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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    First co-infection of malaria and hepatitis E diagnosed in Sri Lanka
    (Sri Lanka Medical Association, 2023) Senarathne, S.; Rajapakse, S.; de Silva, H.J.; Seneviratne, S.; Chulasiri, P.; Fernando, D.
    INTRODUCTION: Imported malaria cases continue to be reported in Sri Lanka. Similarly, hepatitis E is also considered a travel associated imported disease in Sri Lanka. This is a report of the first co-infection of malaria and hepatitis E in Sri Lanka. OBJECTIVES: A 21-year-old European who visited Sri Lanka after a 2 months stay in India, was admitted to hospital with fever, vomiting, abdominal pain, and dark-coloured urine on the 4th day after his arrival. On examination, he had splenomegaly but no hepatomegaly. He had thrombocytopaenia; 89% neutrophils; 9% lymphocytes; elevated liver enzymes and hyperbilirubinaemia. Urine was positive for bile pigment. METHODS: Considering his travel history to India, he was tested for malaria. The rapid diagnostic test became positive for Plasmodium falciparum while microscopy showed P. falciparum ring stages with a parasite density of 120/μl. He was treated as for uncomplicated P. falciparum malaria with oral Artemisinin-based Combination Therapy. The patient became fever-free and blood smears became negative after 13 hours following 2 doses of antimalarials. RESULTS: However, his liver functions were further deranged with apparent jaundice (ALT: 250 U/L; AST: 175 U/L; ALP: 130 U/L; GGT: 179 U/L; total bilirubin: 10.65 mg/dL; direct bilirubin: 8.08 mg/dL; indirect bilirubin: 2.57 mg/dL). Further blood tests detected hepatitis E-specific IgM antibodies. He was treated with oral ursodiol but no specific antiviral was given. Following the completion of antimalarials, he was discharged from the hospital upon clinical recovery. CONCLUSION: Clinicians should be vigilant on travel-associated co-infections in patients who are diagnosed with imported malaria.
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    Identification of type 2 diabetes patients with non-alcoholic fatty liver disease who are at increased risk of significant hepatic fibrosis: a cross-sectional study
    (Sri Lanka Medical Association, 2023) Mettananda, K.C.D.; Egodage, T.; Dantanarayana, C.; Solangarachchi, M.B.; Fernando, R.; Ranaweera, L.; Siriwardhena, S.; Ranawaka, C.K.; Kottahachchi, D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, H.J.
    INTRODUCTION: Annual screening of patients with diabetes for fatty liver, and identifying those with significant hepatic fibrosis using the FIB-4 score and vibration-controlled transient elastography (VCTE) has been recommended to detect patients who may progress to advanced hepatic fibrosis/cirrhosis. However, VCTE is not freely available in resource-limited settings. OBJECTIVES: To identify clinical and biochemical predictors of significant liver fibrosis in diabetics with fatty liver. METHODS: We conducted a cross-sectional study among all consenting adults with T2DM and non-alcoholic fatty liver disease (NAFLD) attending the Colombo North Teaching Hospital, Ragama, Sri Lanka from November 2021 to November 2022. FIB-4 scores were calculated and patients with a score ≥1.3 underwent VCTE. Risk associations for liver fibrosis were identified by comparing patients with significant fibrosis (LSM ≥8 kPa) with those without significant fibrosis (FIB-4<1.3). RESULTS: A total of 363 persons were investigated. Of these, 243 had a score of FIB-4 <1.3. Of the 120 with a FIB-4 ≥1.3, 76 had LSM ≥8 kPa. Significant fibrosis was individually associated with age (OR 1.01, p<0.0001), duration of diabetes (OR 1.02, p=0.006), family history of liver disease (OR 1.42, p=0.035), waist (OR 1.04, p=0.035), and FIB-4 (OR 2.08, p<0.0001). However, on adjusted analysis, significant fibrosis was only associated with a family history of liver disease (OR 2.69, p=0.044) and FIB-4 (OR 1.43, p<0.001). CONCLUSION: In patients with T2DM and fatty liver, advancing age, increased duration of diabetes, a family history of liver disease, waist circumference and a high FIB-4 score increase the risk of significant hepatic fibrosis. Targeted interventions in this group may help prevent progression to advanced hepatic fibrosis/cirrhosis.
