum ferritin, hepatic fibrosis & steatosis (assessed by Transient Elastography), and liver iron concentration/LIC (estimated by FerriScan) were recorded at recruitment and after 2 ½ years of intensive chelation. Compliance for iron chelators was monitored and recorded as good (gc), moderate compliance (mc), and poor (pc) compliance based on the number of days the iron chelators were used. RESULTS: 22/45 (49%) were males [mean age (SD)-19 (4.78) years]. There were 23 (51%), 12 (27%), and 10 (22%) patients with gc, mc, and pc with iron chelators, respectively. The LIC decreased in 36 (80%) patients. The median LIC reduction after 2 ½ years was as follows: gc group-13.5 to 5.1 mg Fe/g dw (P=0.0002); mc group-25.5 to 17.75 mg Fe/g dw (P=0.001). In the pc group, the LIC increased by 10.4 mg Fe/g dw (P =0.058). Liver fibrosis declined in 23 (51%) patients. The liver stiffness at recruitment and after 2 ½ years was 7.6 and 7.1 kPa (P=0.08) in the gc group. In both mc and pc groups, liver fibrosis increased on follow-up [significantly worsened in the pc group (P=0.04)]. CONCLUSION: The reduction of LIC in TDT was related to compliance with chelation therapy; substantial reductions were achieved in those with gc and mc. However, only those with gc managed to arrest the fibrosis progression.Item Seven–minute neurocognitive test battery: A reliable test for dementia(Elsevier, Inc. (2020-Wiley), 2006) de Silva, A.; Pathmeswaran, A.; de-Jager, C.; Kuruppuarachi, L.A.BACKGROUND: The increasing prevalence of Alzheimer’s disease (AD) suggests that there is an increasing need for accurate and easily administered screening instruments to assess cognitive function. OBJECTIVE(S): To examine the reliability of the 7-minute screen as a cognitive screening instrument for AD in a Sri Lankan population. METHODS: 53 patients with mild-moderate AD, 34 with other dementias, 36 with mild cognitive impairment (MCI) referred to a memory clinic, and 60 patients with depression with no evidence of dementia and 56 healthy volunteers (controls) were recruited to the study after informed consent. All were community-dwelling and aged _60 years. Patients with severe dementia, receptive aphasia, visual and motor impairment, and severe depression were excluded. All diagnoses were made according to established criteria and the diagnosis of depression was confirmed after psychiatric evaluation. All subjects underwent cognitive assessment with the Mini Mental State Examination (MMSE) and the 7-minute screen. This screen consists of four components (enhanced cued recall, temporal orientation, verbal fluency, and clock drawing) that assess memory, orientation to time, fluency of expression, and executive function, cognitive functions typically compromised in AD. RESULTS: Baseline characteristics did not differ significantly in the five groups. (see the table). CONCLUSIONS: The 7-minute neurocognitive screen is a highly sensitive instrument to screen for AD and was more reliable than the MMSE to detect AD, MCI, and other dementias in this Sri Lankan population. However, the accuracy of the screen may be confounded by the presence of depression.Item Estimating the treatment cost of selected diseases in three state sector hospitals(College of the Community Physicians of Sri Lanka, 2007) Kasturiratne, A.; Sugimoto, T.; de Silva, A.INTRODUCTION: Costing disease management is useful for appropriate resource allocation and improving accountability in the health system. Protocol based disease management is helpful in cost analysis, but well developed and accepted protocols to cover the entire disease spectrum are yet being developed in the Sri Lankan context. OBJECTIVE: To estimate treatment cost of acute severe asthma and Lower Segment Caesarean Section (LSCS) in three state sector hospitals. METHODS: This descriptive cross sectional study was conducted in Teaching Hospital, Kurunegala (THK), Base Hospital, Kuliyapitiya (BHK) and Colombo North Teaching Hospital, Ragama (CNTH), from September to December 2006. The study populations were Bed Head Tickets (BHTS) in BHK and THK, and patients in CNTH. All study populations fulfilled the same criteria. A time study was conducted at CNTH using direct observation of Clinical management. Results of the step down method, the time study and the data extracted from BHTS were used for estimating direct, para-medical and accommodation costs. RESULTS: The total sample consisted of 240 subjects. The average duration of hospital stay for patients with acute severe asthma was approximately 4 days in THK and BHK, and 7 days in CNTH. The total cost of management ranged from Rs.2520 (THK) to Rs.4933 (CNTH). The cost of a LSCS ranged from Rs.8268 (CNTH) to Rs.9429 (THK). The average duration of hospital stay was 7-8 days. Operation theatre overheads accounted for 20-40% of the total cost. The cost of the time Spent by Medical Officers in the theatre was about 10% of the total cost. For both conditions, the cost of accommodation was the largest contributor to the total cost. CONCLUSION: in the absence of disease management protocols, there is variation in the disease management cost between different levels of hospitals. This may be due to differences in resource availability, utilisation pattern and accepted practices.Item Combination burden of CVD through innovative strategies to improve BP control(Ceylon College of Physicians and Royal College of Physicians London, 2020) de Silva, A.ABSTRACT: Uncontrolled high blood pressure (BP) is the leading attributable risk factor for mortality globally. With over 1.3 billion people worldwide estimated to have hypertension, and just over one-third on any form of treatment, it has been estimated that approximately 20% of all deaths are attributable to non-optimal BP. Proportionately, more cardiovascular disease (CVD) deaths occur in LMICs and Asians have enhanced susceptibility to vascular disease. Control of BP reduces cardiovascular morbidity and Mortality. However, despite wide availability of effective and inexpensive medicines to treat hypertension, less than one-third of individuals with hypertension have controlled BP. Persistent use of monotherapy, which has modest efficacy, and inappropriate lifestyles with poor awareness of CVD risk factors and low patient compliance are considered to be the main contributory factors to inadequate BP control among patients with hypertension. There is, therefore, a need to challenge traditional paradigms that are unlikely to effectively address the CVD crisis and develop innovative strategies both in terms of clinical care and health systems responses to improve overall outcomes. One such strategy was evaluated by us in the TRIUMPH study. In this trial of 700 patients with mild or moderate hypertension, initial treatment with or escalation of monotherapy to low-dose triple combination therapy significantly improved achievement of blood pressure targets. The other study (COBRA-BPS) involving more than 2500 participants demonstrated a low-cost, multi-component intervention delivered at community level through existing primary healthcare infrastructure led to better BP control in rural communities. Both these recently published studies will be presented during the oration.