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
343 results
Search Results
Item Hypertension,hyperkalaemia and metabolic acidosis and low serum renin activity: a case report on psuedohypoaldosteronism type 2 in a six-year-old child(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, K.; Lankapriya, K.R.; Kumarasiri, I.M.; Wijesuriya, H.T.S.K.; Seneviratne, S.N.INTRODUCTION Pseudohypoaldosteronism type 2 (PHA II), also known as Gordon syndrome or familial hyperkalaemia and hypertension syndrome, is a rare cause of monogenic low renin hypertension.Its clinical profile commonly includes hyperkalaemia, metabolic acidosis, diminished serum renin and normal aldosterone levels. It typically follows an autosomal dominant inheritance pattern, involving mutations in WNK1, WNK4, KLHL3, and CUL3 genes. Timely detection and management are crucial as these children are prone to complications arising from hypertension and hyperkalaemia.Here, we present a case where biochemical investigations played a pivotal role in arriving at the final diagnosis of PHAII.CASE PRESENTATION Apparently well 6 years and 2 months old girl presented with bilateral frontal headache persisting for three months. Upon examination, her blood pressure consistently exceeded the 99th percentile for age. Laboratory investigations revealed hyperkalaemia, mild hyperchloridemia and low-normal calcium level and metabolic acidosis, in the background of normal renal functions which raised suspicion on PHA II. Her plasma aldosterone concentration was markedly low, while plasma direct renin concentration fell within the low-normal range.Observation of low plasma renin activity provided further evidence of PHA II.Treatment with age-appropriate doses of thiazide diuretics was given in combination with prazosin.The normalization of blood pressure and serum potassium levels following treatment further supported the diagnosis.DISCUSSION AND CONCLUSIONS Patients with PHA II typically exhibit hyperkalaemia and metabolic acidosis (resembling renal tubular acidosis type IV), in the background of normal renal functions.Further they may present with mild hyperchloremia and hypocalcaemia, as observed in our case.In settings where genetic testing resources are limited, the combination of hyperkalaemia, metabolic acidosis, and low serum renin activity serves as a reliable diagnostic hallmark for PHA II.Item Impact of acalypha indica (Kuppamenia) phytochemicals on glucose-6-phosphate dehydrogenase deficiency: two clinical case studies(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, K.; Fernando, N.; Dayanath, B.K.T.P.; Williams, S.; Premawardhena, A.INTRODUCTION Acalypha indica, known as “kuppamenia” in Sinhala, plays a significant role in ayurvedic medicine in Sri Lanka. Despite its medicinal use, certain phytochemicals within the plant have been linked to oxidative stress-induced haemolysis in individuals deficient in glucose-6-phosphate dehydrogenase (G6PD) enzyme activity. However, we know very little regarding those chemicals due to a dearth of literature. Here, we present two cases highlighting the impact of Acalypha indica ingestion on individuals with G6PD deficiency.CASE PRESENTATION Case 1: A 65-year-old man presented with jaundice, pallor, and haematuria after consuming “Kuppamenia mallum”. His peripheral blood picture showed bite cells and Heinz bodies. Positive Brewer’s test raised the clinical suspicion of G6PD deficiency. He received blood transfusions during the acute phase and was discharged upon improvement of symptoms. Low levels of G6PD enzyme at the follow-up visit confirmed the diagnosis. Case 2: A 61-year-old male presented with respiratory distress, jaundice and haematuria, accompanied by peripheral cyanosis and hypotension. He was admitted following four days of continuous ingestion of Acalypha indica. Peripheral oxygen saturation was low, and Heinz bodies were evident in the peripheral blood film. Blotting paper methaemoglobinaemia assessment revealed a level of 70%. Despite optimal medical management, he succumbed to a cardiac arrest on the fourth day of admission.DISCUSSION AND CONCLUSIONS Despite its antioxidant properties, Acalypha indica can precipitate acute haemolysis in G6PD-deficient individuals. Symptomatology and outcomes vary with the amount ingested, underscoring the necessity for research into identifying potentially toxic phytochemicals and their concentrations.Item Evaluation of point-of-care testing (poct) devices for cardiac troponin i in screening patients with myocardial