Journal/Magazine Articles

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Association of GDF15 levels with body mass index and endocrine status in β-Thalassaemia
(Blackwell Publishing, 2023) Karusheva, Y.; Petry, C.J.; Yasara, N.; Kottahachchi, D.; Premawardhena, A.; Barker, P.; Burling, K.; Sattar, N.; Welsh, P.; Mettananda, S.; O'Rahilly, S.S.
OBJECTIVE: GDF15 has emerged as a stress-induced hormone, acting on the brain to reduce food intake and body weight while affecting neuroendocrine function. Very high GDF15 levels are found in thalassaemia, where growth, energy balance and neuroendocrine function are impaired. We examined the relationships between GDF15 and anthropometric measures and endocrine status in β-thalassaemia. DESIGN: Cross sectional study PATIENTS: All β-thalassaemia patients attending the thalassaemia unit of Colombo North Teaching Hospital for blood transfusions. MEASUREMENTS: Anthropometric data, appetite scores, circulating GDF15, IGF, thyroid and reproductive hormone levels in 103 β-thalassaemia patients were obtained. RESULTS: GDF15 levels were markedly elevated in thalassaemia patients (24.2 fold with β-thalassaemia major compared with healthy controls). Among patients with β-thalassaemia major, the relationship between GDF15 and Body Mass Index (BMI) was curvilinear with all individuals with GDF15 levels above 24,000 pg/ml having a BMI below 20 kg/m2 . After adjustment for BMI, age and Tanner stage, serum IGF1 concentrations correlated negatively with GDF15 in all thalassaemia patients (β=-0.027, p=0.02). We found a significant positive relationship between GDF15 and gonadotropin (in both sexes) and testosterone (in males). CONCLUSIONS: GDF15 levels were markedly elevated in patients with β-thalassaemia and its association with BMI is consistent with the known effect of GDF15 to reduce body weight. The inverse association between GDF15 with IGF1 levels may reflect a neuroendocrine impact of GDF15 or an indirect effect via impaired nutritional state. The positive association with testosterone in males and gonadotropins in both sexes, was surprising and should prompt further GDF15 studies on the hypothalamic pituitary gonadal axis. This article is protected by copyright. All rights reserved.
One-hour fast for water and six-hour fast for solids prior to endoscopy provides good endoscopic vision and results in minimum patient discomfort
(Wiley-Blackwell, 2009) de Silva, A.P.; Amarasiri, D.L.; Liyanage, M.N.; Kottahachchi, D.; Dassanayake, A.S.; de Silva, H.J.
BACKGROUND AND AIM: Current guidelines for upper gastrointestinal endoscopy (UGIE) advise at least 6-8 h fasting for solids and 4-h fasting for liquids. We aimed to determine whether a 6-h fast for solids and one-hour fast for water prior to UGIE gives good endoscopic vision and less patient discomfort. METHODS: 128 patients referred for UGIE were given a standard meal 6 h before endoscopy, and then randomized to either nil by mouth for 6 h (group A, n = 65) or allowed to drink water for up to one hour prior to endoscopy (group B, n = 63). Before endoscopy patients were requested to indicate discomfort due to fasting on a visual analog scale. Fluid in the gastric fundus was aspirated, when present, for volume and pH measurements, and endoscopic vision was graded. RESULTS: 53 patients in group A and 43 patients in group B completed the study. Discomfort was significantly lower in group B than group A (P < 0.0001). Endoscopic vision was good in all 53 patients in group A and 40 in group B, and average in 3 patients in group B. Fluid in the gastric fundus was noted in 11 patients in group A and 16 in group B, but there were no significant differences in volume or pH between groups. There were no complications attributable to endoscopy in either group. CONCLUSIONS: A 6-h fast for solids and a 1-h fast for water prior to UGIE gives good endoscopic vision, and causes minimum patient discomfort.
Suitability of selection criteria as a measure of medical graduates: University of Colombo
(University of Colombo, 2006) Mettananda, D.S.G.; Wickramasinghe, V.P.; Kudolugoda Arachchi, J.; Lamabadusuriya, S.P.; Ajanthan, R.; Kottahachchi, D.
A prime obstacle faced by a medical educator is selecting the right student to be trained as a doctor, and the general consensus is that this is also the most difficult task. This study was designed to evaluate the effects of selected outcome measures on outcome performance of medical undergraduates of the University of Colombo. A retrospective cohort study was conducted using the performance (marks) of students of 4 batches GCE (A/L) 1993 through to 1996). GCE (A/L) aggregate marks, attempt of entry, district of entry, English language proficiency and sex were tested as predictors of success. Results of main assessments were considered as measures of success. Relationship between outcome measures and outcome predictors were assessed using the multiple logistic regression model. Data of 699 students were analyzed and 82% of students entered from the Colombo district. A higher percentage of first attempters (at GCE A/L) performed well and obtained classes. Entering medical school from first two GCE A/L examination attempts was a significant positive predictor of passing any examination (odds ratio 3.2 to 7.5) or obtaining honors (odds ratio 2.8 to 16.0). Attempt of entry predicted 5.4% of the outcome (pass or fail) in university performance. Correlation between the GCE A/L aggregate mark and the student's position in order of merit for the internship appointments was -0.37 (p<0.001). A combination of factors should be used in the selection process of students to embark on the undergraduate process as any single factor is a poor predictor of outcome of performance. We believe that the number of attempts allowed to sit for GCE A/L in order to gain entry to a medical school as well as other degree courses should be confined to two attempts.

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