Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
16 results
Search Results
Item Exposure characteristics of patients presenting to an anti-rabies treatment unit(Sri Lanka College of Microbiologists, 2006) Pinidiyapathirage, M.J.; Wimalarathne, O.; Gunasekara, W.P.A.D.OBJECTIVE: With increased availability, accessibility and safety of rabies post exposure treatment (PET), costs borne by the Government in the purchase of anti-rabies vaccines have increased dramatically. This study was conducted to identify exposure characteristics of patients presenting to an anti-rabies treatment unit (ARU) and to propose measures that could minimise PET use. METHOD: A hospital based descriptive study was carried out in the ARU of the National Hospital of Sri Lanka (NHSL), An interviewer administered questionnaire assessed socio-demographic characteristics and the nature of exposure of patients. Treatment received was obtained from patient records. RESULTS: All consenting, first visit patients (n-266) presented during a period of one week to the ARU with an exposure history to a suspected rabid animal were studied. Mean age of those exposed was 36.6 years (SD 16.6). Exposure to dogs (208, 78.2%) was the commonest followed by exposure to cats (33, 12.4%). Majority were exposed to domesticated animals (172, 64.7%) which were unvaccinated or did not have reliable proof of vaccination (167, 62.8%). Of the 266, 13 (4.9%) did not need PET, 51 (19.2%) needed both anti-rabies inactivated tissue culture vaccine (ARV) and anti rabies serum and202(75.9%) needed ARV only. CONCLUSION: Majority of the exposures that needed PET was to domesticated dogs which were unvaccinated or had no reliable proof of vaccination. Importance of regular vaccination of pets and safe-keeping of animal vaccination records should be stressed to the general public and awareness of responsible pet ownership should be raised among the public.Item Geohelminthic infection in an estate child population in Sri Lanka: association with hygienic practices and eosinophil counts(Sri Lanka College of Microbiologists, 2006) Banneheke, B.M.H.A.; Gunawardane, D.M.D.E.A.; Pinidiyapathirage, M.J.; Ekanayake, S.; Withana, R.J.; Tilakaratne, W.D.T.OBJECTIVES: To describe hygienic practices, prevalence of geohelminthic infections and its association with eosinophil counts among children. Methods: A descriptive cross sectional study was conducted in a tea plantation in Ratnapura District involving 316 school children. An interviewer-administered questionnaire was used to collect data from the child or parent. Stool and blood samples were obtained from all the consenting children. Stool examinations were conducted using saline smear, agar-plate culture technique, and Kato-Katz quantitative technique. Eosinophil count was obtained using blood smears. RESULTS: Mean age of the children (n=317) in the sample was 8.5 years (SD 1.7). Of the selected sample 219(85%) had access to pipe borne water, 228(72%) washed hands before meals, 164(52%) did not use a toilet, 180(57%) had a domesticated dog or a cat and 168(53%) used antihelminthic drugs regularly. A history of asthma, wheezing/allergies was reported by 101(32%) subjects. Of the 317 stool samples examined, Ascaris infection was prevalent in 60(19%), hookworm infection in 25(8%) (15 of them had>4000 eggs per gram - severe infection), Trichuris infection in 7(2.2%) and Strongyloides infection in 3(0.9 %) children. Of the 298 blood samples examined 12 (4%) had an eosinophil count of > 16 %( severe eosinophilia). A statistically significant association was observed with hookworm infection and increased eosinophil counts (p=0.006). CONCLUSION: Prevalence of geohelminthic infections was low among this population, Ascaris showing the highest prevalence (n~60, 19%). An association between the presence of helminthic infection and an increased eosinophil count was observed only with hookworm infection in which (n= 15)60% reported a severe degree of infection.Item Prevalence of psychological morbidity in an urban population: Is it related to modifiable physical risk factors?(Sri Lanka Medical Association, 2013) Williams, S.S.; Pinidiyapathirage, M.J.; Wijeratne, L.T.; Kasturiratne, A.; Peris, M.U.P.K.; Williams, H.S.A.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: To determine the prevalence of psychological morbidity and its relationship to diabetes mellitus, hypertension and alcohol use in an urban population in Sri Lanka. METHODS: This study was conducted in the Ragama Health Study cohort that consists of 2986 individuals, between 35-64 years of age, living in the Ragama Medical Officer of Health area in the district of Gampaha. Subjects were selected using age-stratified random sampling, from the electoral lists in 2007, and investigated using clinical, bio¬chemical and anthropometric examinations. Psychological morbidity was estimated using a pre-validated K10 questionnaire which has high sensitivity and specificity for non psychotic psychiatric disorders and a self administered GHQ 30 questionnaire. Baseline age-adjusted prevalence and three year incidence of hypertension and diabetes were estimated. Odds ratios for independent risk factors were calculated. RESULTS: The prevalence of psychological morbidity identified using the K10 questionnaire ranged from 18- 26% in a total population of 2919. Females had a higher prevalence of psychologrcal morbidity than males (28.6% vs 22.4%; p<0.001). Diabetic or hypertensive status and alcohol use did not predict psychological morbidity. A self report of overall low health status was predictive of psychological morbidity OR1.925 (95% CI 1.62 - 2.28). DISCUSSION: High prevalence of psychological morbidity was identified in this community study. Females are more at risk. In the initial analysis, psychological status was not associated with diabetes mellitus, hypertension or alcohol use.Item Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation(Nature Publishing Company, 2015) Kato, N.; Loh, M.; Takeuchi, F.; Verweij, N.; Wang, X.; Zhang, W.; Kelly, T.N.; Saleheen, D.; Lehne, B.; Leach, I.M.; Drong, A.W.; Abbott, J.; Wahl, S.; Tan, S.T.; Scott, W.R.; Campanella, G.; Chadeau-Hyam, M.; Afzal, U.; Ahluwalia, T.S.; Bonder, M.J.; Chen, P.; Dehghan, A.; Edwards, T.L.; Esko, T.; Go, M.J.; Harris, S.E.; Hartiala, J.; Kasela, S.; Kasturiratne, A.; Khor, C.C.; Kleber, M.E.; Li, H.; Mok, Z.Y.; Nakatochi, M.; Sapari, N.S.; Saxena, R.; Stewart, A.F.; Stolk, L.; Tabara, Y.; Teh, A.L.; Wu, Y.; Wu, J.Y.; Zhang, Y.; Aits, I.; Da Silva Couto Alves, A.; Das, S.; Dorajoo, R.; Hopewell, J.C.; Kim, Y.K.; Koivula, R.W.; Luan, J.; Lyytikäinen, L.P.; Nguyen, Q.N.; Pereira, M.A.; Postmus, I.; Raitakari, O.T.; Bryan, M.S.; Scott, R.A.; Sorice, R.; Tragante, V.; Traglia, M.; White, J.; Yamamoto, K.; Zhang, Y.; Adair, L.S.; Ahmed, A.; Akiyama, K.; Asif, R.; Aung, T.; Barroso, I.; Bjonnes, A.; Braun, T.R.; Cai, H.; Chang, L.C.; Chen, C.H.; Cheng, C.Y.; Chong, Y.S.; Collins, R.; Courtney, R.; Davies, G.; Delgado, G.; Do, L.D.; Doevendans, P.A.; Gansevoort, R.T.; Gao, Y.T.; Grammer, T.B.; Grarup, N.; Grewal, J.; Gu, D.; Wander, G.S.; Hartikainen, A.L.; Hazen, S.L.; He, J.; Heng, C.K.; Hixson, J.E.; Hofman, A.; Hsu, C.; Huang, W.; Husemoen, L.L.; Hwang, J.Y.; Ichihara, S.; Igase, M.; Isono, M.; Justesen, J.M.; Katsuya, T.; Kibriya, M.G.; Kim, Y.J.; Kishimoto, M.; Koh, W.P.; Kohara, K.; Kumari, M.; Kwek, K.; Lee, N.R.; Lee, J.; Liao, J.; Lieb, W.; Liewald, D.C.; Matsubara, T.; Matsushita, Y.; Meitinger, T.; Mihailov, E.; Milani, L.; Mills, R.; Mononen, N.; Müller-Nurasyid, M.; Nabika, T.; Nakashima, E.; Ng, H.K.; Nikus, K.; Nutile, T.; Ohkubo, T.; Ohnaka, K.; Parish, S.; Paternoster, L.; Peng, H.; Peters, A.; Pham, S.T.; Pinidiyapathirage, M.J.; Rahman, M.; Rakugi, H.; Rolandsson, O.; Rozario, M.A.; Ruggiero, D.; Sala, C.F.; Sarju, R.; Shimokawa, K.; Snieder, H.; Sparso, T.; Spiering, W.; Starr, J.M.; Stott, D.J.; Stram, D.O.; Sugiyama, T.; Szymczak, S.; Tang, W.H.; Tong, L.; Trompet, S.; Turjanmaa, V.; Ueshima, H.; Uitterlinden, A.G.; Umemura, S.; Vaarasmaki, M.; van