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    Is splenic stiffness measurement(SSM) better than Baveno VII criteria to predict oesophageal and cardio- fundal varices in patients with compensated advanced liver cell disease (cACLD)?
    (Sri Lanka Medical Association, 2023) de Silva, A.P.; Niriella, M.A.; Nishad, A.A.N.; Samarawickrama, V.T.; Jayasundara, H.; Ranawaka, C.K.; de Silva, S.T.; Withanage, M.; Ediriweera, D.; de Silva, H.J.
    INTRODUCTION: Liver and splenic stiffness measurements (LSM and SSM) using transient elastography (TE) are being increasingly used as a screening tool to predict varices. OBJECTIVES: We aimed to test the utility of Baveno-VII criteria (LSM>25kPa, LSM>20kPa with platelet count <130,000 and LSM>15kPa with platelet count <110,000) and SSM to predict oesophageal and cardio-fundal varices in a cohort of Sri Lankan patients with aALCD. METHODS: Consecutive patients with newly diagnosed Child’s class A cALCD (non-viral, BMI<30) were recruited prospectively. They underwent upper gastrointestinal endoscopy by an endoscopist followed by a Fibroscan by an operator who is unaware of endoscopy findings using ECHOSENS-Fibroscan-502 to measure LSM and SSM. Validity measurements of three Baveno-VII criteria and SSM values to predict oesophageal and cardio-fundal varices were calculated. RESULTS: One hundred and seventy-four individuals were recruited [Mean (95%CI) age 61.4 (59.7-62.8) years, 110 males], and 106 had varices. Our results indicate that the three Baveno VII criteria had sensitivities of 61%, 63% and 42%, and specificities of 79%, 77% and 87%. SSM>30kPa alone or in combination with LSM>15kPa had sensitivity of 81&75%, specificity of 72&83%, PPV of 82&87%, NPV of 71&67% and accuracy of 78&78% consecutively to predict oesophageal and cardio-fundal varices. CONCLUSION: Baveno VII criteria had low sensitivity but high specificity to predict oesophageal and cardio-fundal varices. SSM>30kPa alone or in combination with LSM>15kPa seemed to predict oesophageal and cardio-fundal varices better.
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    Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study
    (Ceylon College of Physicians, 2020) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chackrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.P.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.
    INTRODUCTION AND OBJECTIVES: There are no cardiovascular(CV)-risk prediction models specifically for Sri Lankans. Different risk prediction models not validated among Sri Lankans are being used to predict CV-risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected participants between 40-64 years, by stratified random sampling of the Ragama Medical Officer of Health area in 2007 and followed them up for 10-years. Risk predictions for 10-years were calculated using WHO/ISH (SEAR-B) charts with- and without-cholesterol in 2007. We identified all new-onset cardiovascular events(CVE) from 2007-2017 by interviewing participants and perusing medical-records/death-certificates in 2017. We validated the risk predictions against observed CVEs. RESULTS: Baseline cohort consisted of 2517 participants (males 1132 (45%), mean age 53.7 (SD: 6.7 years). We observed 215 (8.6%) CVEs over 10-years. WHO/ISH (SEAR B) charts with­ and without-cholesterol predicted 9.3% (235/2517) and 4.2% (106/2517) to be of high CV-risk ≥20%), respectively. Risk predictions of both WHO/ISH (SEAR B) charts with- and without-cholesterol were in agreement in 2033/2517 (80.3%). Risk predictions of WHO/ISH (SEAR B) charts with and with­ out-cholesterol were in agreement with observed CVE percentages among all except in high­ risk females predicted by WHO/ISH (SEAR B) chart with-cholesterol (observed risk 15.3% (95% Cl 12.5 - 18.2%) and predicted risk 2::20%). CONCLUSIONS: WHO/ISH (SEAR B) risk charts provide good 10-year CV-risk predictions for Sri Lankans. The predictions of the two charts, with and without-cholesterol, appear to be in agreement but the chart with-cholesterol seems to be more predictive than the chart without-cholesterol. Risk charts are more predictive in males than in females. The predictive accuracy was best when stratified into two categories; low (<20%) and high (≥20%) risk.
