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.de Silva, H.A.

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    Synergistic effect of combining MLC601 and rehabilitation on post-stroke recovery: The Chimes-E Study
    (Asia Pacific Stroke Organization, Hong Kong Stroke Society and Jiangsu Stroke Association & karger publishing, 2017) Suwanwela, N.; Lee, C.F.; Christopher, L.H.; Chen; Sherry, H.; Young; Tay, S.S.; Umapathi, T.; Lao, A.Y.; Gan, H.H.; Alejandro, C.; Baroque; Jose, C.; Navarro; Hang, H.M.; Joel, M.; Advincula; Muengtaweepongsa, S.; Chan, B.P.L.; Chua, C.L.C.; Wijekoon, N.; de Silva, H.A.; Hiyadan, J.H.B.; Wong, K.S.L.; Poungvarin, N.; Eow, G.B.; Venketasubramanian, N.
    BACKGROUND AND RATIONALE: MLC601 has been shown to enhance natural neuro-repair mechanisms after stroke and may also facilitate rehabilitation-stimulated recovery processes. We aimed to assess the effect of MLC601 and concomitant rehabilitation on stroke recovery in the CHIMES-E study to test the hypotheses that there would be a synergistic effect. METHODS: The CHIMES-E study recruited 880 subjects aged ≥18 years with acute ischemic stroke (AIS), National Institute of Health Stroke Scale (NIHSS) 6–14, and pre-stroke modified Rankin Scale (mRS) ≤1 in a planned double-blind extension study of CHIMES trial with MLC601 or matching placebo given for 3 months in addition to standard stroke care and rehabilitation prescribed by the treating physicians. From Month (M) 3 to M24, mRS was compared between MLC601 and placebo. RESULTS: The study population had a mean age of 61.8 ± 11.3 with 318 (36%) women. Data on rehabilitation and mRS at M3 were available in 807 (91.7%) subjects. Treatment groups were balanced in baseline characteristics except for NIHSS mean score being higher in the rehabilitation group (Rehab) (p = 0.013). Stratification of subjects according to rehabilitation status (Rehab or NoRehab) showed a higher treatment effect of MLC601 on both mRS shift and dichotomy (0–1 vs. 2–6) from M3 to M24 in Rehab group, after adjusting for baseline differences and poorer prognosis factors. In the Rehab group, the adjusted odds of functional independence (mRS of ≤1) increased significantly over time in favor of MLC601 from M3 to M24, with the highest OR at M12 of 2.42 (1.53, 3.81). CONCLUSION: Combining MLC601 and rehabilitation increases improvement of functional recovery over 2 years, supporting a synergistic effect on brain neuro-repair processes after AIS, with more subjects improving to functional independence compared to placebo.
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    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 population
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    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 mortality
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    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.
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    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.
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    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.
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    Ante-mortem diagnosis of Alzheimer's disease (AD) by measuring medial temporal lobe (MTL) thickness on CT scans
    (Sri Lanka Medical Association, 2003) de Silva, H.A.; Gunatilake, S.B.
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    Management of yellow oleander poisoning (YOP) with multiple-dose activated charcoal: a randomized placebo controlled trial
    (Sri Lanka Medical Association, 2003) de Silva, H.A.; Fonseka, M.M.D.; Pathmeswaran, A.; Alahakone, D.G.S.; Ratnatilake, G.A.; Gunatilake, S.B.; Ranasinha, C.D.; Lalloo, D.G.; Aronson, J.K.; de Silva, H.J.
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    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.
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    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.