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 Prevalence of chronic kidney disease and associations among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke,W.A.N.V; Ediriweera, D.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Chronic kidney disease is a major non communicable disease in Sri Lanka with a rising prevalence. We studied the prevalence and associations of chronic kidney disease among patients with hypertension in a rural Sri Lankan population. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults with hypertension were investigated with serum creatinine, urine albumin creatinine ratio and eGFR. Socio-demographic and anthropometric data was obtained as well. RESULTS: Total of798 hypertensive patients (546 females and 252 males) were included in the study. 383 (48.7%, 95% CI: 45.2% - 54.0%) had proteinuria .486 (61.I %, 95% CI: 57.7% - 64.5%) of them had stage III or advanced CKD among which 241 had proteinuria. 618 (78.7%, 95% CI: 75.9% - 81.6%) showed either eGFR<60ml/min/l.73m2 or proteinuria. Advancing age (p<0.01), female gender (p<0.01) and raised LDL levels (p=0.01) were significantly associated with CKD.CONCLUSION: Prevalence of CKD is high in this rural hypertensive adult cohort. A significant proportion had non protienuric CKD. It may be justifiable to assess renal functions of all patients with hypertension to establish an early diagnosis of CKD to prevent complications. Considering the very high prevalence, community screening for CKD can be recommended in this populationItem Prevalence and patterns of dyslipidaemia among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke, W.A.N.V.; Ediriweera, N.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Dyslipidaemia and hypertension are major risk factors for cardiovascular disease. Data on prevalence and patterns of dyslipidaemia in rural settings of Sri Lanka are limited. We conducted a study to determine the prevalence of dyslipidaemia among hypertensive adults over 40 years of age in the Puttalam district. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Socio-demographic data were obtained from adult hypertensive and basic investigations were carried out. RESULTS: Total of 798 hypertensive patients (546 females and 252 males) were included in the study. Median (Interquartile range) levels of total cholesterol, HDL, LDL and TG of the patients were 205 (173 - 238), 55 (48 - 63), 125 (96 - 155), 109 (85 - 143) respectively. Elevated levels of total cholesterol, LDL, TG and non HDL were reported in 192 (24. %), 371(46.4%), 173 (21.6%) and 527 (66%) respectively and low HDL was observed among 40 (5%) patients. High non HDL cholesterol was associated with female gender (P=0.03) and advancing age showed a negative association (P<0.01). CONCLUSION: Prevalence of dyslipidaemia is high in this hypertensive adult cohort. Suboptimal level of modifiable risk factor control is observed in this population which should be addressed to further reduce cardiovascular morbidity and mortalityItem Prevalence of hypertension in a rural district of Sri Lanka(Sri Lanka Medical Association, 2017) Luke, W.A.N.V.; Ediriweera, D.S.; de Silva, K.C.; Balasooriya, E.R.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION & OBJECTIVES: Hypertension is a leading cause of cardiovascular morbidity and mortality. Data on prevalence of hypertension in rural settings of Sri Lanka is limited. We conducted a study to determine the prevalence of hypertension among adults over 40 years of age in the Puttalam district.METHODS: A community-based prevalence study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults over 40 years of age living in consecutive households were screened by trained research assistants using digital blood pressure (BP) meters. Basic demographic data were obtained using an intervieweradministered questionnaire. Previously undiagnosed adults with persistent elevation of BP (SBP > 140 and /or DBP > 90 mmHg on two readings) and those already on treatment for hypertension were identified. RESULTS: A total of 2289 were screened. The mean (SD) of SBP and DBP were 134.5(21.3) and 82.1 (13.5) mmHg respectively. The overall hypertension prevalence was 458.5 (95% CI 438.1– 478.8) per 1000 population. 16.3% were newly diagnosed. Prevalence of uncontrolled hypertension among those on treatment was 516.2 (95% CI 479.4–552.9) per 1000. 98.7 (95% CI 86.6–110.9) per 1000 had blood pressure >160/110 mmHg. There was an increasing trend in blood pressure with increasing age (OR=1.07, 95% CI 1.06–1.08, p<0.01) but not with the male sex. CONCLUSION: Prevalence of hypertension is high in this rural adult cohort. Previously undetected hypertension and uncontrolled hypertension among those already on treatment are common. Community-based approaches targeting screening and BP control are essential to reduce adverse outcomes of hypertension.Item Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases(Sri Lanka Medical Association, 2016) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; de Silva, H.A.; Dawson, A.INTRODUCTION AND OBJECTIVES: Adverse drug reactions (ADRs) are a major problem in drug utilization. The study aimed to describe the incidence and nature of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHOD: This prospective observational study conducted in a tertiary-care hospital recruited in-ward patients with NCCDs. All ADRs that occurred during the index hospital admission and in the 6-month period following discharge were detected by active surveillance. Details were recorded using the ADR reporting form, developed based on the publication of the Clinical Center, Pharmacy Department, National Institutes of Health. RESULTS: 715 patients were studied (females-50.3%, mean age–57.6 years). The mean number of medicines given per patient was 6.11±2.97. The most prevalent NCCDs were hypertension (48.4%; 346/715), diabetes (45.3%; 324/715) and ischemic heart disease (29.4%; 210/715). 