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 Long-term function after transanal versus transabdominal ileal pouch-anal anastomosis for ulcerative colitis: a multicenter cohort study(Wiely-Blackwell, 2019) Chandrasinghe, P.; Carvello, M.; Wasmann, K.; Tanis, P.; Warusavitarne, J.; Spinelli, A.; Bemelman, W.AIM:The novel transanal approach to ileal pouch-anal anastomosis (ta-IPAA) provides better exposure with lower short-term morbidity in ulcerative colitis (UC). The aim of this study was to assess the long-term outcomes after ta-IPAA versus abdominal IPAA (abd-IPAA) in UC. METHOD:This is a multicentre cohort analysis between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. The primary end-point was CGQL (Cleveland Global Quality of Life) score at 12 months. RESULTS:374 patients (100 ta-IPAA vs 274 abd-IPAA) were included. Mean CGQL scores were comparable between the two groups (0.75 ± 0.11 vs 0.71 ± 0.14; respectively, P = 0.1). Quality of life (7.71 ± 1.17 vs 7.30 ± 1.46; P = 0.04) and energy level (7.16 ± 1.52 vs 6.66 ± 1.68; P = 0.03) were significantly better after ta-IPAA, while the quality of health item was comparable (7.68 ± 1.26 vs 7.64 ± 1.44; P = 0.9655). Stool frequencies (> 10/24 h:22% vs 21%; P = 1.0) and major incontinence rates (27% vs 26%; P = 0.89) were similar. Thirty-day morbidity rates (33% vs 41%; P = 0.2) and anastomotic leak rates were comparable (6% vs 13%; P = 0.09). CONCLUSION: This study, for the first time, provides evidence of comparable long-term functional outcome of ta-IPAA vs abd-IPAA for UC.Item Survival following curative surgery for colorectal cancer (CRC) in the middle-aged population: data from a South Asian cohort(Springer, 2021) Vishwajith, P.; Chandrasinghe, P.; Gunasekare, K.; Gajasinghe, S.; Kumarage, S.BACKGROUND/AIM : Colorectal cancer (CRC) is the fourth commonest cancer in Sri Lanka. Disease burden and survival among the middleaged population (50–70 years) with CRC is less studied. With the aging global population, this cohort has a high economic and a social impact. This study aims to analyse the survival pattern and contributing factors in a middle-aged patient cohort with CRC. METHODS: CRC patients managed with a curative intent between 1997 and 2020 at a specialised tertiary care unit were analysed. Demographic data, tumour characteristics and survival of the patients aged between 50 and 70 years was analyzed. Overall survival was compared with the younger (\50 years) and older ([70 years) populations with CRC using Kaplan–Meire curves. Individual variable analysis was performed to sought for significant association of survival with age, sex, tumour stage and tumour site. Multifactorial analysis was performed using Cox-proportional hazard model. RESULTS: A total of 411 patients between 50 and 70 years age group with CRC were analysed (mean 60.07 years; range—50–70 years, male—47.45%). Overall survival of the middle-aged population was significantly better (mean— 133 months, SE 6.84) compared to the elderly population (mean—58 month, SE = 7.74) but worse compare to the younger population (mean—167 month, SE = 10.81). Majority of the tumours (60.5%) in the middle-aged group were locally advanced on presentation ([T3). Tumor site and age at presentation were significant factors that influence survival in this age group. CONCLUSION: Middle-aged patients have a better mean overall survival than their older counterparts but fare worse compared to the younger age group. Tumor stage and age were the only factor that significantly influenced survivalItem Quality of life following curative surgery for colorectal cancer in a Sri Lankan cohort; North Colombo experience(Springer, 2021) Godahewa, S.; Gunasekare, K.; Gajasinghe, S.; Kumarage, S.; Chandrasinghe, P.BACKGROUND/AIM: Colorectal cancer (CRC) is the 4th commonest cancer in Sri Lanka. It is increasingly approached with a curative intent due to the advancements in the surgical and medical management. This has resulted in a large cohort of cancer survivors that needs to be managed. Quality of life (QOL) and patient reported outcomes in CRC survivors assist in identifying and managing unique issues in this population. This study aims to describe objectively measured quality of life after surgery for colorectal cancer in a South Asian population. METHODS: Patients who underwent surgery for CRC and are currently disease free were included. QOL was assessed using the translated and validated SF36 questionnaire (Sinhala) along with patient complaints. SF36 components were aggregated into physical component summery (PCS) and mental component summery (MCS). Patient reported symptoms were categorized in to organ function, life style, and psycho-sexual. RESULTS: A Total of 100 patients completed the survey (median age—61 years; range 25–86, female—56%). Of the total 65% were rectal cancers while 35% were colon cancers. QOL assessment reported a PCS of 0.64 and a MCS of 0.67 (Max- 1.0). There was no difference in QOL between rectal and colon cancers (PCS: rectal—0.64 vs colon—0.63, P = 0.9; MCS: rectal— 0.65 vs colon—0.66) or based on follow-up period (\5 years vs[ 5 years; P = 0.3 and 0.9). Organ function related problems were reported by 69% and increased frequency was the main complaint (27%). CONCLUSION: The QOL of a Sri Lankan cohort of CRC survivors is described. QOL did not differ between rectal and colon cancers. Neither PCS nor MCS had significantly improved over time following surgery.Item Survival pattern and clinicopathological data from a South Asian cohort of young colorectal cancers treated with curative intent(Springer, 2021) Gunasekare, K.; Godahewa, S.; Vishwajith, P.; Gajasinghe, S.; Ekanayake, M.; Kumarage, S.; Chandrasinghe, P.BACKGROUND/AIM :Colorectal cancer (CRC) has the fourth highest incidence among cancers in Sri Lanka. Although CRC is considered as a disease of the elderly, currently there is a shift towards an increasing incidence of young cancers globally. Despite the increasing incidence there is a scarcity of data from the South Asian region. This study aims to analyze the clinicopathological features and long term survival of young CRC from a South Asian cohort of patients. METHODS: All patients treated for CRC at a tertiary care center from 1997 to 2017 were prospectively followed up. Demographics, tumour characteristics and survival data were recorded. Age less than 45 years at diagnosis was considered as a young cancer. Overall survival among the populations was compared using Kaplan-Mire survival curves. A P value of\0.05 was considered significant. Results: A total of 113 (16.5%) young cancers (Mean age 36.35; range 17–45; female 53.1%) were operated during the period. Rectum (60.2%) was the commonest site followed by the right colon (24.8%) and left colonic (15%) tumors. Adenocarcinomas of moderately differentiated variety (72.4%) was the commonest histological type. Seventy percent of cases had locally advanced disease (T3/T4) with 53.2% having positive nodal status. Of the total 27% received neoadjuvant treatment and 66.7% received adjuvant treatment. Young CRC patients had a significantly better overall survival compared to their older counterparts (P = 0.008). CONCLUSION Young cancers accounts for a significant proportion of the colorectal cancers in this cohort. Over 75% of the cancers were on the left colon and the majority was locally advanced disease. Overall survival of the young CRCs were better compared to the older population in this cohort.Item Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases(Elsevier, 2017) Wijekoon, C.N.; Shanika, L.G.T.; Jayamanne, S.; Coombes, J.; Dawson, A.BACKGROUND: Adverse drug reactions (ADRs) pose a major problem in medication use. This study was done to describe incidence, nature and associated factors of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHODS: The prospective observational data presented here are obtained as a part of a large study conducted in a tertiary-care hospital in Sri Lanka. In-ward patients with NCCDs were recruited systematically using the admission register in the ward as the sampling frame. All ADRs occurred during the index hospital admission and 6-month post-discharge period were detected by active surveillance. RESULTS: 715 patients were studied (females – 50.3%; mean age – 58.3±15.4years). 35.4% were aged ≥65years. Mean number of drugs prescribed per patient was 6.11±2.97. Most prevalent NCCDs were hypertension (48.4%), diabetes (45.3%) and ischemic heart disease (29.4%). 154 ADRs [33 (21.4%) during index hospital admission; 121 (78.6%) during 6-month post-discharge period) were detected involving 112 (15.7%) patients. 