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 Standards of care of management of diabetes among rural cohort in Sri Lanka - a descriptive study(Sri Lanka College of Internal Medicine, 2021) Chathuranga, P.A.D.U.; Meegodawidanage, N.; Rathnayaka, T.M.; Luke, W.A.N.V.; Mettananda, K.C.D.Introduction: Type 2 Diabetes mellitus (T2DM) is a challenge to health care leading to increase in morbidity and mortality. Objective: We conducted a descriptive study in rural Sri Lanka to assess the standards of care and disease control among patients with diabetes to identify areas for improvement. Methods: A retrospective follow-up study was conducted in five hospitals in Anuradhapura district. All type 2 diabetic patients, diagnosed and started on oral hypoglycemic drugs 24 months prior to recruitment, who attended the above clinics during the study period were enrolled to the study. Data on demographics, medications and blood sugar control were collected using an interviewer-administered questionnaire and perusing medical records. Drug compliance was studied using a self-administered questionnaire. Results: Control of Diabetes and other cardiovascular risk factors 2 years following initiation of oral hypoglycaemic drugs in 421 patients (19.2% male, mean age 58.3±10.4 years) were studied. Even after 2 years of medications, 48.2% were overweight, 34.0% obese and 53.9% were physically inactive. Prevalence of medication use among them were, metformin 96.7%, statins 64.1 % and anti-hypertensives 49.4%. Their mean Fasting Blood Sugar(FBS) was 139±54.3 mg/dl and Body Mass Index(BMI) was 26.5±4.5kgm-2. Poor compliance to medication was found in 60.3%. Sub-optimal risk factor control, FBS >130mg/dl, blood pressure >130/80mmHg, and LDL >100mg/dl were seen in 45.1.%, 19.94% and 16.1%, respectively. Conclusion: Even though majority were started on necessary medicines, FBS control was poor in this rural population. The reasons behind poor FBS control need to be studied and addressed to improve care of patients with diabetes in rural Sri Lanka.Item Incidence and predictors of metabolic syndrome among urban, adult Sri Lankans: a community cohort, 7-year follow-up study(European Association for the Study of Diabetes, 2017) de Silva, S.T.; Niriella, M.A.; Kasturiratne, A.; Kottahachchi, D.; Ranawaka, U.K.; Dassanayake, A.; de Silva, A.P.; Pathmeswaran, P.; Wickremasinghe, R.; Kato, N.; de Silva, H.J.BACKGROUND AND AIMS In 2007, we reported a 38.9% prevalence of metabolic syndrome (MetS) in an urban, adult population. Published data on incident MetS from South Asia is lacking. This study investigated the incidence and risk factors for MetS after a 7-year follow-up of the initial cohort. MATERIALS AND METHODS: The study population (selected by age-stratified random sampling from the Ragama MOH area) was screened in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions, structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests were performed. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Total body fat (TBF) and visceral fat percentage (VFP) were measured in 2014, using impedance. Abnormal TBF was defined as >32% for females and >25% for males. Abnormal VFP was defined as >10% for both sexes. Non-alcoholic fatty liver disease (NAFLD) was diagnosed on established ultrasound criteria, safe alcohol consumption (Asian standards: <14 units/week for men, <7 units/week for women) and absence of hepatitis B and C markers. RESULTS: 2137/2967 (72.0%) of the initial cohort attended follow-up [1229 (57.5%) women; mean-age 52.4 (SD-7.7) years]. 1000/2137 [548 (54.8%) women; mean age 57.5 years (SD-7.74)] had MetS (prevalence-46.8%). Out of 1246 individuals who initially did not have MetS in 2007, 318 [225 (70.8%) women; mean age 57.5 (SD 7.7) years] had developed incident MetS after 7 years (annual incidence-2.13%). Comparison of incident MetS with those with no MetS in 2014 is shown in Table 1. On logistic regression, female sex (OR 3.6, p<0.001), central obesity [OR 4.58, p<0.001], BMI >23kg/m2 [OR 4.84, p<0.001], increase in weight 2%-5% [OR 2.02, p<0.001], increase in weight >5% [OR 5.3, p<0.001), increase in waist circumference (WC) 5-10-cm [OR 3.68, p<0.001], increase in WC >10cm [OR 10.34, p<0.001] and NAFLD (OR 2.44, p<0.001) in 2007 were independently predictive of incident MetS in 2014. Abnormal VFP [OR 4.23, p<0.001] and abnormal TBF [OR 5.25, p<0.001] were also associated with incident MetS. CONCLUSION: In this prospective community study, the annual incidence of MetS was 2.13%. Female gender, increase in weight and WC from baseline and the presence of NAFLD predicted the development of incident MetS. Obesity at baseline was the only defining individual component of MetS that predicted future MetS.Item The role of pharmacist counselling in the control of diabetes(Sri Lanka Medical Association, 2017) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; de Silva, A.; Lynch, C.B.; Wickramasinghe, N.D.D.INTRODUCTION & OBJECTIVES: Diabetes is a global health burden. Data in international literature prove the success of involving pharmacists to achieve glycaemic control. This is the first study in Sri Lanka on the impact of pharmacist counselling among outpatients with diabetes. The objective was to assess the impact of pharmacist counselling on glycaemic control of outpatients with diabetes. METHODS: A total of 400 consecutive patients with diabetes mellitus attending the outpatient diabetes clinics at Base Hospital, Dambadeniya, were randomized into either the intervention group (IG) or the control group (CG). IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to the standard care at the clinic, while the CG received standard care only. Glycaemic control was assessed for both groups with HbA1c measured at the end of the four monthly visits.RESULTS: Mean age of participants was 57.14±10.15 years and 67.5% were females. Non parametric tests were performed as data did not follow the normal distribution. On analysis of HbA1c data, the IG had a median of 7.2% (IQR: 8.2%-6.5%) whereas the CG had a median of 7.7% (IQR: 8.8%-6.9%). The IG patients had statistically lower HbA1c levels compared to the CG patients, according to the Mann-Whitney U test (p<0.05). HbA1c levels <8.00% indicate good/fair glycaemic control. 73.9% of the IG, but only 58% of the CG subjects had levels <8.00%. However, 9.1% of the IG and 10% of the CG had very poor glycaemic control (HbA1c level >10.00%). CONCLUSION: Pharmacist counselling in the outpatient clinics can improve the glycaemic control of patients with diabetes.Item The Recto-Anal Inhibitory Reflex (RAIR): abnormal response in diabetics suggests an intrinsic neuro-enteropathy(BMJ Publishing, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.INTRODUCTION: The recto-anal inhibitory reflex (RAIR) is characterized by reflex relaxation of the anal canal in response to electrical stimulation of the rectal mucosa, and is mediated by nitrergic neural plexuses within the gut wall. Impairment of this reflex may lead to incontinence. AIM: To measure anal canal pressures, anal mucosal electrosensation and RAIR in diabetic patients and correlate these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male:Female=13:17, median age 57 years (range 37- 70)], and these data were compared with similar data obatained from 22 age and sex matched 'healthy' controls [Male:Female= 9:13, median age 51 years (range 19 - 65 )]. Median duration of diabetes was 8 years (range 3 -30 ). 12 (40%) of the 30 diabetics had impaired continence for gas (n=12) and liquid faeces (n=3). None ofthe controls had incontinence. RESULTS: Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30mmHg (20-75) vs. Controls 40mmHg (20-105), P=0.61. Maximum squeeze pressure (MSP) [median (range)]: Patients 65mmHg (30- 150) vs. Controls 84mmHg (35-230), P=0.59. Threshold rectal mucosal eletrosensation (RMES-T) [median (range)]: Patients 27 mA (5-40) vs. Controls l3mA (5-28), P=0.03. Maximum tolerable rectal mucosal electrosensation [median (range)]: Patients 40 mA (20-60) vs. Controls 20 mA (10-30), P=0.042 (all comparisons using Wilcoxon rank test). RAIR was present in 8, abnormal in 5 (1 with incontinence), and absent in 17 (II with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (test of proportion, P=0.03 I). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.Item Dietaryadviceongdmmothers-an audit(Sri Lanka College of Obstetricians and Gynaecologists, 2006) Jayasundar, C.; Ellepola, U.K.; Herath, H.M.R.P.; Perera, A.; Wijesundere, A.BACKGROUND: Gestational Diabetes Mellitus (GDM) is considered a global problem and in Sri Lanka. It is emerging as a common complication in pregnancy. Hence, an audit was undertaken to evaluate dietary advice given to GDM mothers as it is the primary modality of treatment. OBJECTIVE: To ascertain the standard of dietary advice given to GDM mothers attending a tertiary care ,. ater.STUDY TYPE: Retrospective study. STUDY SETTING: Tertiary care center. STUDY SAMPLE: 49 consecutive GDM mothers, who was diagnosed in the ANC and ward. METHOD: Study was carried out from 1st of June to 1st of August 2006. A questionnaire was developed to evaluate the standard of the dietary advice in accordance with the unit policy. RESULTS: Out of the population 39% were in the age group of 21-30 and 61% in the 31-40 age category. Out of the total sample 96% of mothers received advice on a diabetic diet but out of which, only 4% had been supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized dietician.