Dam, R.M.; van Gilst, W.H.; van Veldhuisen, D.J.; Viikari, J.S.; Waldenberger, M.; Wang, Y.; Wang, A.; Wilson, R.; Wong, T.Y.; Xiang, Y.B.; Yamaguchi, S.; Ye, X.; Young, R.D.; Young, T.L.; Yuan, J.M.; Zhou, X.; Asselbergs, F.W.; Ciullo, M.; Clarke, R.; Deloukas, P.; Franke, A.; Franks, P.W.; Franks, S.; Friedlander, Y.; Gross, M.D.; Guo, Z.; Hansen, T.; Jarvelin, M.R.; Jorgensen, T.; Jukema, J.W.; Kähönen, M.; Kajio, H.; Kivimaki, M.; Lee, J.Y.; Lehtimäki, T.; Linneberg, A.; Miki, T.; Pedersen, O.; Samani, N.J.; Sorensen, T.I.; Takayanagi, R.; Toniolo, D.; BIOS-consortium; CARDIo GRAMplusCD; LifeLines Cohort Study; InterAct Consortium; Ahsan, H.; Allayee, H.; Chen, Y.T.; Danesh, J.; Deary, I.J.; Franco, O.H.; Franke, L.; Heijman, B.T.; Holbrook, J.D.; Isaacs, A.; Kim, B.J.; Lin, X.; Liu, J.; März, W.; Metspalu, A.; Mohlke, K.L.; Sanghera, D.K.; Shu, X.O.; van Meurs, J.B.; Vithana, E.; Wickremasinghe, A.R.; Wijmenga, C.; Wolffenbuttel, B.H.; Yokota, M.; Zheng, W.; Zhu, D.; Vineis, P.; Kyrtopoulos, S.A.; Kleinjans, J.C.; McCarthy, M.I.; Soong, R.; Gieger, C.; Scott, J.; Teo, Y.Y.; He, J.; Elliott, P.; Tai, E.S.; van der Harst, P.; Kooner, J.S.; Chambers, J.C.We carried out a trans-ancestry genome-wide association and replication study of blood pressurephenotypes among up to 320,251 individuals of East Asian, European and South Asian ancestry. We find genetic variants at 12 new loci to be associated with blood pressure (P = 3.9 × 10(-11) to 5.0 × 10(-21)). The sentinel blood pressure SNPs are enriched for association with DNAmethylation at multiple nearby CpG sites, suggesting that, at some of the loci identified, DNAmethylation may lie on the regulatory pathway linking sequence variation to blood pressure. The sentinel SNPs at the 12 new loci point to genes involved in vascular smooth muscle (IGFBP3, KCNK3, PDE3A and PRDM6) and renal (ARHGAP24, OSR1, SLC22A7 and TBX2) function. The new and known genetic variants predict increased left ventricular mass, circulating levels of NT-proBNP, and cardiovascular and all-cause mortality (P = 0.04 to 8.6 × 10(-6)). Our results provide new evidence for the role of DNA methylation in blood pressure regulation.Item Cardiovascular risk profile of the estate population of Sri Lanka(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Chackrewarthy, S.; Perera, P.S.; Wijayasinghe, Y.S.; Williams, S.; Williams, S.S.; Kato, N.; Wickremasinghe, A.R.OBJECTIVES: To estimate the prevalence of biochemical and anthropometric risk markers of cardiovascular diseases in the estate population of Sri Lanka. METHODS: Using a cross sectional design, consenting adults aged 35-64 years resident in 3 selected estates in the Nuwara-Eliya District were recruited with the support of estate medical assistants and welfare officers. AH participants were subjected to an interview, blood pressure and anthropometric measurements and collection of fasting blood samples. RESULTS: Of the 401 participants recruited, 53% were females and 99% were cither Indian or Sri Lankan Tamils. The mean age of the participants was 50.3 years (SD 8.5). 47 (12%) participants had a BMI >25, 8 (2%) a BMI >30. 29 males (15%) and 29 females (14%) had a waist circumference [WC] >90cm and >80 cm, respectively. 