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 Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, postmenopausal, urban Sri Lankan females: a community cohort follow-up study(Wiley Publishing, 2017) Dias, T.; Niriella, M.; de Silva, S.; Motha, C.; Palihawadana, T.S.; Ediriweera, D.; de Silva, J.OBJECTIVES: Metabolic syndrome (MetS) has been recognised as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old female cohort by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: 813/1636(49.7%) of the original female cohort attended follow-up; ET was measured in 567(69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57(10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95%CI:1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95%CI:1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95%CI:0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95%CI:0.10–0.89, p<0.05] were protective. CONCLUSIONS: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.Item Do traditional risk factors for knee osteoarthritis predict pain flares in knee osteoarthritis?.(BMJ Publishing, 2016) Atukorala, I.; Pathmeswaran, A.; Chang, T.; Zhang, Y.; Hunter, D.J.BACKGROUND: Knee pain is the main cause of disability and reduced function in knee osteoarthritis (KOA). Though knee pain in osteoarthritis was previously perceived as a chronic condition it is now established that KOA pain fluctuates. There is emerging evidence that time variant risk factors-such as knee injury, buckling and mood- are associated with knee pain flares. But, it is not known whether conventional risk factors associated with KOA - age, gender, body mass index-are associated with pain flares in KOA. OBJECTIVES: This study examines whether conventional time invariant risk factors for KOA and baseline pain felt by the patient are associated with KOA pain flares. METHODS: Study participants were selected from a 3-month web-based longitudinal follow up study developed to identify risk factors for KOA pain flares. Participants were requested to complete online questionnaire at days 0, 30, 60 and 90 (control period assessment points) and at time points whenever they experienced knee pain flare (case period assessment points) during the follow up period. A KOA pain flare was defined as current pain with a greater than 2 point increase (on a 0-10 point numeric rating scale) from the mildest KOA pain intensity reported at day 0. The association of pain flares with traditional risk factors for knee osteoarthritis -gender, weight, height, body mass index- was assessed by negative binomial regression. The duration of knee osteoarthritis, baseline pain intensity (lowest pain and highest pain scores at baseline) were similarly evaluated. The best explanatory variable was decided by forward selection. RESULTS: 345 persons (61.2% females) with multiple KOA pain flares were selected. Their mean age was 62.1years (SD +/-8.2). The mean body mass index was 29.8kg/m2 (SD +/-6.5). The participants rated their baseline pain (on a numeric rating scale) as being 4.41 (SD+/- 2.02) and their worst pain as being 7.91 (SD +/-1.74). An average of 1.92 (SD 2.59) flares were documented during the 3-month period. The levels of baseline pain - usual and worst pain felt at baseline- were the only parameters significantly associated with KOA pain flares (Table 1). CONCLUSIONS: The baseline pain scores were the strongest predictors of pain flares of knee osteoarthritis. The traditional risk factors associated with knee osteoarthritis did not usefully predict pain flares. The traditional time invariant risk factors may not be associated with short term variability in pain though they are associated with long term outcomes of knee osteoarthritis. It is postulated that as knee pain is already present, time invariant risk factors that contributed to the original symptom causation are not associated with pain flare. (Table Presented).Item Factors associated with urinary tract infections caused by extended spectrum beta-lactamase (ESBL) producing organisms in Sri Lanka(Elsevier, 2016) Fernando, S.; Luke, N.; Wickramasinghe, S.; Sebastiampillai, B.; Gunathilake, M.; Miththinda, N.; Silva, S.; Premaratna, R.BACKGROUND: Urinary tract infections (UTI) caused by extendedspectrum beta-lactamase (ESBL)-producing organisms are a major burden in clinical practice. Hospitalization in the past 3 months, antibiotic treatment in the past 3 months, age over 60 years, diabetes mellitus, Klebsiella pneumoniae infection, previous use of second or third-generation cephalosporins, quinolones or penicillins are known associations and risk factors for ESBL-UTI. METHODS & MATERIALS: A descriptive study was conducted over a period of 6 months from January - July 2015 recruiting patients with UTI caused by ESBL producing organisms, who were admitted to the Professorial Medical unit, Colombo North Teaching Hospital, Ragama Sri Lanka in order to identify risk factors and associations. Data were obtained using a pre-tested interviewer administered questionnaire and from relevant medical records after obtaining informed written consent. RESULTS: 52 patients were recruited; males 30 (57.7%), mean (SD) age 64.1(.12.6)years. Of them, 46 (88.5%) had diabetes mellitus, 32 (61.5%) had hypertension and 10 (19.2%) had chronic liver disease as comorbidities.20 (38.5%) had ultrasonographic evidence of acute pyelonephritis. At presentation16 (30.8%)had biochemical and/or ultrasonographic evidence of chronic or acute on chronic kidney disease. History of constipation was observed in 18 (34.6%), hospitalization during the past 3 months was seen in 24(46.2%)and history of urinary catheterization in 16(30.8%). Features of obstructive uropathy such as hydronephrosis, hydroureter and prostatomegaly were seen in 4 (7.7%) patients each. Antibiotic treatment within the past 3 months was observed in 32(61.5%);penicillins in 18(34.6%), 3rd generation cephalosporins in 16(30.8%),quinolones in 14(26.9%) and 2nd generation cehalosporins in 12 (23.1%). 18 (34.6%) had received more than one antibiotic within the past 3 months. 8(15.4%)patients studied were on prophylactic antibiotics for recurrant UTIs. None of them had recent Klebsiella pneumonia. CONCLUSION: Similar to other studies,diabetes mellitus, recent antibiotic treatment, hospitalization and catheterization were observed in our patients with ESBL-UTI. The fact that only 53.8% patients had received antibiotics at community level and 38.5% patients had never received antibiotics prior to developing ESBLUTI suggest high prevalence of ESBL producing organisms at community level.Item Anal incontinence during postpartum period: a community based cross sectional study(College of Community Physicians of Sri Lanka, 2009) Rajeshkannnan, N.; Pathmeswaran, A.INTRODUCTION: Anal incontinence is regarded as the "unvoiced symptom". It has a negative impact on the quality of life of the sufferer. The commonest cause in women in the reproductive age group is child birth and it is important to determine the burden of anal incontinence and identify possible risk factors in order to improve the quality of intra partum and postpartum care. OBJECTIVE: To determine the frequency and severity of anal incontinence among post partum mothers in Vavuniya district and to identify factors associated with it. METHODS: A community based cross sectional study was conducted. Sample included all mothers (hospital and home deliveries) who had completed postpartum period between 1st August and 30th September 2007. They were identified from the "expected date of delivery" registers maintained by Public Health Midwives (PHMs). Data were collected by trained PHMs at the respondents' houses using an interviewer administered questionnaire. RESULTS: The mean age of the 540 postpartum mothers interviewed was 28 (range: 16 - 44) years. Majority 78 % (n=423) were Sri Lankan Tamils, 13 %(n=68) Sinhalese and remaining 9%(n=49) Moors. Thirty nine percent (n=209) of them were primi parous. Eighty one percent (n=435) had a normal vaginal delivery and 79% (n=344) of them had an episiotomy. Eighty nine mothers complained of anal incontinence giving a prevalence of 16.5% (95% Cl: 13.4 - 19.6). Among them 94.4% (n=84) considered it as a minor problem and only 39.3% (n=35) had consulted a health worker for the symptom. Risk factors for anal incontinence according to descending order of risk included, having an episiotomy (OR= 5.06; 95%CI: 2.60-9.86), vaginal delivery (OR=4.58; 95% Ci: 1.63-12.84), primi parity (OR= 3.45; 95% Cl: 2.25 -5.21), family income above Rs5000/- per month (OR-1.92; 95% Cl: 1.21 - 3.04) and duration of labour (OR= 1.81; 95% Cl : 1.15-2.87) CONCLUSION: Anal incontinence is not an uncommon symptom in postpartum mothers and majority of affected individuals avoid seeking medical attention. Factors associated with increased risk of anal sphincter damage should be considered during delivery and an attempt should be taken to reduce it.Item Prevalence of non-alcoholic fatty liver disease and its risk factors in an urban adolescent cohort in Sri Lanka(Sri Lanka Medical Association, 2015) Jayasinghe, Y.C.; Rajindrajith, S.; Kasturiratne, A.; de Silva, S.T.; Niriella, M.A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Priyantha, T.A.C.L.; Vithiya, K.