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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Knowledge, attitudes, and beliefs about liver transplantation among caregivers of children with liver diseases; a single centre experience from Sri Lanka
(Sri Lanka Medical Association, 2023) Gunaratne, A.L.S.N.; Gunarathna, P.G.P.D.; Gunawardana, A.D.J.N.; Hansamali, U.V.S.; Heenkenda, H.M.A.N.; Ekanayaka, J.; Fernando, C.M.P.
INTRODUCTION: Paediatric Liver transplantation (PLT) is evolving in Sri Lanka. There is no data documented related to caregivers' knowledge of PLT. OBJECTIVES: To determine the knowledge, attitudes, and beliefs about liver transplantation (LT) among caregivers of children with liver diseases. METHODS: A descriptive cross-sectional study was conducted among the caregivers attending the paediatric liver clinic at Ragama. The calculated sample size was 186. Data were collected using an interviewer-administered questionnaire. Descriptive statistics with SPSS 27.0 were used for analysis. Ethical approval was obtained from the Faculty of Medicine, Ragama. Since there were no previous similar studies, as the tool, we used a newly designed, pre-tested questionnaire which included the basic facts about the knowledge of LT. RESULTS: Of 186 caregivers, the majority were mothers (n=107, 57%). A mixed religious background was noted with Buddhists, Catholics, Islam and Hindus being 80%, 11%, 7% and 2% respectively. Most were educated up to or above the GCE ordinary level (n=180, 97%). The majority (n=124, 68%) were from low-income families with a monthly income of less than 50,000 LKR. Almost half of the participants, 89 (47.8%) knew someone who had undergone an LT. Knowledge of having PLT within the country, living donation, diseased donation, blood group matching and life-long medications were accurate in 171 (91.9%), 170 (91%, 75 (40%), 172 (92%), 116 (62%) respectively. Regarding the beliefs and attitudes towards LT, 170 (91%) were willing to donate and 144 (77%) indicated to support LT. There were 32 (17%) who believed that liver diseases can be cured with alternative medicine and 103 (55%) believed being religious would result in better outcomes. CONCLUSION: Knowledge of LT among caregivers is promising with a positive attitude. Some of their beliefs seem to be non-scientific.
A retrospective analysis of the prevalence of heart disease in pregnancy – a Sri Lankan experience
(Wiley-Blackwell, 2015) Motha, C.; Palihawadana, T.; Dias, T.; Thulya, S.D.; Godage, T.
INTRODUCTION: With improvement in obstetric care, the burden due to direct causes of maternal mortality has declined bringing medical conditions to the forefront. Heart disease in pregnancy remains a major cause of maternal morbidity and mortality in Sri Lanka. In the absence of a robust pre-conception care programme, many women with pre-existing heart disease embark on pregnancy unaware of the underlying abnormalities. This study was aimed at describing the proportion of women with heart disease, the type of heart disease and the time of detection in this population. METHODS: The North Colombo Obstetric database (NORCOD) records data for all women who deliver at the university obstetric unit of the North Colombo Teaching hospital, Ragama, Sri Lanka. Details of women delivered between March and August 2014 were used in a retrospective analysis. Data on booking screening, and pregnancy care with regard to heart disease were analysed. RESULTS: A total of 1830 pregnancies were included. Fifty (2.7%) were complicated with heart disease. 15 (0.8%) patients were known to have pre-existing heart disease at the time of booking. They included 10 with congenital heart disease (treated ASD in 3, untreated ASD in 1, untreated VSD in 1, ligated PDA in 1 and mitral valve disease in 4) and 5 acquired heart disease due to rheumatic heart disease. A cardiac murmur on auscultation was detected in 61 women (3.3%) at their booking screening. 26 (42.6%) of them were found to have an underlying cardiac lesion. The commonest lesion was isolated mitral valve prolapse (n = 11), followed by mitral regurgitation associated with mitral valve prolapse (MVP) in 10, tricuspid regurgitation (TR) in 3, and one each of ASD and VSD. Nine others were found to have underlying cardiac lesion at assessment during pregnancy, in the absence of any abnormality at booking. These included 6 with MVP, 2 with mitral regurgitation (MR) with MVP, and one with MR. CONCLUSION A significant proportion of women with cardiac abnormalities (70%) were detected during pregnancy. This highlights the importance of pre-conception care with screening in this population. While booking screen was able to identify a majority of patients, some were detected only during subsequent assessment. Clinical vigilance throughout pregnancy facilitates such detection.
Diabetes mellitus in pregnancy – a Sri Lankan experience
(Wiley-Blackwell, 2015) Dias, T.; Palihawadana, T.; Motha, C.; Thulya, S.D.
INTRODUCTION Diabetes mellitus in pregnancy carries high perinatal morbidity/mortality and maternal morbidity. Only a proportion of women would have pre-existing diabetes mellitus with the majority developing gestational diabetes (GDM). The burden of diabetes in pregnancy is expected to increase in Sri Lanka as obesity is high among pregnant population. Aims of this study were to look at the prevalence, risk factors and complications of diabetes in pregnancy. METHODS The North Colombo Obstetric database (NORCOD), which records pregnancy data of all women delivering at the university obstetric unit of the North Colombo Teaching hospital, Ragama, Sri Lanka, was used for retrospectively analysis. 1830 deliveries between March and August 2014 were included. Those with incomplete data were excluded. Details regard to prevalence, associated risk factors and complications were identified. RESULTS: Diabetes mellitus complicated 130 (7.1%) pregnancies. This consisted of 26 with pre-existing disease and 104 with GDM. A positive family history in first degree relative (OR 7.87, 95% CI 5.08–12.1), and a BMI of >23 kg/m2 (OR 2.68 95% CI 1.75–4.11) were associated with development of GDM. The mean (SD) age was significantly higher among women who developed GDM compared to those did not (32.1 (4.76) versus 28.7 years (4.7), P = 0.03 respectively). The mean (SD) postprandial blood sugar (PPBS) estimate done in the first half of the pregnancy was significantly higher among women who developed GDM later in pregnancy compared to those who did not (120 (39.2) versus 95 mg/dL (14.6), P < 0.0001 respectively). Hypertensive disorders of pregnancy was significantly associated with diabetes in pregnancy (OR 2.39 95% CI 1.49–3.83) and a birthweight of >3 kg at term (OR 1.63 95% CI 1.11–2.40). CONCLUSION: Diabetes mellitus complicates a significant number of pregnancies. Pre-existing diabetes constitutes one fifth of thesepregnancies, highlighting the importance of provision of preconception care to women contemplating pregnancy. A positive family history increases the risk of GDM by nearly 8 fold. Abnormal PPBS results in early part of pregnancy, in women who later develop GDM suggest the presence of abnormal glucose homeostasis in this group even at early stages of pregnancy. This has the potential for developing in to a test of early detection of GDM in pregnancy.
First series of laparoscopic sleeve gastrectomy in Sri Lanka-technical feasibility and outcome in a resource poor setting in asia.
(New York; Springer, 2014) Wijeratne, T.K.; Bulugahapitiya, U.; Kumarage, S.; Rajaratnam, H.
INTRODUCTION: Morbid obesity and metabolic syndrome are emerging as a major health issues in developing South Asian countries. Laparoscopic Sleeve Gastrectomy (LSG) has been introduced to this region with excellent out comes in controlling morbid obesity and metabolic syndrome. OBJECTIVE(S): Assess the technical feasibility and outcome of LSG as a surgical procedure in a resource poor country in south Asia where Bariatric surgery is still a novel concept. METHOD(S): Prospective Analytical study of the first 15 patients who underwent LSG in a tertiary care hospital in Sri Lanka over 2 years. All data on pre operative, surgical and post operative follow up were recorded in a pre-designed research Performa and all patients were followed up for a minimum period of 6 months by Surgical and Endocrine team. All Surgeries were performed by the same surgeon and the surgical team using total Laparoscopic technique using a 40 F Gastric bougie to standardize the Sleeved stomach. There were 14 females and one male in the study group. Weight range was from 83 to 167 kg with a mean weight of 106.2 kg. Average BMI 45 kg/m2 Results: There were no major complications. The percentage excess weight loss during first 3 months was 28.8 % and at 6 months 42.3 %. Resolution of comorbidities especially Diabetes and Metabolic Syndrome was excellent and one out of two patients who had surgery for subfertility conceived during study period. CONCLUSION(S): LSG can be performed safely in a resource poor setting in south Asia and is effective as a Bariatric surgical procedure for Sri Lankan population.
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.
Future trends in veterinary public health and emerging viral diseases
(Annual Scientific Sessions of the Sri Lanka Veterinary Association., 2012) Sunil-Chandra, N.P.
Veterinary Public Health (VPH) is currently defined as "the slim of all contribusions to the physical, melltal and social well-being of humans through an understanding and application of veterinalry science" (WHO 1999). This definition is more consistent with the values. goals and targets of the WHO vision 'Health for all in the 21 st century". Human health is strongly linked to animal health and production. This link between human and animal populations, and with the surrounding environment. is particularly close in developing regions where animals provide transportation. draught power, fuel and clothing as well as proteins (meat, eggs and milk). In both developing and industrialized countries. however, this can lead to a serious risk to public health with severe economic consequences. A number of communicable diseases known as zoonoses are transmitted from animals to humans. Veterinary medicine has a long and distinguished history of contributing to the maintenance and promotion of public health. Approximately 90 percent of the worldwide burden of all causes of death and disability occur in developing regions of the world but only 10 percent of all health care funds are spent in these regions (WIIO & World Bank). Six communicable disease categories that include pneumonia and infiuenza. AIDS. diarrhoeal disease. tuberculosis. malaria and mcasles are responsible for 90 percent of the estimated 13.3 million deaths in children and young aduits worldwide due to major infectious and parasitic diseases. Zoonotic agents contribute in several of these categories. Livestock disease control programmes in developing countries and countries in transition are often established, even though not very critically, on their economic importance. As a result zoonotic control programmes may not be seriously considered, especially if they do not apparently impact animal heahh and produclion. Obviously, there is a need to be¬ter define the economic impact of zoonoses and other veterinary public health problems with ‘burden of disease' analyses, as used by the World Health Organisation (WHO) and the World Bank.
Correlates of serum homocysteine in a Sri Lankan population
(American Association For Clinical Chemistry, 2010) Chackrewarthy, S.; Wijayasinghe, Y.S.; Gunasekera, D.; Wickremasinghe, R.; Kato, N.
Correlates of total serum homocysteine concentration in a Sri Lankan population BACKGROUND: Hyperhomocysteinemia, a possible risk factor for vascular disease occurs at a higher prevalence in South Asian countries. Serum homocysteine concentrations are influenced by genetic, nutritional and lifestyle factors. Correlates of total serum homocysteine concentration (tHcy) are not well characterized in the Sri Lankan population. Such information is important in developing therapeutic and preventative strategies. OBJECTIVE: To investigate the factors potentially associated with fasting levels of serum tHcy in a Sri Lankan population. METHODS: In a cross sectional study, 177 apparently healthy volunteers (91 men and 86 women) aged 38-65 years were selected from residents in an urban health administrative area. Individuals with a history of chronic disease and with any pharmacological treatment were excluded from the study. Information on diet, lifestyle factors and medical history were recorded. Anthropometric indices and blood pressure were measured according standard protocols. Fasting serum levels of tHcy, insulin, creatinine, folate and lipids were estimated using standard protocols. RESULTS: Fasting serum tHcy levels were higher in males than in females (geometric mean +/- SD, 13.75 mumol/l +/- 1.41 Vs. 9.58 mumol/l +/- 1.43, p<0.001) and were positively associated with age (r=0.204, p< 0.01) in both sexes. 32.3% of males and 10.3% of females had mild hyperhomocysteinemia (tHcy>15mumol/l). tHcy levels were significantly higher in smokers than in non-smokers (geometric mean +/- SD, 14.58 mumol/l +/- 1.44 Vs.12.71 mumol/l +/- 1.37, p<0.05) and in alcohol consumers than in non-consumers (geometric mean +/- SD, 14.53 mumol/l +/- 1.43 Vs.12.14 mumol/l +/- 1.32, p< 0.02). In males, tHcy levels were negatively related to serum insulin (r= -0.397, p<0.001) and BMI (r= -0.244, p <0.02) and positively related to serum creatinine (r=0.235, p<0.02). In females, there was a positive relationship between tHcy and systolic blood pressure (r= 0.239, p<0.02) but there was no significant correlation with serum insulin. In both sexes, serum tHcy levels strongly correlated with serum folate (r= -0.412, p<0.001). There were no significant associations between tHcy and serum lipids. Stepwise regression analysis confirmed the associations between tHcy and folate (p<0.001 in both sexes), insulin (p=0.026 in males) and creatinine (p=0.036 in males). CONCLUSION: Low intake of folate, alcohol consumption and smoking were associated with increased tHcy concentrations. Serum insulin and creatinine were independent correlates of tHcy in males, but not in females. Difference in tHcy levels between sexes may partly be attributed to differences in lean muscle mass and to a metabolic link between creatinine synthesis and homocysteine production. Insulin may regulate serum tHcy concentrations by homocysteine remethylation or by increasing homocysteine clearance.
Of love and isolation: Narratives of siblings of children with cerebral palsy in Sri Lanka.
(Blackwell Publishing-National Spastics Society Medical Education and Information, 2016) Hettiarachchi, S.; Kitnasamy, G.
AIM: Siblings of children with cerebral palsy are often in the periphery of discussions; their views not always taken into account. The aim of this study was to uncover the narratives of young siblings of children with cerebral palsy in Sri Lanka. METHOD: Semi-structured interviews and artwork were gathered from 10 children who have siblings diagnosed with cerebral palsy. The data was analyzed using the key principles of Framework Analysis (Ritchie & Spencer, 1994) to determine the key themes within the narratives. RESULTS: The key themes to emerge were complex and nuanced. These included themes of love and feeling of protectiveness; jealousy and uncertainly; guilt and hope. CONCLUSIONS: The results highlight the need to take document the views of siblings who are often on the margins of the family and of family decisions and discussions. It also supports the need to offer safe spaces and opportunities for siblings of children with disabilities to express their feelings and to receive support where required.
Clinical and histopathological characteristics of cutaneous leishmaniasis in a group of military personnel in Sri Lanka
(American Society of Tropical Medicine and Hygiene, 2015) Manamperi, N.H.; Fernando, C.S.; Pathirana, A.; Abeyewickreme, W.; de Silva, V.C.; Karunaweera, N.D.
Cutaneous leishmaniasis (CL) is a newly established vector-borne parasitic disease in Sri Lanka. Military personnel have an occupational risk for CL due to being stationed in endemic areas and exposure to vectors outdoors. This study describes the clinical and histopathological features of CL in a group of military personnel. Thirty five patients with smear positive for Leishmania amastigotes were included, their data analyzed for clinical features and skin biopsies processed routinely for histology, examined at a conference microscope and classified into 4 groups using modified Ridley criteria for Leishmaniasis as: I-parasitized macrophages with variable lymphocytes and plasma cells; II-parasitized macrophages with lymphocytes, plasma cells and ill formed histiocytic granulomata; III-a mixture of macrophages (with or without parasites), lymphocytes, plasma cells and epithelioid granulomata; IV-epithelioid granulomatous response with a few lymphocytes and plasma cells but no amastigotes. Lesions were categorized by duration, as acute (< 6 months) or chronic (> 6 months). Study group composed of all males with a mean age of 32.6 years (range 22-47) and lesion duration of 5.6 months (range 1-24). Number of lesions varied from 1 to 6 with majority (71.4%, n= 25) having a single lesion. Nodular (37.1%, n=13) and nodulo-ulcerative (25.7%, n=9) lesions in upper limbs (68.6%, n=24) was the commonest presentation. Twenty nine (82.9%) of the biopsies were positive also by histology. Twenty two (62.9%) were acute and 13 (37.1%) chronic. Group I, II, III and IV patterns were seen in 14 (40%), 12 (34.3%), 5 (14.3%) and 4 (11.4%) respectively and 9 (40.9%), 9 (40.9%), 2 (9.1%) and 2 (9.1%) of acute lesions and 5 (38.5%), 3 (23.1%), 3 (23.1%) and 2 (15.4%) of chronic lesions respectively. Necrosis was not seen in any of the lesions. Majority in this group of military personnel with CL had single lesions affecting the upper limbs and sought treatment within 2 years of appearance of lesions. The histological picture varied from diffuse infiltration of parasitized macrophages admixed with chronic inflammatory cells to ill-formed histiocytic granulomata.
The Prevalence of asthma in Sri Lankan adults
((Wiley Blackwell Scientific Publications, 2016) Amarasiri, D.L.; Undugodage, U.C.M.; Silva, H.K.M.S.; Sadikeen, A.; Gunasinghe, W.; Fernando, A.; Wickremasinghe, A.R.; Gunasekera, K.D.
BACKGROUND AND AIMS: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and related symptoms amongst adults in the general population. METHODS: A multi-centered, cross-sectional study was conducted using an interviewer-administered translated version of the screening questionnaire of the European Community Respiratory Health Survey from June to December 2013 in 7 provinces of Sri Lanka. Subjects were selected randomly from different regions by stratified sampling. The prevalence of asthma was defined as "wheezing in the past 12 months (current wheeze)", 'self-reported attack of asthma in the past 12 months' or 'current asthma medication use'. RESULTS: The study comprised 1872 subjects (45.1% males, 48.8% aged18-45 years) of which 12.2% were current smokers. In the total population, the prevalence of current wheeze was 23.9% (95% CI: 22.0%-25.9%), of self-reported asthma was 11.8% (95% CI: 10.3%- 13.2%) and of current asthma medication use was 11.1% (95% CI: 9.6%- 12.5%). The prevalence of asthma according to a positive response to either of the above questions was 31.4% (95% CI: 29.3%-33.4%) The prevalence of symptoms was higher in adults aged >45 years. Of those with current wheeze, 60.9% denied a diagnosis of asthma and only 38.2% admitted to use of asthma medication. In those with current wheeze, wheezing was the only symptom in 19.9% whereas 80.1% had at least one other respiratory symptom (tightness of chest, cough or shortness of breath) of which cough was the most common symptom. In those without current wheeze, self-reported asthma and current asthma medication use, 30%, 35.9% and 36.6% respectively had at least one other respiratory symptom. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is high in comparison with global data. A significant percentage of symptomatic individuals deny having asthma and are not on medication.

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