151 (38%) participants had systolic blood pressure (SBP) > 140mmHg , 127 (32%) had diastolic blood pressure (DBF) > 90mmHg and 170 (42%) had either SBF > 140 or DBF > 90. 41(10%) participants had fasting blood glucose (FBG) >126mg/dL. In 197 (49%) participants, some form of dyslipidaemia was present. Males had a significantly higher mean BMI, FBG and triglyceride (TG) level and a significantly lower high density lipoprotein (HDL) level as compared to females. CONCLUSIONS: Obesity, as defined by BMI or WC, was low in this population as compared to other reported studies from different population groups in the country. But prevalence of hypertension and dyslipidaemia (especially high TG and low HDL levels in males) was high.Item Epidemiology of hypertension in an urban population of Sri Lanka(Sri Lanka Medical Association, 2011) Kasturiratne, A.; Pinidiyapathirage, M.J.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: To describe the epidemiology of hypertension in 35-64 year old adults resident in Ragama Medical Officer of Health area in the Gampaha district, Sri Lanka. Methods: The Ragama Health Study is conducted in the Ragama MOH area of the Gampaha district. An age- stratified random sample of 2986 adults between 35-64 years of age, were screened for cardiovascular risk factors. Socio-demographic and risk factor related data were obtained by structured interview. Anthropometric and blood pressure measurements were obtained and relevant biochemical investigations were conducted. RESULTS: The prevalence of hypertension (systolic > 139 mm Hg and/or diastolic > 89 mm Hg) in 2986 participants (males 45%), was 30.4% (27.8% in males; 32.5% in females). 31.8% (n=288) were previously undetected. Of the known hypertensives, 19.5% were not on anti-hypertensive medication and only 32.1% were controlled (defined by systolic <140 mm Hg and diastolic <90 mm Hg). Factors associated with hypertension in both males and females were body mass index, waist circumference, fasting blood glucose and serum triglycerides. CONCLUSIONS: The prevalence observed is comparable to the prevalence of developed countries with relatively older populations. A considerable proportion of known hypertensives are not on treatment and the observed poor control indicates problems in drug compliance. Interventions targeting lifestyle modification and drug compliance are essential to control adverse outcomes of hypertension.Item The burden of diabetes mellitus in an urban population of Sri Lanka(Sri Lanka Medical Association, 2011) Pinidiyapathirage, M.J.; Kasturiratne, A.; Williams, S.; Wijekoon, N.; Pathmeswaran, A.; Ranawaka, U.K.; Warnakulasuriya, T.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: To describe the burden of diabetes in middle and old aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, in which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and 51ood pressure measured by trained personnel. Blood samples were taken after a 14 hour fast for measurement of glucose, HbAlc and lipids. The prevalence of diabetes (fasting plasma glucose [FPG] >7mmol/L) and impaired fasting glycaemia [IFG] (FPG=5.6-6.9mmol/L) and major predictors of diabetes in Sri Lanka were estimated from the population based data. RESULTS: In the whole sample two thirds of the participants were diagnosed as either people with diabetes (20%) or IFG (45%). Among the diabetics only 23.8% were optimally controlled. Through the present screening, 235 diabetics (7.9%) and 1257 (42.1%) participants with impaired fasting glucose levels were newly identified. Old age (OR=5.1, 55-64 years vs. 35-44 years), male sex (OR=3.1), family history (OR- 2.7), central obesity (OR-1.8), and reduced physical activity (OR=1.3) were significantly associated with increased risk of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in the general population. Short and long term control strategies are required not only for optimal-therapy among those affected but also for nationwide primary prevention of pre-diabetes.Item Anti-tuberculous drug induced hepatitis in Sri Lankan patients(Sri Lanka Medical Association, 2007) Senaratne, W.V.; Pinidiyapathirage, M.J.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.OBJECTIVE: To determine the incidence and risk factors of anti-TB drug induced hepatitis (AIH) in Sri Lankan patients and to address management options. DESIGN, SETTING AND METHODS: 783 patients with a confirmed diagnosis of TB who presented to a unit at Chest Hospital, Welisara from April 2001 to April 2002 were recruited for a follow up study. WHO category 1 for new and category 2 for re-treatment cases was commenced using single drug formulations. Doses were based on three weight bands. AIH was diagnosed when patients complained of decreased appetite, nausea/vomiting and elevated serum biliru&n (SB) l.lmg/dl or elevated serum alanine transferase (ALT) 3 times upper limit of normal (ULN). Results: 74 patients (9.5%) out of 783 enrolled patients developed AIH; the majority (58%) developing AIH within the first two weeks of the intensive phase of treatment. AIH was commoner among patients over 60 years (p=0.018), with pulmonary TB (p=0.028) and weighing 33-35 kg (p=0.004). Using regression analysis, age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60 and treatment was modified in six; two defaulted and six died. Conclusions: Incidence of AIH among Sri Lankan patients is 9.5%. They develop symptoms of hepatitis when ALT levels rise to three times the ULN lowering the threshold for diagnosis of AIH. Old age, 33-55 kg weight band and rifampicin over dosage are risk factors for AIH. Majority (81%) of AIH patients could be restarted on standard treatment.Item Translational research for diabetes self-management in Sri Lanka: A randomized controlled trial(Elsevier, 2015) Jayasuriya, R.; Pinidiyapathirage, M.J.; Jayawardena, R.; Kasturiratne, A.; de Zoysa, P.; Godamunne, P.; Gamage, S.; Wickremasinghe, A.R.AIMS: The study tested the hypothesis that a theory driven Diabetes Self-Management (DSM) intervention delivered by trained nurses would result in a clinically significant improvement in glycaemic control. METHODS: Patients with an HbA1c >7.5% (58mmol/mol) and free of diabetes complications were enrolled into a randomized controlled trial (n=85). Intervention consisted of four sessions and monthly follow up for 6 months. Biochemical tests, and diet and physical activity assessments were done in both groups. Analysis of covariance was used to test the effectiveness of the intervention. RESULTS: At 6 months, there was a significant difference (P=0.001) in HbA1c between the groups controlling for baseline values and other variables. Based on the primary outcome, 28% in the intervention group achieved the target value of 6.5% HbA1c, compared to 8% in the "usual care" group (P<0.001; η2=0.65). The reduction in total energy intake and increase in physical activity was significant in the intervention group between baseline and follow up. CONCLUSIONS: The DSM intervention has resulted in a clinically significant impact on glycaemia, change in diet and physical activity, and has demonstrated the feasibility of using it within existing care arrangements in a developing country setting. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.Item The Burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka(Wiley-Blackwell, 2013) Pinidiyapathirage, M.J.; Kasturiratne, A.; Ranawaka, U.K.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Warnakulasuriya, T.; Wickremasinghe, A.R.AIMS: To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS: Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes