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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Premorbid blood pressure control of incident transient ischaemic attacks and strokes; prevalence and determinants; Analysis of individual patient data over 10 Years(Lippincott Williams & Wilkins, 2017) Mettananda, C.; Li, L.; Lau, G.; Wharton, R.; Bull, L.; McCulloch, E.; Welch, S.; Mehta, Z.; Silver, L.; Rothwell, P.; Oxford Vascular StudyBACKGROUND: Uncontrolled blood pressure is the most important modifiable risk factor for strokes. AIMS AND METHODS: We determined the prevalence and determinants of blood pressure control in patients with incident transient ischaemic attacks(TIA) and strokes from 2002-2012 in a population-based cohort(Oxford Vascular Study). Controlled blood pressure(BP) was defined as having BP<140/90mmHg and was studied in different cardiovascular risk groups according to the Framingham 10-year general cardiovascular risk(CV-Risk) predicted at time of event and 10years pre-event; low(≤ 10%), moderate(11-19%) and high(≥ 20%) risk. We also studied the associations of controlled BP adjusted for age and sex. RESULTS: Among 1741 patients with incident TIA/strokes, 1051 (60.4%) had known hypertension, of which 891 (84.8%) were on anti-hypertensive treatment. However, only 698 (40.1%) of all and 306 (29.1%) of treated patients had controlled BP. On predicted 10-year CV-Risk at event, 861 (72.5%) of 1188 (77.0%) in high risk group had known hypertension, of which 758 (88.0%) were on treatment. However, only 346 (29.1%) of all in high-risk group and 190 (25.1%) of treated high risk patients had controlled BP. In contrast, 120 (88.2%) of 136 (8.8%) in low risk group had controlled BP. Risk stratification without scoring for BP showed consistent results except the number in high-risk group dropped to 863 (55.9%). Analysis with CV-risk 10years pre-event also showed similar trends. Age(adjusted OR=0.97, 95%CI=0.97-0.98, p<0.001), high CV-risk at event/10years pre-event (0.97, 0.95-0.99, p<0.013, 0.95-0.99, p=0.008), being treated for hypertension(0.43, 0.35-0.52, p<0.001), BMI≥ 30Kg/m2(0.72, 0.55-0.92, p=0.010) and high total cholesterol(0.91, 0.84-0.99, p<0.026) were negatively associated with controlled BP. However history of atrial fibrillation(1.35, 1.03-1.77, p=0.030) and physical dependency(modified-Rankin-Scale>2; 1.54, 1.15-2.06, p<0.001) were positively associated with controlled BP. CONCLUSIONS: Premorbid blood pressure control in patients with incident TIA/strokes was inadequate especially in high-risk patients. Controlling BP to targets in elderly and high CV-risk patients would be important in reducing incident TIA/strokes.Item Analysis of nutritional status and factors associated with undernutrition in children aged 6-59 months in a rural area of Sri Lanka(Sri Lanka College of Paediatricians, 2019) Samarasekara, G.S.; Mettananda, S.; Punchihewa, P.OBJECTIVE: To describe the prevalence and factors associated with undernutrition in children aged 6-59 months in a rural area of Sri Lanka. METHOD: A community-based, cross-sectional study was carried out among children aged 6-59 months attending well baby clinics in Dehiattakandiya Medical Officer of Health area from November 2016 to January 2017. Data collection was done using an interviewer-administered questionnaire. Weight and height measurements were taken with calibrated instruments. Data analysis was done using logistic regression by SPSS 16.0. RESULTS: Four hundred and sixty four children were recruited having a mean age of 29.3 ±14.6 months; 53% were females. Prevalence of stunting, underweight and wasting was 36.4%, 42.9% and 19.0% respectively. The following independent associations were identified: for stunting- low birth weight, breastfeeding beyond 2 years, lower maternal education and paternal smoking; for underweight- birth order more than 2, low birth weight, breastfeeding beyond 2 years, lower maternal education and paternal smoking and alcohol use; for wasting- male sex, low birth weight and paternal smoking. CONCLUSIONS: Low birth weight, prolonged breastfeeding, lower maternal education level and paternal smoking had a significant association with stunting and underweight whilst male sex, low birth weight, and paternal smoking had a significant association with wasting in children aged 6-59 months.Item Assessment of anxiety, depression, stress, and associated psychological morbidities among patients receiving ayurvedic treatment for different health Issues: first study from Sri Lanka.(Hindawi Pub. Co., 2019) Gunathilaka, H.J.; Vitharana, P.; Udayanga, L.; Gunathilaka, N.BACKGROUND:Good mental condition is a vital part of health. Physical impairments would potentially have psychiatric manifestations during the course of a disease that could cause patients to experience a wide range of psychological conditions. This study was conducted to determine prevalence of anxiety, depression, stress, and psychological morbidities among the patients who received warded treatments at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Sri Lanka. METHODS: A total of 148 patients admitted to the hospital were selected for the study on a random systematic basis under four systemic groups (gastrointestinal, integumentary, musculoskeletal, and nervous system) depending on the chief complaint. The presence of depressive, anxiety, and stress symptoms was assessed by the Depression Anxiety Stress Scale 21 item version (DASS 21). The General Linear Model (GLM) was used for statistical analysis. RESULTS:Over 50% of the participants in all four patient groups belonged to age group of 35 to 65 years, encompassing the fraction of population that actively contribute to the workforce in the society. Stress, anxiety, and depression values of patients belonging to different complications varied significantly, as indicated by GLM (p < 0.05). Patients diagnosed with integumentary system-related issues denoted the highest stress levels (27.7 ± 2.54), while the mean stress values among the other systemic groups were not significantly different among each other. The highest anxiety levels were indicated by patients with nervous system-related issues (18.6 ± 1.51), while the lowest anxiety levels were indicated by patients with integumentary disorders (6.0 ± 2.73). The highest depression level was identified from patients suffering from integumentary system-related disorders (31.7 ± 3.42), followed by nervous system (23.2 ± 1.78), gastrointestinal (19.5 ± 3.77), and musculoskeletal (16.8 ± 1.57) disorders. CONCLUSION:Overall, high distress levels were observed among the majority of the patients. Furthermore, integumentary issues may lead to significant psychological impacts. As most of the patients seek for Ayurveda treatments when their diseased condition becomes chronic, it is vital to focus on a biopsychosocial approach to patient assessment and patient care, in actual practice.Item High prevalence of overweight/obesity in urban Sri Lanka: findings from the Colombo urban study.(Hindawi Limited, 2019) Somasundaram, N.; Ranathunga, I.; Gunawardana, K.; Ahamed, M.; Ediriweera, D.; Antonypillai, C.N.; Kalupahana, N.BACKGROUND:South Asian countries face a double burden of malnutrition characterized by high prevalence of underweight, overweight, and obesity. Understanding the distribution of this public health problem is important to tailor targeted interventions for communities. The objective of the current study was to find out the prevalence of obesity in urban Sri Lanka and to identify sociodemographic factors associated with it. METHODS:Adult males and females residing in an urban government division of the Colombo District in Sri Lanka were included in this study (Colombo Urban Study). Stratified simple random sampling was used to select a sample of 463 from the total population. Sociodemographic data using an interviewer-administered questionnaire, anthropometric measurements, and serum samples were obtained for investigations. RESULTS: When the global BMI cutoffs were applied, the community prevalences of underweight, normal weight, overweight, and obesity were 7.7%, 39.6%, 37.0%, and 15.8%, respectively. When the Asian BMI cutoffs were applied, the respective prevalences were 7.7%, 26.8%, 34.3%, and 31.2%. The community prevalence for abdominal obesity was 58.1% when using Asian cutoffs. Females had a higher prevalence of both obesity and abdominal obesity. There was an ethnic difference in obesity rates with Moors having the highest rates (65.5%) followed by Sinhalese (52.3%) and Tamils (40.2%). The highest obesity prevalence was observed in the most educated group. Multiple regression analysis showed that high BMI was associated with female gender and family history of hypertension. Serum LDL negatively associated with BMI while the strength of this relationship was impacted by serum HBA1c levels. Finally, serum triglyceride level showed positive association with BMI, and the effect was more marked in Moors compared to Sinhalese. CONCLUSION:Two-thirds of adults in the studied urban population were overweight or obese. This highlights the urgent need for interventions to curb this epidemic. The gender, ethnic differences in obesity, its associations with educational status, and the interactions with metabolic comorbidities indicate that these interventions may need to be targeted towards different groups in the population.Item Prevalence of vitamin D deficiency/insufficiency and its metabolic associations in an urban setting in Sri Lanka: Data from Colombo Urban study(Endocrine Society of Sri Lanka, 2019) Subasinghe, C. J.; Gunawardana, K.; Ediriweera, D.; Somasundaram, N.P.INTRODUCTION: Vitamin D deficiency is a commonly prevalent, but less attended problem in Asia. Vit D status has many metabolic associations. We designed this community-based study to describe the prevalence of vitamin D deficiency/insufficiency and its metabolic associations in Sri Lankan population. METHODS: A representative sample aged 18 years and above was included. Demographic, anthropometric, and social details were recorded using a standard proforma. Blood analysis was done for vitamin D status, and other metabolic parameters. Prevalence was estimated using weighted age standardized calculations. Multiple logistic regression analyses were used to study associations to vitamin D status. RESULTS: Cumulative community prevalence of Vit D deficiency and insufficiency was 90.2%. Prevalence was highest among young and females. Obese had significantly lower vitamin D levels. According to the linear regression, Moors showed a significantly lower Vit D levels compared to Sinhalese while Triglyceride levels showed an inverse association with Vit D levels. Dysglycaemia was not associated with Vit D deficiency. DISCUSSION: Very high prevalence of Vit D problem was anticipated on clinical grounds and this is comparable with regional data. High prevalence among young needs early attention to avoid future poor bone health outcomes. Moor ethnicity shows high rates due to many known factors. Obesity is an emerging health problem in the country and co existent Vit D deficiency would increase its burden. CONCLUSION: Vitamin D deficiency and insufficiency and other metabolic problems are highly prevalent in this population. Causative factors and consequences of this problem should be further researched to plan strategies to replete the Vit D and prevent this problem.Item High prevalence of Diabetes Mellitus in Sri Lankan urban population – Data from Colombo Urban Study(Endocrine Society of Sri Lanka, 2019) Somasundaram, N.P.; Ranathunga, I.; Gunawardana, K.; Ediriweera, D.S.BACKGROUND: In recent decades, Sri Lanka has experienced rapid urbanization, with approximately 30% of the population currently residing in urban areas. We report the age- and sex-specific prevalence of dysglycaemia in an urban population in Colombo, Sri Lanka. METHODS: Using a stratified random sampling method, 463 subjects (139 men; 324 women) aged 18 years and above were included. Physical activity was quantified using international physical activity questionnaire (IPAQ). Bio impedence was used to estimate body fat. Insulin sensitivity was estimated using the HOMA calculations. Prevalence was estimated using weighted age standardized calculations. Multiple logistic regression analyses were used to study associations to diabetes and prediabetes. RESULTS: There were 124 adults in the 18-40 age group (70% female), 209 adults in the 41-60 age group (73% female) and 130 adults in the > 60 age group (63% female). The overall prevalence of diabetes was 27.6% (95% CI: 23.7-31.4). The prevalence of diabetes in those aged 18-40 was 12.4% (95% CI: 6.4 -18.4), 36.1% (95% CI: 29.8 – 42.4) in those aged 41 – 60 and 48.3% (95% CI: 40.7 – 55.8) in those aged >60. Pre-diabetes was detected in 30.3% (95% CI 25.9-34.8) of the population (with either an HbA1c of 5.7-6.4%, FPG of 110-125 mg/dl or 2 Hr PPG of 140-199 mg/dl). Cumulative prevalence of diabetes and pre-diabetes in the population was 57.9%. CONCLUSIONS: This urban study demonstrates that along with the changes in the socio-demographic status, the metabolic profile of the Sri Lankan adult has transformed, with a high prevalence of dysglycaemia and obesity.Item Prevalence of ectoparasitic infections and other dermatological infections and their associated factors among school children in Gampaha District, Sri Lanka(Hindawi Publishing Corporation, 2019) Gunathilaka, N.; Chandrasena, N.; Udayanga, L.Skin disorders are one of the commonest conditions among school children in developing countries. There are only a few published studies available from Sri Lanka on the prevalence of skin disorders. A community-based cross-sectional study was carried out among five government-run schools randomly selected from the district of Gampaha, Sri Lanka, during 2016-2017. A total of 41 students between 5 and 16 years of age were randomly selected from each school. Sociodemographic profile and hygienic behaviors of selected students were assessed using a pretested interviewer-administered questionnaire. Students were examined by a medical officer for the presence of different skin disorders. The chi-squared test of association and binary logistic regression were used for the identification of the significance of socioeconomic factors and hygienic practices among the study participants. A total of 205 school children participated in the study. The commonest skin disorder was pediculosis (42.0%; n=86), followed by dandruff (8.3%; n=17), fungal infections (6.8%; n=14), and scabies (1.5%; n=3). Almost one-fourth of the study participants (22.9%; n=30/131) had more than one disorder, majored by Pediculus captis infestation with dandruff. Over one-third (36.1%; n=74) were free of any skin disorders. The prevalence of skin disorders was significantly high among females (87.3%; n=110), compared to males (26.6%; n=21). Presence of long hair, higher family size, and limited number of rooms in the house were risk factors associated with the prevalence of skin disorders. The commonest skin disorder was pediculosis, while scabies and fungal infections were scarce among school children in the district of Gampaha, Sri Lanka. Implementation of health education and monitoring programs at the school level for maintaining the dermal health status of school children is recommended.Item Prevalence of gastrointestinal parasitic infections and assessment of deworming program among cattle and buffaloes in Gampaha District, Sri Lanka(Hindawi Publishers, 2018) Gunathilaka, N.; Niroshana, D.; Amarasinghe, D.; Udayanga, L.Gastrointestinal (GI) parasitic infection is a serious issue in cattle management. The effects of GI parasites may vary with age, sex of cattle, nutritional condition, and severity of infection. Prevalence of GI parasites among cattle population in Gampaha District has not been studied and there is no published study available. A total of 45 farms rearing cattle were selected randomly in three areas, namely, Kelaniya, Ganemulla, and Welisara, under three Veterinary Surgeon Divisions (VSD) in Gampaha District (Mahara, Gampaha, and Welisara). Freshly voided cattle fecal samples were collected randomly from the selected farms during March 2017–December 2017. Out of 163 cattle and buffaloes examined, 13.39% (n=22) were positive for eggs of one or more species of GI parasites. The prevalence of parasitic infection was higher in buffaloes (31.25%, 5/16) as compared to that of cows (11.56%, 21/147), but the difference was not significant (P >0.05). Hookworms (Bunostomum spp.), whipworms (Trichuris spp.), digenetic trematodes (Paramphistomum spp.), cestodes (Moniezia spp.), and oocysts of protozoans (coccidians) were found during the study. The nontreated animals indicated the highest percentage of parasitic infections accounting for 46.67% (n= 14), followed by partially treated individuals (15.15%, n= 5). GI parasite prevalence in males was higher when compared to that of females, but the difference was nonsignificant (P >0.05). General Linear Modelling (GLM) revealed that the effect of treatment status was significantly associated with the prevalence of GI parasites. The calves and yearlings had the highest rate of GI parasitic infections. The highest infection rate was observed at Kelaniya, followed by Welisara. Future investigations are necessary to evaluate the economic impact of GI parasites in the study areas.Item Prevalence of human papilloma virus and their high-risk genotypes in Sri Lankan women(Springer, 2018) Shanaka, K.A.S.N.; Wilathgamuwa, S.; Gunawardene, Y.I.N.S.; Dassanayake, R.S.Human papilloma virus (HPV) causes cervical cancer in women and approximately 700 deaths have been reported annually in Sri Lanka due to this cancer. Despite, attempts have not been made to investigate the prevalence of HPV amongst Sri Lankan women with normal cytology. In this study, a polymerase chain reaction based assay was set up to detect HPV in both normal and abnormal cytology and the positive samples were then tested for the genotypes, HPV 16 and HPV 18 as they have been identified as the high-risk types associating with cervical cancer. Eighty-four (number = 84) clinical samples (age range 27-69) analyzed in this study indicated that the prevalence of HPV, regardless of cytological abnormalities was 15.5%, (n = 13, 95% class interval ± 7.7) while it was 100% (n = 3) for those with abnormal cytology. Association of HPV 16 and HPV 18 among the abnormal cytology was 0 and 50% (n = 1), respectively and further, the prevalence of HPV 16 and HPV 18 in women was found to be 3.6% (n = 3, 95% CI ± 4.0) and 2.4% (n = 2, 95% CI ± 3.3), respectively. Moreover, age wise prevalence analysis revealed women of the age of 35-years or more to have higher HPV prevalence. The prevalence of HPV among normal cytology is 12.3% (n = 10, 95% CI ± 7.2) which is similar to the rates in other regions of Asia (China 15.4%; India 10.43%). Finally, higher prevalence of HPV in women of the age of 35-years or more in Sri Lanka, especially with malignant types call for such age group to be screened for proper clinical intervention to be made in reducing the incident of cervical cancers. This is the first report of prevalence of HPV among women with normal cytology in Sri Lanka.Item 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.