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    Incidence and prevalence of stroke and time trends in vascular risk factors among urban/semi-urban Sri Lankans: A population-based cohort study
    (Ceylon College of Physicians, 2020) Mettananda, K.C.D.; Ranawaka, U.K.; Wickramarathna, K.B.; Kottahachchi, D.C.; Kurukulasuriya, S.A.F.; Matha, M.B.C.; Dassanayake, A.S.; Kasturiratne, K.T.A.A.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.
    INTRODUCTION AND OBJECTIVES: Incidence of stroke is declining in developed countries, but is increasing in developing countries. There is no data on incidence of stroke in Sri Lanka, and only limited data on prevalence of stroke. METHODS: We studied a population-based cohort (35-64 years) selected by stratified random sampling from an urban/semi-urban health administrative area (Ragama Health Study) in 2007, and evaluated them again in 2014 with regard to new onset stroke and prevalence of vascular risk factors. Possible stroke patients were independently reviewed by a neurologist and a physician with regard to the diagnosis of stroke. The prevalence of stroke (at baseline) was estimated. Prevalence of vascular risk factors in the population were compared between 2007 and 2014. RESULTS: The baseline cohort in 2007 consisted of 2985 individuals (females 54.5%, mean age 52.4 ± 7.8 years). Of them, 2204 attended follow-up in 2014 (female 57.6%, mean age 59.2±7.6 years). 19 had a history of strokes at enrolment (stroke prevalence 6.37/1000 population) and 24 episodes of strokes occurred over the 7 years (annual incidence of stroke 1.56/1000 population). Risk factor prevalence in 2007 and 2014 were; hypertension 48.7% and 64.3%; hyperlipidaemia 35.5% and 39.3%; diabetes mellitus 28.2% and 35.7%; and obesity 2.6% and 17.9%, respectively. CONCLUSION: Stroke incidence and prevalence rates of Sri Lanka lie between those of developed and developing countries. Prevalence of vascular risks have increased over time in this urban/semi­ urban Sri Lankan population.
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    Incidence and Phenotype of Inflammatory Bowel Disease From 13 Countries in Asia-Pacific: Results From the Asia-Pacific Crohn's and Colitis Epidemiologic Study 2011-2013
    (American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2016) Ng, S.C.; Kaplan, G.; Banerjee, R.; Wei, Shu-Chen; Tang, Whitney; Zeng, Z.; Chen, Min-hu; Yang, H.; de Silva, H.J.; Niriella, M.A.; Ong, D.E.; Ling, Khoon-Lin; Hilmi, I; Pisespongsa, P.; Aniwan, S.; Limsrivilai, J.; Abdullah, M.; Chong, V.H.; Cao, Q.; Miao, Y.; Ong-Go, A.K.; Bell, S.; Niewiadomski, O.; Kamm, M.A.; Ng, K.K.; Yu, H.H.; Wang, Yu-Fang; Ouyang, Q.; Goh, K.L.; Lin, Hung-Hsin; Lin, Wei-Chen; Wu, K.; Simadibrata, M.; Chan, F.K.; Sung, J.