51.9%(80/154) of them were potentially avoidable. 47% (73/154) of ADRs were 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 (6/46) and hypotension due to anti-hypertensives (6/46). ADRs were more common in elderly (34% vs 14.7%, p<0.001), in those who were on ≥5 drugs (25.9% vs 12.7%, p<0.001) and among those with diabetes (28.5% vs 15.6%, p<0.001). 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 drugs and were potentially avoidable. Factors associated with a higher incidence of ADRs were age ≥65years, ≥5drugs in the prescription and presence of diabetes. The healthcare system in the study setting needs improvement in order to minimize ADRs.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 Patterns of alcohol use and occurrence of alcoholic fatty liver disease: a prospective, community cohort, 7-year follow-up study(Sri Lanka Medical Association, 2017) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.INTRODUCTION & OBJECTIVES: Data is limited on alcoholic fatty liver disease (AFLD). We investigated patterns of alcohol use and AFLD, among urban, adult, Sri Lankans. METHODS: Study population (selected by age-stratified random sampling from Ragama MOH-area) was screened initially in 2007 (35-64 years) and re-evaluated in 2014. On both occasions they were assessed by structured-interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. AFLD was diagnosed on ultrasound criteria, unsafe alcohol consumption (Asian standards: males>14units, females>7units per week) and absence of hepatitis B/C markers. Controls were individuals with unsafe alcohol consumption, but had no ultrasound criteria of AFLD. Case-control genetic-association for PNPLA3 (rs738409) polymorphism for AFLD was performed. RESULTS: A total of 2983/3012 (99%) had complete data. 272/2983(9.1%) were unsafe-drinkers [males- 70; mean-age 51.9 (SD-8.0) years]. 86/2983 (2.9%) of the cohort and 86/272 (31.6%) of unsafe-drinkers had AFLD [males-85; mean-age 50.2 (SD-8.6) years]. Males [p<0.001], increased waist circumference (WC) [p=0.001], BMI>23kg/m2 [p<0.001], raised triglycerides (TG) [p<0.001], low education level (LEL-not completed secondary-education) [p<0.01] and low monthly household-income (23kg/m2 [p<0.001], raised TG [p<0.001] and LEL [p<0.05] independently predicted incident-AFLD. The genetic association study [133-cases (combined 2007-2014), 97-controls] showed no association with AFLD at PNPLA3 (rs738409). CONCLUSION: The prevalence of AFLD was 2.9% in 2007 and annual incidence among heavy drinkers, after 7-year follow-up was 5.7%. Incident-AFLD was associated with males, obesity, raised TG and LEL.Item Incidence, prevalence and demographic and life style risk factors for obesity among urban, adult Sri Lankans: a community cohort follow-up study(Sri Lanka Medical Association, 2017) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranasinghe, R.M.A.G.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.INTRODUCTION & OBJECTIVES: Obesity is a global problem. Data from the South Asian region is limited. METHODS: In a cohort follow-up study we investigated obesity among urban, adult, Sri Lankans (35-64y; selected by age-stratified random sampling from Ragama-MOH area; initial screening 2007; re-evaluation 2014). On both occasions structured interview, anthropometry, liver ultrasound, biochemical and serological tests were performed. Total body fat (TBF) and visceral fat percentage (VFP) were assessed by impedance in 2014. General-obesity (GO) was BMI>25kg/m2. Central-obesity (CO) was waist circumference (WC)>90cm males and WC>80cm females. Multinomial logistic regression was fitted to assess associations. RESULTS: In 2007 (n=2967), 614 (20.7%) were overweight [51.9%-women], 1161(39.1%) had GO [65.9%-women] and 1584(53.4%) had CO [71%-women]. Females (p<0.001), raised-TG (p<0.001), low-HDL (p<0.001), diabetes (p<0.001), hypertension (p<0.001), NAFLD (p<0.001), and low household income (p<0.001) were significantly associated with prevalent GO and CO respectively. Additionally, increased-age (p=0.05), low-educational level (p<0.001) and unhealthy eating (p<0.001) were associated with prevalent CO. Inadequate physical activity was not associated with either. 2137 (72%) attended follow-up in 2014. Of those who were initially non-obese who attended follow-up, 189/1270 (14.9%) [64% women] had developed GO (annual-incidence 2.13%) and 206/947 (21.9%) [56.3% women] had developed CO (annual incidence 3.12%) after 7 years. TBF and VFP significantly correlated with incident GO and CO (p<0.001). Female gender (OR-1.78, p<0.001; 2.81, p<0.001) and NAFLD (OR-2.93, p<0.001; OR-2.27, p<0.001) independently predicted incident GO and CO respectively. CONCLUSION: The prevalence and incidence of GO and CO were high in this cohort. Both incident GO and CO were strongly associated with female gender and NAFLD.Item Lean non-alcoholic fatty liver disease (Lean-NAFLD): characteristics and risk factors from a community cohort follow up study(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is usually associated with obesity. However, some NAFLD patients are lean. We assessed the characteristics and risk factors for lean-NAFLD. METHOD: In a community cohort follow up study (initial screening-2007, re-evaluation-2014), NAFLD was established on USS criteria and exclusion of alcohol overuse and secondary causes. Lean (BMI <23 kg/m2) and non-lean (BMI ≥23 kg/m2) NAFLD were compared. The two groups were compared for differences in gender, diabetes, hypertension, hypertriglyceridemia, low-HDL, weight and waist circumference (WC) at baseline. They were also compared for differences in development of incident diabetes, hypertension, hypertriglyceridemia, low-HDL, and change in weight and WC. RESULTS: 678 (69.6%) individuals with NAFLD detected in 2007 presented for follow up in 2014. 78(11.5%) [males-32(41%); mean-age 53.7(SD-7.1) years] were lean and 600(88.5%) [males-191(31.8%); mean-age 52.3(SD-7.5) years] were non-lean. Hypertension (p=0.007) and a smaller WC (<90cm for males, <80cm for females) (p<0.001) were associated with lean-NAFLD. After 7 years, change in BMI was less (p=0.022) among lean-NAFLD. There were no differences in change in WC or incident metabolic co-morbidities. Of those who did not have NAFLD in 2007, 746 developed incident NAFLD in 2014; lean-NAFLD 193/746 (25.9%) [males-100(51.8%); mean age 59.6(SD-7.5)], non-lean-NAFLD 553/746 (74.1%) [males-201(36.3%); mean age 58.2(SD-7.7)]. On logistic regression analysis, presence of diabetes (p=0.002, OR 2.1) and raised WC (p=0.003, OR 1.7) were associated with incident lean-NAFLD. CONCLUSIONS: Among individuals with NAFLD, lean-NAFLD is associated with hypertension and smaller WC. In the community, diabetes and bigger WC predict incident lean-NAFLD.Item Incidence and risk factors for non-alcoholic fatty liver disease in an urban, adult Sri Lankan population – a community cohort follow-up study(Sri Lanka Medical Association, 2016) Niriella, M.A.; Kasturiratne, A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyarathna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.INTRODUCTION: In 2007, we reported a 33% prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with PNPLA3(rs738409) gene polymorphism in an urban, adult Sri Lankan population. OBJECTIVES: This study investigated incidence and risk factors for NAFLD after seven years follow-up. METHOD: The study population (42-71-year-olds, selected by age-stratified random sampling from the Ragama MOH area) was screened initially in 2007 and re-evaluated in 2014. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on established ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and incident NAFLD was also performed. RESULTS: 2155/2985 (72.2%) of the original cohort attended follow-up [1244-women, 911-men; mean-age 59.2(SD, 7.7) years]. 1322 [839 women; mean-age 58.9 (SD, 7.6) years] had NAFLD. Out of 795 [466 women] who initially did not have NAFLD, 365 [226 women, mean-age 58.6(SD,7.9) years] had developed NAFLD after 7 years (annual incidence-6.6%). Increased waist circumference [p=0.001], BMI>23kg/m2 [p<0.001] and raised plasma triglycerides [p<0.05] independently predicted incident NAFLD. The updated genetic association study (1310 cases, 427 controls) showed borderline association with NAFLD at 2/10 candidate loci: PPP1R3B(rs4240624), PNPLA3(rs738409) (one-tailed p=0.044 and 0.033, respectively). CONCLUSIONS: In this community cohort follow-up study, the annual incidence of NAFLD was 6.6%. Incident NAFLD was associated with features of metabolic syndrome, and showed tendency of association with PNPLA3 and PPP1R3B gene polymorphisms.