infarction(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, K.; Jayasekara, D.; Kulasinghe, M.; Silva, P.; Harshanee, K.G.A.T.; Bandara, S.R.R.; Dayanath, B.K.T.P.INTRODUCTION AND OBJECTIVES Cardiac troponin I (cTnI) is a crucial biomarker for diagnosing myocardial infarction (MI). However, many remote hospitals lack access to cTnI assessment facilities. This study investigates the feasibility of using Point-of Care Testing (POCT) devices to triage MI patients in such settings, facilitating their transfer to tertiary care hospitals. Assessing the quality of POCT devices is essential for this purpose. This report outlines the assessment methodology of two POCT devices and presents the obtained results.METHODS Two POCT devices, labelled X and Y, for measuring cTnI were compared against the Ortho-Vitros 3600, serving as the reference method, with optimum internal and external quality control measures. Basic specifications of the POCT devices and the comparator were obtained from their respective kit inserts. Routine patient samples were analyzed in singlicate using POCT devices and the reference method. Linear regression analysis was conducted, and correlation graphs were generated. Within-run precision was evaluated using a patient sample and imprecision (CV) was calculated for the POCT devices.RESULTS The linearity ranges for cTnI measurement with POCT devices X and Y were 0.01–15 ng/mL and 0.03–30 ng/ mL, respectively, with decision-making cutoff values for diagnosing MI established at 0.04 ng/mL and 0.5 ng/ mL, respectively. Regression analysis demonstrated acceptable linearity for both POCT devices, with correlation of R2=0.7388 for device X and R2=0.8881 for device Y. However, higher imprecision was observed for both analyzers, with a CV of 26% for device X and 20% for device Y at decision-making cutoff levels.CONCLUSIONS This study highlights major challenges associated with the implementing POCT devices for cTnI assays in triage settings aimed at diagnosing MI in acute care. Specifically, the adoption of higher cutoff levels in the POCT devices, not aligned with the recommended 99th percentile for the healthy population, and the poor precision observed at these cutoff values emerge as significant hurdles.Item Comparative analysis of alkaline phosphatase with two assays using different buffers; diethanolamine (dea) and 2-amino-2-methyl-1-propanol (amp): establishing correlation factors for diagnostic consistency(College of Chemical Pathologists of Sri Lanka, 2024) Jayasekara, D.; Fernando, K.; Kulasinghe, M.; Silva, P.; Madurangi, D.W.D.D.; De Silva, D.D.S.; Harshanee, K.G.A.T.; Bandara, S.R.R.; Dayanath, B.K.T.P.INTRODUCTION AND OBJECTIVES Alkaline phosphatase (ALP) serves as a pivotal biomarker for bone and liver diseases, employing assays utilizing either 2-amino-2-methyl-1-propanol (AMP) (IFCC recommended) or diethanolamine (DEA) buffers, with the latter consistently yielding higher values. This study aimed to develop a correlation factor for ALP reagents using DEA buffer from supplier X, in comparison to routine automated ALP assay at the central laboratory using AMP.METHODS Twenty-five serum samples were analyzed in the central laboratory assay using AMP buffer in a fully automated analyzer with dedicated reagents and the test assay using DEA buffer on a semi-automated biochemistry analyzer within two hours of receipt. Both assays employed the same biochemical reaction, differing only in buffer composition. The linearity ranges for the test assay with DEA buffer and the routine assay with AMP buffer were determined as 1600 U/L and 800 U/L, respectively. RESULTS Patient samples exhibited ALP levels ranging from 0 to 339 U/L by routine assay. The correlation graph demonstrated a satisfactory R2>0.75, indicating adequate number of sample inclusion and quality. A correction factor of 1.2 was calculated for the ALP assay utilizing DEA, compared to the AMP-based assay, employing simple linear regression analysis.CONCLUSIONS According to the sample availability, only ALP levels up to 339 U/L by AMP-based assay were included. Therefore, the correction factor of 1.2 is applicable only up to an ALP level of 400 U/L with the DEA-based assay, necessitating dilution of samples with higher values for the correlation factor’s application. This study indicates a correction factor of 1.2, which is deviated from factors close to 2, observed in literature because of reagents being from different manufacturers and running two assays on two different platforms (automated/ semiautomated). It is important