    Background: The Asia-Pacific Crohn's and Colitis Epidemiology Study, initiated in 2011, aimed to determine the incidence and phenotype of inflammatory bowel disease (IBD) in Asia-Pacific. We herein present incidence and phenotype data from 2011 through 2013 for 12 countries or areas in Asia (Brunei, China, Hong Kong, India, Indonesia, Macau, Malaysia, Philippines, Singapore, Sri Lanka, Taiwan, Thailand) and Australia. Methods: We performed a prospective, population-based study of IBD incidence in predefined catchment areas using a web-based database. New cases were diagnosed based on standard criteria and ascertained from multiple sources. Endoscopy, pathology, and pharmacy records were searched for completeness of case capture. Age-standardized incidence was calculated with 95% confidence interval (CI). Crude incidence in different regions within Asia was pooled together using a random effect model. Results: We identified 1,572 new IBD patients (2011-2012, n=419; 2012-2013, n=1,153; 131 from Australia) including 1,057 (67%) ulcerative colitis (UC) and 515 (33%) Crohn's disease (CD). The mean annual incidence for IBD per 100,000 was 1.68 (95% CI, 1.59-1.77) in Asia and 22.28 (95% CI, 18.48-26.71) in Australia. The three countries within Asia with the highest incidence per 100,000 was India (9.31; 95% CI, 8.38-10.31), China (Guangzhou) (3.30; 95% CI, 2.68-4.06) and Hong Kong (2.58; 95% CI, 2.20-3.03). Within five regions of China, IBD incidence varied from 0.49 to 3.30 per 100,000. Pooled incidence of UC and CD within East Asia (China, Macau, Hong Kong, Taiwan) was 1.12 (95% CI, 0.77-1.48) and 0.33 (95% CI, 0.17-0.49), respectively. Pooled incidence of UC and CD within South East Asia (Brunei, Malaysia, Singapore, Indonesia, Thailand, Philippines) was 0.38 (0.21-0.55) and 0.30 (95% CI, 0.22-0.38), respectively. Ratio of UC:CD was 2.21 in Asia and 0.64 in Australia. Median time from symptom onset to diagnosis was 3 months [interquartile range (IQR), 2-10] for UC and 7 months (IQR 2-19) for CD. Stricturing, penetrating and perianal CD at diagnosis was common (21%, 10% and 17%, respectively) in Asia. Conclusion: Robust large-scale comparative epidemiologic IBD data from newly industrialized countries are emerging. Incidence of IBD varies throughout Asia with a higher incidence in East than South-East Asia. Complicated CD at diagnosis remains prevalent in Asia. Emergence of IBD in Asia will result in the need for specific health-care resources.
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    Occurence of tick bits and serological evidence of exposure to rickettsioses among Sri Lankan military personnel
    (International Society for Infectious Diseases, 2009) Premaratna, R.; Chandrasena, T.G.A.N.; Nawasiwatte, B.M.T.P.; Kulasiry, K.I.R.; Rajeev, S.; Bandara, K.B.K.R.G.W.; Rajapakse, R.P.V.J.; Kularatna, S.A.M.; de Silva, H.J.
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    Predicted cost benifits of establishment of Ricckettsial didease diagnostics in Sri Lanka
    (American Society of Rickettsiology, 2008) Premaratna, R.; Dissanayake, I.; Chandrasena, T.G.A.N.; Attanayake, N.; de Silva, H.J.
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    Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: A hospital based study
    (American Society of Rickettsiology, 2007) Premaratna, R.; Loftis, A.D.; Chandrasena, T.G.A.N.; Dasch, G.A.; de Silva, H.J.
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    The role of antioxidants in filarial infection
    (Royal Society of tropical medicine and Higiene (RSTMH), American Society of tropical medicine and Higiene(ASTMH), British Society for Parasitology, 2000) Premaratna, R.; Chandrasena, T.G.A.N.; Senarath, S.; Chandrasena, L.G.; de Silva, N.R.; de Silva, H.J.
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