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: High prevalence of non-alcoholic fatty liver disease (NAFLD) is reported among adults in Sri Lanka. Although limited data on childhood obesity is available, community prevalence of NAFLD and its risk factors among adolescents is unknown. We investigated the prevalence and risk factors for NAFLD in an urban adolescent birth cohort in Sri Lanka. METHODS: The study population consisted 14 year-olds, belonging to the birth cohort born in 2000, residing in the Ragama Medical Officer of Health area. NAFLD was diagnosed based on established ultrasound criteria. Anthropometric measurements, blood pressure (BP) and total body fat distribution (TBF) estimates were made. Fasting blood sugar, serum insulin, fasting serum lipid and serum alanine aminotransferase (ALT) levels were measured. Independent predictors of NAFLD were determined by multivariate analysis. RESULTS: 508 adolescents [263 (51.8%) girls] participated in the study. Overall 44 (8.7%) had NAFLD [22 (8.4%) girls]. 46 (18.8%) boys and 54 (20.5%) girls had a BMI above the equivalent of 23 kgm2in adults. 44 (17.1%) boys and 77 (29.3%) girls had elevated TBF. On multivariate analysis, having an elevated BMI [OR=10.1 (95% confidence interval: 3.9-29.2) and elevated TBF [OR=4.4 (95% confidence interval: 1.5-12.8)] were independently associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adolescents in this urban Sri Lankan community is high, and is strongly associated with obesity and abnormal TBF. Despite elevated TBF being commoner in girls, we found no gender differences in prevalence of NAFLD among adolescents in this urban Sri Lankan community is strongly associated with obesity and abnormal TBF. Our findings emphasize the needs to access these risk factors through preventive and screening programs.Item Risk factors associated with human leptospirosis in the District of Gampaha, Sri Lanka(University of Kelaniya, 2013) Denipitiya, D.T.H.; Athapaththu, M.; Chandrasekharan, N.V.; Abeyewickreme, W.; Hapugoda, M.D.Background & Objective: A large number of leptospirosis cases are recorded in Sri Lanka every year. Increased numbers of cases have been reported in the District of Gampaha in the recent past. The incidence of leptospirosis is often influenced by various socio-economic, occupational, environmental and other factors. To date, a study on potential risk factors has not been conducted in the District of Gampaha. The objective of this study is to identify risk factors involved in transmission of leptospirosis to humans in the District of Gampaha. Methods: Data were collected at the household level, using an interviewer-administered questionnaire and by inspecting the surrounding of laboratory confirmed leptospirosis patients (n=81) and non leptospirosis persons (n=117) during the period of June 2011 to June 2013. The risk factors in the questionnaire were divided into three broad categories: environmental, contact with animals and behavioral/occupational factors. Chi-square test (The SAS System for Windows 9.0) was used for comparison of data from different categories. Results and discussion: 95% of the leptospirosis patients were adult males (77/81) and they had a monthly income of Rs. 10,001-20,000 and 50% of them were agricultural and rental work labourers (40/81). In contrast, 56% of persons not infected with leptospirosis were adult females (66/117) and most of them (48%) were housewives or homemakers (56/117). Data on the type of premises were collected under three categories as poor, moderate and well constructed along with the land use type of the surrounding areas. There were significant statistical associations between the leptospirosis patient with the type of premises (, χ2=23.38, p=0.00), surrounding cleanliness of premises (χ2=45.05, p=0.00), sanitary facilities (χ2=11.66, p=0.00), waste disposal method (χ2=32.23, p=0.00) and age level of patients (χ2=21.07, p=0.00). No significant statistical associations were observed between recorded leptospirosis cases and vegetation coverage in surrounding area of premises (χ2=1.25, p>0.05), source of drinking water (χ2= 0.55, p>0.05) and numbers of persons in family (χ2=0.17, p>0.05). Conclusion: Identification of the potential risk factors would help understand the transmission dynamics of the disease and formulate public health interventions.