to derive a factor for an ALP assay with DEA buffer to make the results comparable to IFCC recommended AMP buffer used ALP assay.Item Comparative Analysis of Albumin Measurement by Bromocresol Green Versus Capillary Zone Electrophoresis(College of Chemical Pathologists of Sri Lanka, 2024) Harshanee, T.; Jayasekara, D.; Fernando, K.; Kulasinghe, M.; Silva, P.; Bandara, S.; Dayanath, B.K.P.T.INTRODUCTION Quantitative assessment of albumin and globulins in serum protein electrophoresis (SPE) relies on the calculation derived from total protein measurements obtained from the biuret assay. Validation of these results involves comparing sample albumin concentration assessed using the bromocresol green (BCG) method to those obtained from capillary zone electrophoresis (CZE). This study aimed to assess the relationship between albumin values derived from SPE and routine spectrophotometric analysis with BCG method, and to establish a cut-off value to identify significant differences between the two values in SPE validation process. METHODS 187 serum samples were subjected to total protein assessment by biuret method, albumin assessment by BCG method, and SPE by CZE method. SPE derived albumin level using total protein values and BCG method indicated albumin values were analyzed by correlation analysis. The standard error for the difference (SEdif) between the two albumin results were calculated, with statistical significance set at p <0.05. Internal and external quality assessments were deemed acceptable for all three analytical procedures. RESULTS Mean albumin levels obtained via BCG and CZE methods were 38.3 mg/dL and 33.2 mg/dL, respectively, indicating a negative bias for the latter method. A strong correlation (r=0.844, p<0.001) was observed between albumin levels measured by BCG and CZE methods, with Bland-Altman analysis revealing an average negative bias of 5 mg/dL. Using SEdif at 95% significance, the maximum acceptable difference between the two albumin values was determined to be -5.4 mg/dL. CONCLUSIONS BCG method yielded higher albumin results compared to CZE method. This positive bias could be attributed to potential lack of specificity of BCG assay for albumin. A maximum allowable difference of 5.5 mg/dL between the two methods is suggested. Exceeding this threshold indicates potential issues with either the BCG albumin assay, biuret total protein assay, or SPE assay, necessitating further investigation for assay reliability, particularly in reporting SPE by CZE.Item Do doctors really know about “hs-cTnI”? A comprehensive evaluation of knowledge regarding high-sensitivity cardiac troponin I (hs-cTnI) assay among medical officers in Gampaha district(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, N.; Fernando, K.; Gallage, T.; Dayanath, B.K.T.P.; De Silva, S.INTRODUCTION AND OBJECTIVES The high-sensitivity cardiac troponin I (hs-cTnI) assay is a crucial diagnostic marker in the triage of patients presenting with chest pain. Notably, errors in interpreting the testing method have been identified among medical officers, leading to an increased likelihood of inaccuracies in testing and interpretation. This study aims to evaluate the level of understanding among medical officers regarding the hs-cTnI assay in relation to the most recent European Society of Cardiology (ESC) guideline released in 2020. METHODS A cross sectional questionnaire-based study was conducted at two government hospitals in Gampaha District during June 2022. A self-administered e-questionnaire was used to assess knowledge regarding hs-cTnI. Knowledge was measured through cumulative scoring of questionnaire responses, subsequently categorized as either good or poor knowledge. Scores below 60% were designated as poor, and vice versa. Descriptive statistics were employed for data summarization. RESULTS Out of 300 participants, 76% (227) responded. Only 14.5% (33/227) exhibited proficient knowledge of the analytical component, while 41.9% (95/227) demonstrated good knowledge of the clinical component. A score ≥60% on the analytical component knowledge correlated significantly with factors such as designation being a senior registrar or consultant (p<0.001), postgraduate enrolment (p<0.001), participation in continuous professional development programmes (p<0.001), and employment in a teaching hospital (p=0.025). Conversely, no significant associations were observed with age (p=0.066) or private practice (p=0.118). Clinical component knowledge scores ≥60% were significantly associated with age between 25 and 35 years (p=0.006), postgraduate enrolment (p<0.001), participation in continuous professional development programs (p<0.001), and employment in a teaching hospital (p=0.001) but not with doing private practice (p=0.170). CONCLUSIONS In Sri Lanka, medical officers’ analytical knowledge on the hs-cTnI assay seems lacking. Ongoing training programmes are essential to enhance their knowledge and proficiency in hs-cTnI testing.Item Spatial distribution of COVID-19 patients in Sri Lanka(BioMed Central, 2023) Galgamuwa, Lahiru Sandaruwan; Liyanawahunge, Nishan Madhushanka; Ratnayake, Chamilka Gayashini; Hakmanage, Navodi Mekala; Aslam, Fahim; Dharmaratne, Samath D.The research paper comprehensively and consistently addresses all relevant theoretical areas related to the topic and includes an extensive empirical analysis of the absorption of EU funds and their impact on the sustainable development of Croatia, Slovenia, Hungary, and Poland. The analysis aims to investigate the efficiency of the absorption of funds from the EU, the impact of these funds on regional development of countries, and the reasons for such impacts. The “Regional Development Model Based on EU Funds” was tested with the aim of applying the model to the Republic of Croatia, countries in the region, and other European countries, to achieve a higher level of absorption of financial resources from the available EU funds. Data for the empirical analysis were collected using a highly structured survey questionnaire completed by a sample of 244 respondents involved in the preparation and implementation of EU-funded projects. The contribution of economic science in theoretical terms arises from the development of scientific knowledge and ideas about the importance of increasing the number of development projects that will increase the absorption of funds from the European Union, thereby increasing economic activities in Croatia and the region. The expected contribution of economic science in the applied sense is based on the formulation of the “Regional Development Model Based on EU Funds”, which is based on the application of knowledge, good practices, and stakeholder experiences, considering relevant indicators from available sources. The greatest contribution is demonstrated through testing the “Regional Development Model Based on EU Funds”, which is applicable to the Republic of Croatia, countries in the region, and other European countries over a longer period. Finally, research into the impact of EU funds on the regional development of recipient countries is considerably less represented and very modest, and is only in the “upswing” of systematic scientific research. The research aims to fill the gaps in research and to encourage the thinking of key stakeholders responsible for regional development, who should eventually realize the importance of defining a regional policy aimed at EU funds as a key to regional development and reducing regional disparities within countries.Item Assessing motivation to lose weight: the psychometric properties of the Sinhala version of University of Rhode Island Change Assessment (URICA) scale(Sri Lanka Medical Association, 2023) Niriella, M.A.; de Silva, S.T.; Hapangama, A.; Baminiwatta, A.; Fernando, R.; Ediriweera, D.INTRODUCTION: Weight reduction through lifestyle modifications is an important component in the management of various chronic diseases. The degree of motivation to change has been shown to predict outcomes in weight reduction interventions. Thus, the availability of a validated self-report tool assessing the degree of motivation for weight management would be useful for both clinical and research purposes in Sri Lanka. OBJECTIVES: To examine the structural validity and internal consistency of the URICA for weight management in a sample of Sri Lankan adults with chronic medical conditions. METHODS: Standard procedures for cross-cultural adaptation of a questionnaire were followed in translating the 32-item URICA into Sinhala. The Sinhala version was administered to 208 patients aged 18-60 years attending outpatient clinical services for non-disabling chronic medical diseases. Psychometric testing included confirmatory factor analysis and the assessment of internal consistency (Cronbach α). RESULTS: The commonly accepted four-factor structure of URICA reflecting Prochaska and Di Clemente’s transtheoretical model (pre-contemplation, contemplation, action and maintenance) showed good model fit, after the removal of four items from the pre-contemplation subscale due to inadequate factor loadings (<0.4). In line with theory, factor correlations indicated that the pre-contemplation factor was inversely correlated with the other three factors, while the other three factors were positively correlated with one another. All four subscales showed good internal consistency (Cronbach α ranging from 0.73 to 0.89). CONCLUSIONS: The Sinhala version of a modified 28-item URICA was found to have sound psychometric properties as a measure of motivation for weight management among Sinhala-speaking adult patient.Item Knowledge, attitudes, and practices about first aid given for childhood injuries among mothers of preschool children in Ragama MOH area, Sri Lanka(Sri Lanka Medical Association, 2023) Wickramasinghe, P.M.T.B.; Jayasena, A.K.O.M.; Jayathilake, J.M.P.S.; Jayathissa, J.T.M.; Jayathissa, A.V.A.P.; Jayawardena, M.A.T.INTRODUCTION: Children under 5 are the most vulnerable group for unintentional injuries and mothers as the main prehospital caregivers it is vital to have first aid knowledge for common childhood injuries. OBJECTIVES: To assess the existing knowledge about first aid given for unintentional injuries such as burns, cut injuries, poisoning, choking, drowning & fractures and their attitudes, and practices in providing first aid and to find associated factors with knowledge. METHODS: A descriptive cross-sectional study was conducted in the Ragama MOH area, in 2022. 343 mothers were recruited from 12 preschools, using the cluster sampling method. A self-administered questionnaire was distributed, data were analysed using SPSS software and associations were analysed using the Chi-Square test, (p<0.05 -significant) RESULTS: Most of the mothers were young housewives and their knowledge was overall inadequate at first aid. (54.2%) The highest median score was obtained for questions on fractures 3.732 (SD ± 1.454) and the lowest for cut injury 2.752 (SD ± 1.2187). The majority (89.5%) knew the ambulance contact number. Only 47.2% of the mothers had given first aid in an emergency and out of them 67.9% had felt tense while doing so. Most had provided first aid for burn injuries (18.7%). CONCLUSIONS: The majority of participants’ knowledge of first aid was inadequate. Most of them had a positive attitude towards first aid and were willing to learn further. The factors associated with their knowledge were education level and their perception of their own knowledge. Most preferred a hands-on training program for knowledge acquisition.Item Knowledge on common snakes of Sri Lanka, bite prevention, first aid and associated factors among the adults of Ragama medical officer of health area(Sri Lanka Medical Association, 2023) Jayasinghe, A.G.; Hettiarachchi, I.U.; Ilukpitiya, I.S.L.; Imanji, R.P.C.; Huzair, M.M.M.; Jayatissa, R.N.U.; Kurukulasuriya, S.A.F.INTRODUCTION: Snakes, being keystone species in maintaining the existence of ecosystems, always have had a unique influence on humans throughout history. Poor public understanding of snakes has contributed to an increase in disease burden from snakebites. World Health Organisation identifies snake bites as a neglected tropical disease. OBJECTIVES: To evaluate the knowledge on common snakes of Sri Lanka and snakebites among the adults of Ragama Medical Officer of Health area. METHODS: A descriptive cross-sectional study was done using cluster sampling with a sample population of 637 residents (323 females, 314 males, mean age of the population 41.31, SD of 15.59). Interviewer administered questionnaire was used. A unified score was calculated for each participant considering ability to identify of common snakes, knowledge on venom status, bite prevention measures and first aid for snake bites. Participants who achieved 50% or above were attributed with 'good knowledge'. SPSS (version 22) was used. Statistically significant associations were identified by performing the Chi-square test. RESULTS: 59% of the total population had a 'good knowledge'. Of the highly venomous snakes, 98% identified Naja naja, 57% identified Daboia russelii, 44% identified Hypnale Spp and Craspedocephalus sp, 36% identified Bungaurus ceylonicus and 28% identified Bungarus caeruleus. Statistically significant associations regarding knowledge were recognised with sex, previous education on snakes and occupation. CONCLUSIONS: The population had a satisfactory knowledge and awareness on the domains examined. Statistically significant associations were noted between knowledge and sex, participants' occupation and previous education on snakes.