Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Introduction of a Safe Water System (SWS) In a tsunami attuned community In Hikkaduwa, Sri Lanka
(College of the Community Physicians of Sri Lanka, 2007) Pinidiyapathirage, M.J.; Wijeyaratnez, P.; Wickremasinghe, A.R.; Kalluri, P.
INTRODUCTION: The SWS is an intervention that employs simple, robust, and inexpensive technologies to make drinking water safe at the point oi use through disinfection and safe storage. OBJECTIVE: To introduce a sale water system using household chlorination and washing of hands with soap in the community. METHODS: A commercially prepared solution of 0.9% sodium hypochlorite ('Chlovathura') in 130ml plastic bottles and a 20-liter plastic container with a narrow mouth and a lid was provided tree 01 charge. Trained community assistants distributed and promoted the use of the SWS using interpersonal communication methods. Hand washing using soap was promoted simultaneously. Surveys were conducted at baseline (n=452). six months (n=100) and 18 months (n=200) post- intervention to assess use. RESULTS: All were aware of the product ’Chlovathura' by six months of its introduction. 0t those who were aware oi the product, 49% (n=98) correctly described how it should be used at baseline and this percentage improved to 75% (n=149) post-intervention. When stored water at household level was tested for chlorine, it was present in the specified concentration in 6% 01:26), 27% (n=27) and 34% (n=67) at baseline, six months and 18 months respectively. The incidence of a diarrhoeal episode within the past two weeks among children under 5 years in the sample reduced to 4.8% (n=4) at 18 months from 5.4% (n=8) at baseline (p>0.05). CONCLUSION: The SWS was accepted and correctly practiced by more than one third of the target population. The SWS can be promoted in other areas with remote access to safe drinking water and may be a solution to reduce the morbidity due to diarrhoeal diseases in the country.
Mortality in an urban cohort in Ragama, Sri Lanka
(BMJ Publishing Group, 2011) Vithanage, P.V.T.S.; Panapitiya, P.A.S.; Padmakumara, N.; Hemantha, S.; Kasturiratne, K.T.A.A.; Wickremasinghe, A.R.; Pathmeswaran, A.; Pinidiyapathirage, M.J.
INTRODUCTION: The leading causes of mortality in Sri Lanka are due to chronic diseases. We describe the mortality patterns in a 35–64-year-old urban cohort resident in Ragama, Sri Lanka and followed over 3 years. METHODS: A follow-up study was conducted among 2986 35–64 year olds randomly selected from the Ragama Medical Officer of Health area, Sri Lanka. A baseline survey was conducted from January to September 2007 and a follow-up survey was conducted from March to November 2010. Mortality data were obtained from next of kin and cause of death was verified from death certificates. RESULTS: There were 49 deaths during 9186.46 person years of observations. Of the 49 deaths, 11 were due to myocardial infarctions, 5 were due to strokes, 5 were due to other ischaemic heart disease and the rest included 6 due to cancer and 2 due to train accidents. The increase in mortality in men occurs after 45 years and in females it is observed later on. Mortality among men was more than twice as much as females (RR 7.96 vs 3.17 per 1000 person years). All cause mortality was significantly higher in diabetics. Mortality was not associated with hypertension, dyslipidaemia, smoking, central obesity, obesity or physical activity. Conclusions Diabetes Mellitus was significantly associated with all cause mortality. Other associations may have not been significant due to the small number of deaths.
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.
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.
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.
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.
Knowledge and practices of dengue control and their effect on breeding sites and vector populations
(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Gunethilake, M.A.G.N.; Wijegunawardana, N.D.A.D.
OBJECTIVE: To describe the association between knowledge and practices of dengue control with the observed dengue breeding sites and vector populations in a community. METHODS: A cross-sectional survey was conducted among households in Negombo area in July 2009 during the height of the dengue epidemic in the country. Knowledge and practices in this community were measured using two methodologies. The first was a questionnaire, to be answered by the household respondent; the second, a mosquito larval survey, to identify potential and actual mosquito breeding sites in the corresponding household. The use of the two instruments allowed comparison of respondent knowledge and reported practice with the actual condition of the compound. RESULTS: All respondents (n=120) have heard of dengue, 89% knew at least one symptom of dengue and 93% knew that a mosquito was responsible for transmission. 60% correctly stated the preferred biting times of the vector and 80% knew that discarded tyres, bottles and plastic containers with water collections were the potential vector breeding sites. On inspection, 104 (87%) households had at least one potential breeding source. However, Aedes aegypti/albopictus larvae/pupae were observed only in water samples collected from 3 (2.5%) households. Knowledge about dengue symptoms, methods of prevention or level of education had no association with the potential breeding sites found. Low income was significantly associated with having at least one potential breeding source in the household. CONCLUSION: Although the level of knowledge about dengue was high in this community, we found only httle evidence that this knowledge was put into practice.
Alcohol consumption and tobacco smoking in an urban adult Sri Lankan population
(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Pinidiyapathirage, M.J.; Perera, H.K.K.; Fernando, E.D.P.S.; Ranasinha, C.D.; Edirisinghe, P.A.S.; Makaya, M.; Kato, N.
BACKGROUND: Data on the prevalence and patterns of alcohol consumption and smoking in the general population in Sri Lanka are scarce. Objective: To describe patterns of alcohol use and smoking in an urban adult population in Sri Lanka. DESIGN, SETTING AND METHODS: A random sample of the general population aged between 35-65 years, resident in the Ragama Medical Officer of Health area was interviewed to obtain drinking and smoking habits. RESULTS: Among 2985 subjects [males 45.5%; mean age 52.7 years (SD7.8)], 1156(39.7%) reported ever use of alcohol, and 892(29.7%) reported current use. 58.8% of males and 5.7% of females were current drinkers. 190(14%) males and 12(0.7%) females consumed alcohol above the weekly safe limit (>14 units for males, >7 units for females). The median duration of alcohol use among ever users was 18 years (interquartile range 10-25), and current users was 20 years (interquartile range 1,0-25). The commonest type of alcohol consumed was arrack (n=492), followed by beer (n=217). 60.2% of males and 2.1% of females reported ever smoking, 483(16.2%) were current smokers. 35.1% of males and 0.5% of females were current smokers. The median duration of smoking was 20 years among both ever smokers (interquartile range 10-27.3), and current smokers (interquartile range 15-30). Most (55.3%) smoked cigarettes, only 36(4.2%) smoked beedi. The median pack years of current smokers was 4,5 (interquartile range 2-10). CONCLUSION: Lifetime and current use of alcohol and smoking are high among males. Focused interventions are required to reduce current rates among males and to maintain low rates reported by females.
Lifestyle correlates of cardiovascular risk factors in a Sri Lankan population
(Sri Lanka Medical Association, 2008) Pinidiyapathirage, M.J.; Kasturiratne, A.; de Silva, B.A.; Perera, D.M.; Ramanayake, R.P.J.C.; Sumathipala, W.L.A.H.; Mizoue, T.; Makaya, M.
OBJECTIVES: To determine the association between selected lifestyle risk behaviours (physical activity-PA, smoking and fruit, vegetable and alcohol consumption) and cardiovascular risk factors in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: A random sample of 3650 individuals between 35-64 years resident in the Ragama MOH area were selected from the electoral list. A validated, interviewer-administered, food frequency questionnaire and a physical activity questionnaire were used to collect data. Blood samples were analysed for serum lipid and fasting blood glucose (FBG) concentrations. RESULTS: Of the 2602 participants (males:46%), 47% reported low physical activity (PA), 51% sub-optimal fruit consumption, 13% sub-optimal vegetable consumption, 6% excess alcohol consumption and 16% were current smokers. A significantly higher percentage of males reported moderate to high physical activity, had a lower BMI, consumed more alcohol, smoked currently and consumed less fruits. Vegetable consumption was similar between sexes. In females, risk behaviours were not associated with serum lipid and FBG concentrations. Among males, those reporting a low PA had a significantly higher percentage with serum triglyceride concentrations >150mg/dl and FBG >110mg/dl. A significantly higher percentage of male smokers had a serum total cholesterol concentration >200mg/dl and serum LDL concentration >100mg/dl. Excessive alcohol consumption in males was associated with high triglyceride concentrations (>150mg/dl). Serum lipid and FBG levels were similar among those with different fruit and vegetable consumption patterns, CONCLUSION: Low physical activity, smoking and excessive alcohol consumption were associated with serum lipid and FBG concentrations in males. Fruit and vegetable consumption was not correlated with risk factors.
Availability of drugs for the treatment of non-communicable diseases in the government health care institutions in Sri Lanka
(Sri Lanka Medical Association, 2006) Pinidiyapathirage, M.J.; Chandratilake, M.N.; Kasturiratne, A.; Jayaratna, G.S.; Jayasekera, D.P.A.R.N.; Subhasini, K.A.P.; Mahawithanage, S.T.; Wickremasinghe, A.R.
OBJECTIVE: To assess the availability of commonly used drugs in the treatment of non-communicable diseases in government health care institutions. METHODS: Forty four government health care institutions, representing the 3 levels of health care institutions (level 1 - CD & MH, level 2 - PU, DH, RH, level 3 - BH, GH, PH, TH) were randomly selected from the districts of Colombo, Anuradhapura, Moneragala and Matara. Each of the selected institutions was visited and the availability of a selected list of drugs was ascertained on the day of the visit. Availability was considered satisfactory if the drug was available in at least 75% of institutions of a particular level. RESULTS: Of the drugs that should be available at each level the following results were obtained: Level I -Availability of thiazides, beta-blockers, aspirin and nitrates were satisfactory. Availability of benzathine benzylpenicillin, glibenclamide andprednisolone were unsatisfactory. LevelII- Furosemide, thiazides, nitrates, glibenclamide, metformin andprednisolone were available in all and the availability of methyldopa, nifedipine, beta-blockers and aspirin was satisfactory. Availability of benzathine benzylpenicillin, insulin (isophane/so ruble) and spironolactone were unsatisfactory. Level III - Furosemide, thiazides, metformin, aspirin, beta-blockers, nitrates, nifedipine and prednisolone were available in all while the availability of benzathine benzylpenicillin, captopril, spironolactone, methyldopa, glibenclamide, insulin (isophane/soluble) and timolol eye-drops were satisfactory. Availability of steptokinase, inhalation steroids and salbutamol, ipratropium bromide, losartan, and tamoxifen were unsatisfactory. CONCLUSIONS: Availability of some essential drugs for non-communicable diseases was unsatisfactory at all 3 levels of health care institutions. This may be a reason for patients bypassing smaller institutions and the back referral system not functioning properly in the country. Inadequacy of national stocks cannot by itself explain the non-availability of these drugs as the survey was carried out in July/August.

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