Journal/Magazine Articles

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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine

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Author: search.filters.author.Kottahachchi, D.Has files: Yes

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    Exploring the impact of occupational exposure: A study on cardiovascular autonomic functions of male gas station attendants in Sri Lanka
    (Wiley periodicals LLC on behalf of the physiological society and the American physiological society, 2024-10) Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; Rathnayake, P.; Ariyawansa, J.; Dissanayake, T.; Sandeepani, P.; De Silva, D.C.; Devanarayana, N.M.
    Fuel dispensing at fuel stations is performed manually by unprotected male gas station attendants in Sri Lanka, who have long working hours. These workers are exposed to hydrocarbon fuels associated with multiple health effects by modulation of the autonomic nervous system. This study was performed to determine cardiovascular autonomic functions among fuel pump attendants in Sri Lanka. Fuel pump attendants (n = 50) aged between 19 and 65 years were identified for the study from seven fuel stations. They were compared with age- and gender-matched controls (n = 46) without occupational exposure to fuel. A physical examination was performed before the autonomic function and heart rate variability (HRV) assessment. There were no significant differences in weight, height, or BMI between the study and the control populations (p > 0.05). Both the systolic blood pressure (SBP) (Mann Whitney U (MWU) = 743.5, p = 0.003) and diastolic blood pressure (DBP) (MWU = 686.5, p = 0.001) were significantly higher among the gas station attendants compared to controls. Valsalva ratio was significantly higher among the study group (MW U = 874.00, p = 0.043) compared to controls. The HRV analysis showed significantly higher SDNN and SD2 (MWU = 842.00, p = 0.034, and MWU = 843.50, p = 0.035 respectively) among the gas station attendants compared to controls. The changes to the cardiovascular autonomic parameters among those exposed to fuel vapor as a gas station attendant indicate an increase in sympathetic outflow to the vessels. In the occupational setting as fuel pump attendants need periodic monitoring.
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    Future of endocrinology – The role of the female physician
    (Endocrine Society of Sri Lanka, 2023) Muthukuda, D.T.; Wijenayake, U.N.; Afsana, F.; Kottahachchi, D.; Punchihewa, P.G.; Premadasa, B.A.M.; Ali, S.S.; Moazzam, A.; Shaikh, S.S.; Shreshtha, D.; Karuppiah, D.; Bajaj, S.
    No abstract available
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    The effect of glycaemic control on neutralizing antibody response to COVID-19 among patients with type 2 diabetes mellitus in the Kurunegala district of Sri Lanka; A prospective cohort study
    (Endocrine Society of Sri Lanka, 2023) Kottahachchi, D.; Badanasinghe, N.; Samarathunga, P.; Sandeepani, P.; Cooray, S.; Warnakulasuriya, T.
    BACKGROUND: The antibody response following COVID-19 vaccination among patients with diabetes mellitus (DM) is of particular concern given the increased risk of severe disease in this population. The correlation between glycaemic control among persons with DM and the antibody response was not published in Asian populations. Hence, this study aimed to determine whether glycaemic control has an association with the development of an adequate antibody response for SARS-CoV-2 among patients with DM following the administration of two doses of the COVID-19 vaccine. METHODS: A prospective cohort study was carried out at three vaccination centers in the Kurunegala district from November 2021 to January 2022. Seventy-one patients with type 2 diabetes were recruited for this study and followed up on vaccination with the Sinopharm COVID-19 vaccine. HbA1 c levels at the first dose and after 6-8 weeks from the second dose of vaccine were analyzed. The neutralizing antibodies (NAbs) were analyzed using C Pass™ neutralizing antibody detection ELISA Kit following 6-8 weeks of the 2nd dose. RESULTS: The median (IQR) age of the total population (63.4% females) was 53 years (44.0-58.0) and they were diagnosed with diabetes for 6 years (3-11 years). The median first and second HbAlc values were 9.3% (7.2-10.7%) and 8.2% (7.1-10.2%) respectively. From the total population, only 66.2% developed protective levels of NAbs after 6-8 weeks of the second dose of the vaccine. The second HbAlc value was significantly lower compared to the first (z=-2.63, p=0.008). There was no significant difference in terms of sex, age, duration of diabetes, pre-vaccination HbAlc level, or HbAlc level 6-8 weeks after the vaccination among those who developed protective levels of antibodies and those who did not (p>0.05). There was no difference in sero-conversion depending on the abnormal HbAlc value (.28%) (1st HbAlc p=0.957, 2nd HbAlc p=0.360). Conclusion: We did not detect an association between glycaemic control and sero-conversion. However, 1/3rd of patients with diabetes did not have a protective level of NAbs following 2 doses of Sinopharm COVID-19 vaccination. Furthermore, glycaemic control did not deteriorate with COVID-19 vaccination.
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    Identification of patients with type 2 diabetes with non-alcoholic fatty liver disease who are at increased risk of progressing to advanced fibrosis: a cross-sectional study
    (BMJ Publishing Group Ltd, 2023) Mettananda, C.; Egodage, T.; Dantanarayana, C.; Fernando, R.; Ranaweera, L.; Luke, N.; Ranawaka, C.; Kottahachchi, D.; Pathmeswaran, A.; de Silva, H.J.; Dassanayake, A.S.
    INTRODUCTION: Identification of advanced hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD) is important as this may progress to cirrhosis and hepatocellular carcinoma. The risk of hepatic fibrosis is especially high among patients with diabetes with NAFLD. Annual screening of patients with diabetes for fatty liver and calculation of Fibrosis-4 (FIB-4) score and exclusion of significant fibrosis with vibration-controlled transient elastography (VCTE) have been recommended. However, VCTE is expensive and may not be freely available in resource-limited settings. We aim to identify predictors of significant liver fibrosis who are at increased risk of progression to advanced liver fibrosis and to develop a prediction model to prioritise referral of patients with diabetes and NAFLD for VCTE. METHODS AND ANALYSIS: This cross-sectional study is conducted among all consenting adults with type 2 diabetes mellitus with NAFLD at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All patients get the FIB-4 score calculated. Those with FIB-4 ≥1.3 undergo VCTE (with FibroScan by Echosens). Risk associations for progression to advanced liver fibrosis/cirrhosis will be identified by comparing patients with significant fibrosis (liver stiffness measure (LSM) ≥8 kPa) and without significant fibrosis (LSM <8 kPa). A model to predict significant liver fibrosis will be developed using logistic regression. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (P/66/07/2021). Results of the study will be disseminated as scientific publications in reputable journals.
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    Incidence and risk factors for metabolic syndrome among urban, adult Sri Lankans: a prospective, 7-year community cohort, follow-up study.
    (BioMed Central, 2019) de Silva, S.T.; Niriella, M.A.; Ediriweera, D.S.; Kottahachchi, D.; Kasturiratne, A.; de Silva, A.P.; Dassanayake, A.S.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
    BACKGROUND:The metabolic syndrome (MetS) is a clustering of abdominal obesity, diabetes and prediabetes, high cholesterol and high blood pressure, that confers an increased risk of cardiovascular disease. There is limited data on incidence of MetS from South Asia. This study investigated incidence and risk factors for new onset MetS in an urban adult Sri Lankan population.METHODS:Subjects (selected by age-stratified random sampling from the Ragama Medical Officer of Health area) were screened initially in 2007 (35-64 years) and re-evaluated in 2014 (42-71 years). On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, and biochemical/serological tests. MetS was diagnosed on International Diabetes Federation (IDF-2006) criteria. Total body fat (TBF) and visceral fat percentage (VFP) were measured in 2014, using body impedance method. Incidence and factors at baseline, associated with new onset MetS, were investigated among those who presented for re-evaluation.RESULTS:2985 (99.1%) [1636 (54.8%) women (54.8%); median age (IQR) 53 (47-59) years] from the initial cohort in 2007 had complete data. 2148 (71.9%) [1237 (57.6%) women; median age (IQR) 60 (54-66) years] attended follow-up. 949 of them [701 (73.9%) women; median age (IQR) 60 (54-65) years] had MetS (prevalence 47.2%, 95% CI 45.0-49.4%). Of 1246 who did not have MetS in 2007, 265 [178 (67.1%) women, median age (IQR) 57 (51-64) years] had developed MetS after 7 years (annual incidence 3.5% (95% CI 2.4-4.5%). Females (OR = 4.9, 95% CI 3.4-7.4), BMI > 23 kg/m2 in 2007 (OR = 1.6 per unit increase, 95% CI 1.5-1.7), weight gain (by 2-5% OR = 2.0, 95% CI 1.1-3.5; by > 5% OR = 2.2, 95% CI 1.4-3.4), and increase in waist circumference (by 2-5% OR = 7.0, 95% CI 4.0-12.2; by > 5% OR = 13.4, 95% CI 8.3-22.4) from baseline and presence of non-alcoholic fatty liver disease (NAFLD) in 2007 (OR = 1.70, 95% CI 1.04-2.76) were associated new onset MetS. Those with MetS had abnormal VFP and TBF in 2014 [P < 0.001].CONCLUSION:In this study, annual incidence of MetS was 3.5%. Female gender, BMI > 23 kg/m2 and NAFLD in 2007 and increase in weight and waist circumference from baseline were significantly associated with new onset MetS. Obesity was the best predictor of future MetS
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    The drug compliance among patients with diabetes in Sri Lankan setting
    (Endocrine Society of Sri Lanka, 2017) Gunathilake, G.; Kottahachchi, D.; Siyambalapitiya, S.
    INTRODUCTION: Diabetes mellitus is a chronic non-communicable disease that is associated with vascular complications. Treatment of diabetes complications are expensive and it is much more expensive than the treatment for the disease itself. However, most of these vascular complications can be prevented with good glycaemic control and to achieve this, compliance to medication is essential. Similar to most of the other chronic diseases, drug compliance has been poor among patients with diabetes. The objective of this study was to assess the level of drug compliance and the factors that influence the drug compliance among Sri Lankan patients with diabetes. METHOD: Three sets of patients were recruited from three different clinical settings, the diabetes clinic, the medical clinics and the general practitioner clinics in the community. Data were collected using an interviewer administered questionnaire. RESULTS: There were 247 patients recruited for the study and majority were females (80.2%). The majority (79.4%) attended the clinics regularly. However, a good compliance to medication was seen in 38.4% of patients. The large number of tablets that they need to swallow, fear of side effects with long-term drug intake and unclear instructions are the main reasons for poor drug compliance among our patients. CONCLUSIONS: Similar to most of the previously done studies, drug compliance is poor among our patients with diabetes. However, the compliance can be improved by avoiding polypharmacy by using combined pills and with proper patient education regarding drug intake and the side-effects.
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    Non-alcoholic fatty liver disease and its associations among adolescents in an urban, Sri Lankan community
    (BioMed Central, 2017) Rajindrajith, S.; Pathmeswaran, A.; Jayasinghe, C.; Kottahachchi, D.; Kasturiratne, A.; de Silva, S.T.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
    BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a common problem across the world. We aimed to determine the prevalence of NAFLD and its associations in Sri Lankan adolescents living in an urban Sri Lankan community. METHOD: The study population consisted of the birth cohort of the year 2000, residing in the Ragama Medical Officer of Health area. Socio-demographic and anthropometric data [anthropometric measurements, blood pressure and total body fat distribution] of these adolescents were collected by trained data collectors. Fasting blood sugar, serum insulin, fasting serum lipids and serum alanine aminotransferase (ALT) levels were measured and an abdominal ultrasound was performed. NAFLD was diagnosed on established ultrasound criteria for fatty liver and absent alcohol consumption. RESULTS: The study sample consisted of 499 adolescents [263 (51.8%) girls]. Forty two (8.4%) had NAFLD. NAFLD was significantly associated with being breast fed for less than 4 months (33.3% vs. 17.1 in controls, p = 0.02), higher waist circumference (prevalence risk ratio 83.3/20.3, 4.1, p < 0.0001), higher body mass index (prevalence risk ratio 40.5/4.8, 8.4, p < 0/0001),higher HOMA-IR (3.7 vs. 1.9, p < 0.0001) and high triglycerides (prevalence risk ratio 14.3/5.8, 2.5, p = 0.033). Adolescents with NAFLD also had a higher amount of total body fat (p < 0.001) and subcutaneous fat (p < 0.001) than those without NAFLD. The number of children with metabolic derangements was higher among adolescents with NAFLD than those without (85.8 vs 26.3 in controls, p < 0.0001), but a family history of hypertension, diabetes, myocardial infarction or dyslipidaemia were not. CONCLUSION: Prevalence of NAFLD was high in Sri Lankan adolescents, and was associated with metabolic derangements, especially obesity, insulin resistance and early cessation of breast feeding.