112 patients (15.7%) experienced at least one ADR. In the 112 patients, 154 ADRs (33 during index hospital admission; 121 during 6-month period following discharge) were detected. 51.9% (80/154) of them were potentially avoidable. 47% (73/154) of ADR swere Serious Adverse Events (SAEs); 13 were life threatening, 46 caused hospitalization and 14 caused disability. The most common causes for re-hospitalization due to ADRs were hypoglycemia due to anti-diabetic drugs (17/46), bleeding due to warfarin (14/46) and hypotension due to anti-hypertensives (6/46). CONCLUSIONS: Incidence of ADRs was high in the study population. A large proportion of them were SAEs. The majority of ADRs that required re-hospitalization were caused by widely used medicines and were potentially avoidable.Item Cluster randomized trial on integrated primary care strategies to reduce high blood pressure in rural communities in Sri Lanka: Report from the feasibility study(Sri Lanka Medical Association, 2016) de Silva, H.A.; Kasturiratne, A.; Luke, W.A.N.V.; Ediriweera, D.S.INTRODUCTION: Hypertension is the leading cause of mortality worldwide. Control of Blood Pressure and Risk Attenuation (COBRA) trial conducted in Pakistan, demonstrated that the combined intervention of home health education (HHE) plus training general practitioners (GPs)was more effective for lowering blood pressure (BP) compared to usual care. OBJECTIVES: A feasibility study was conducted to adapt and integrate evidence-based strategies to control hypertension in the primary healthcare system in rural Sri Lanka. METHOD: Public Health Midwives (PHMs) in three Medical Officer of Health areas in Kurunegala district were trained on digital BP measurement and health education of hypertensive patients and their families PHMs screened household members above 40 years of age to identify individuals with hypertension. Socio-demographic data was collected and HHE was delivered as per training manual.PHMs referred probable patients to trained medical officers in the closest divisional hospital for further care and regular follow up. A referral loop was maintained by tracking the referred patients at the rural hospital by supervising PHM and medical officers. RESULTS: 142 hypertensive individuals were recruited and 129(90.8%) of them presented to the health care facility for follow up. At the end of follow up mean systolic blood pressure reduction of 13.8 mmHg (p-0.001) in those with poorly controlled BP (SBP≥160or DBP≥100 ) was demonstrated. CONCLUSIONS: It is feasible to implement this community-based strategy integrated to routine care for improving the management of hypertension in rural communities. Findings of this feasibility study will be fully evaluated in a large randomized controlled trial.Item Prevalence of dementia in a semi-urban population in Sri Lanka(Sri Lanka Medical Association, 2002) de Silva, H.A.; Gunatilake, S.B.BACKGROUND: The Sri Lankan population is aging rapidly. However, the prevalence of dementia, a devastating disease of the elderly, is unknown. Methods: A community survey to assess the prevalence of dementia in a semi-urban population was done in the Gampaha district. The study was conducted in two phases. Phase I: after informed consent 703 randomly selected subjects over 65 years from four PHM areas in Ragama (population 15828) were screened for cognitive impairment using the Sinhala Mini Mental State Examination (MMSE). Subjects scoring <17 were regarded as suspected dementia cases. Phase II: all subjects who screened positive in phase I were included in phase II for detailed evaluation of dementia according to DSM IV and NINCDSADRDA criteria which included structured neuropsychiatric assessment, laboratory investigations, axial and temporal lobe-oriented CT scans of the brain and an informant interview. The average time interval between screening and detailed evaluation for 1 dementia was 7.7 months. RESULTS: 42 subjects screened positive in phase I. Of these, four died, one moved home and one suffered a stroke before detailed evaluation, and two did not consent. Two had psychiatric disease I and five had no evidence of dementia. 27 subjects [Mean age =71(6.37); M:F=8:19] were diagnosed as having dementia according to operative criteria. Of these, 19 (70.4%) had probable Alzheimer's disease (AD), three had vascular dementia (11.1 %), three had mixed (vascular and AD) dementia (11.1 %), one had Lewy body dementia, and one had dementia due to syphilis. CONCLUSIONS: In our study population, the prevalence rate of dementia is at least 3.8%, and the majority (66.6%) is of the Alzheimer type.Item Efficacy of Liv 52 in alcoholic liver disease(Sri Lanka Medical Association, 2001) de Silva, H.A.; Thabrew, M.I.; Saparamadu, P.A.M.; Pathmeswaran, A.; Fonseka, M.M.D.; de Silva, H.J.OBJECTIVE: To assess the efficacy of Liv 52 in patients with alcoholic liver disease. METHOD: A randomized, double-blind, placebo-controlled trial was conducted at Teaching Hospital. Ragama. 80 patients with alcoholic liver disease who fulfilled inclusion criteria were randomly assigned Liv 52 (cases; n=40) or placebo (controls) three capsules twice daily for six months. All subjects underwent clinical examination, and laboratory investigations for routine blood chemistry, serum cholesterol and liver function before commencement of therapy (baseline). Thereafter, clinical assessments were done monthly, while laboratory investigations were done after 1 month and 6 months of therapy. RESULTS: There was no significant difference in the age composition, alcohol intake and baseline liver function between the two groups. The two sample t-test was used to analyze data obtained after 2,3.4,5 and 6 months of therapy against baseline values. There was no significant difference in clinical outcome and liver chemistry between the two groups at any time point. No adverse effect attributable to the drug was reported. CONCLUSION: Liv 52 does not seem to be useful in the management of patients with alcohol induced liver disease.Item Effectiveness of single dose intravenous methyl prednisolone in reversing on going vascular leakage in dengue(Sri Lanka Medical Association, 2013) Premaratna, R.; Abeyrathna, C.; de Alwis, K.; de Silva, H.A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Non-resolution of vascular leakage within 48 hours in dengue shock syndrome (DSS) can result in complications in the recovery phase due to fluid overload. It can also result in death in 0.5-5%. No medication is known to reverse the ongoing vascular leakage. METHODS: Single dose intravenous methyl prednisolone (SDIVMP) was administered to 11 consecutive PCR confirmed adult patients who had ongoing high fever on the 5th day of illness and evidence of plasma leakage; significant rise in Hb, PCV, AST levels and confirmation of fluid leakage by ultrasonography. Informed written consent was obtained from all patients prior to administering SDIVMP. RESULTS: 7/11 were males. Mean age was 24 years (SD 8). At the time of administering SDIVMP; median rise of Hb 9% (5-12), PCV 12%(10-19), absolute rise of AST from 56 iu/L(24-68) to 678iu/L (320-1034) and drop in platelets from 123xl09/L (96-165) to 32xl09/L (15-56). After administration of SDIVMP in all patients, fever reduced rapidly within one hour and there was no further clinical deterioration, rise in Hb, PCV, AST or worsening of ascites or pleura! effusions. However in 5 patients platelet counts continued to drop to < 10x10 /L over the next 2-3 days. None of the patients developed sepsis, abnormal sugars or any other complications such as sepsis, or abnormalities in glucose control. CONCLUSIONS: SDIVMP was effective in reversing fluid leakage in dengue. These findings support the conduct of a double blind placebo controlled trial.Item Comparison of one and two weeks of triple therapy for eradication of H. pylori: a randomized, controlled study in a tropical country(Wiley Blackwell Scientific Publications, 2004) de Silva, H.A.; Hewavisenthi, J.; Pathmeswaran, A.; Navarathne, N.M.M; Peiris, R.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Resistance of H. pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing duration of treatment (triple therapy) from one week to two or three weeks. AIM : To assess the efficacy and tolerability of one-week versus two weeks triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: 82 consecutive patients aged 18–70 years with peptic ulcer disease testing positive for H. pylori infection (histology and rapid urease test on gastric antral biopsies) were randomly allocated to two treatment groups. The baseline characteristics of the two groups were similar. Both groups received omeprazole 20mg, clarithromycin 250mg, and tinidazole 500mg. Group A (n = 42) received the trial medication twice daily for one week and the Group B (n = 40) twice daily for two weeks. H. pylori eradication was defined as a negative 14C labeled urea breath test at two weeks after completion of therapy. The assessors were blind to randomization and other patient information. RESULTS; All patients presented for follow up after completion of therapy. H. pylori infection was eradicated in 36 (85.7%) patients in group A and 36 (90%) patients in group B (p = 0.9; 95% CI: -19.1 to 10.8). 23 (55%) patients in group A and 17 (43%) in group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. 3 (7.5%) patients in group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for one-week is well tolerated and provides as good a rate of H. pylori eradication as two weeks therapy in Sri Lankan patients.Item Impact of a ward-based clinical pharmacy service in reducing drug-related hospital re-admissions in patients with chronic non-communicable diseases; evidence from a controlled trial in Sri Lanka(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Mamunuwa, N.; Dawson, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Literature showed that pharmacists' interventions helped to reduce drug related hospital re-admissions. The objective of this study was to determine the impact of a ward-based clinical pharmacy service on drug related hospital re-admissions in Sri Lanka. METHOD: This was a part of a controlled trial conducted in a tertiary care hospital in Sri Lanka to evaluate the clinical pharmacy service. The intervention group (IG) received a clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases. clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases.