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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Fetal echocardiographic assessment: impact of gestational age and maternal obesity.(Jaypee Brothers Medical Publishers, 2023) Patabendige, M.; Kodithuwakku, S.U.; Perera, M.N.I.; Dias, T.AIM: To identify the ability to acquire various fetal cardiac views using two-dimensional ultrasound at different gestational age and body mass index (BMI) categories. MATERIALS AND METHODS: We performed a prospective observational study among low-risk women with singleton pregnancies attending the University Obstetrics Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka. The ability to obtain satisfactory views of the situs, four chambers, right and left outflow tracts, three vessels, aortic arch, ductal arch, and superior and inferior vena cava of fetal heart was studied. RESULTS: A total of 314 eligible pregnant women underwent fetal echocardiography and 288 had complete data. All eight cardiac views were obtained with 100% success at the gestational age of 18 – 21 + 6 weeks and days. All eight cardiac views were satisfactory in more than 97% at the gestational age of 22 – 25 + 6 weeks and days. Body mass index was not significantly associated with acquisition of cardiac views at all gestations (p = 0.62). All eight cardiac views were obtained with 50% success at 14 – 17 + 6 weeks and 5.4% success at 11 – 13 + 6 weeks and days. CONCLUSIONS: Acquisition of all fetal cardiac views was best at 18 – 21 + 6 weeks and days of gestation, but reasonably successful till 26 weeks. Acquisition was sub-optimal in first trimester, below 18 weeks and for some cardiac views after 26 weeks. BMI does not hamper the ability to obtain cardiac views during fetal echocardiography. CLINICAL SIGNIFICANCE: This could be used as a guide for the timing of echocardiography when a particular cardiac defect is suspected in the fetus, where specific cardiac view(s) are used to confirm the particular diagnosis as well as the most appropriate gestational age period.Item Prevalence of overweight and obesity among women in two medical officer of health areas in Kalutara district(College of Community Physicians of Sri Lanka, 2023) Herath, D.; Kasturiratne, A.INTRODUCTION: Overweight and obesity are rising burdens in the w orld. Gender disparities in its prevalence are more evident in developing countries compared to developed countries. OBJECTIVES: To determine the prevalence of overweight and obesity among 35-44-year-old women in Bandaragama and Horana Medical Officer of Health (MOH) areas METHODS: This was a community-based descriptive cross-sectional study conducted among 770 women aged 35-44 years residing in two MOH areas of Kalutara District for the l ast six months at the time of data collection. Overweight/obesity were assessed on the Asian cutoff values recommended by the WHO based on body mass index (BMI). The prevalence was estimated with 95% confidence interval (CI). RESULTS: The prevalence of overweight in Bandaragama and Horana MOH areas was 41.35% (95% CI: 37.9, 44.81) and 39.7% (95% CI: 36.3, 43.2), respectively, while the correspondi ng prevalence of obesity was 36.1% (95% CI: 32.8, 39.6) and 26.6% (95% CI: 16.4, 39.1). CONCLUSIONS & RECOMMENDATIONS: The prevalence of overweight /obesity among women aged 35-44 years was relatively high. Barriers to a healthy lifestyle, women's role in the household and existing service gaps at primary healthcare level should be considered when preventive measures ar e introduced to reduce this burden.Item Selected obesity related non-communicable diseases (NCD’s), associated risk factors and knowledge on NCD’s among Buddhist monks and lay people in Colombo district, Sri Lanka(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Abeyratne, V.; Weerasooriya, S.D.; de Zoysa, D.N.P.; Thrimadura, R.D.; Kapuwella, I.Introduction: Obesity related non-communicable diseases (NCDs) have become a global pandemic. Buddhist monks have been excluded from most studies on NCDs done in Sri Lanka. Objectives: This cross-sectional study is the first study conducted on Buddhist monks with the aim of comparing the presence of obesity related NCDs, associated risk factors and knowledge on NCDs and comparing them with laypeople in Colombo district. Methods: An interviewer-administered questionnaire was administered to 80 monks and male lay people each, aged 18-60 years. The collected data on the presence of NCDs, associated risk factors and knowledge were analyzed by chi-square and independent sample t-tests. Results: Diabetes was the commonest NCD among monks while both hypertension and diabetes were equally common in laypeople. Among monks, presence of NCDs increased with period of ordination and good knowledge on risk factors was associated with a higher percentage of adequate physical activity. Laypeople had greater overall knowledge on selected NCDs, and risk factors and this proportion increased with their education level. The presence of family history of NCDs was also higher among laypeople while fresh fruit consumption was low in both groups. Conclusions: The findings of this study indicate that a significant proportion of monks and lay people have at least one NCD and the knowledge of Buddhist monks on NCDs needs to be improved. More studies with greater sample sizes should be done to assess if the NCD prevalence increased with ordination period due to age or the different lifestyles that Buddhist monks lead.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 Screening of cushings syndrome in patients with poorly controlled type 2 diabetes with hypertension and obesity(2018) Karuppiah, D.; Cooray, M.S.A.; Somasundaram, N.; Ediriweera, D.S.INTRODUCTION: Cushing’s syndrome (CS) may be unrecognized in patients with diabetes. There is no consensus on routine screening for CS in patients with type 2 diabetes (T2DM). Aim of the study was to evaluate the prevalence of unsuspected CS in out-patients with diabetes. METHODS: Cross sectional prospective study was conducted at diabetes clinic in National Hospital of Sri Lanka among patients with diabetes who were attending for out-patient visit from January-2016 to January- 2017. Total of 287 patients were investigated with over-night dexamethasone- suppression test (ODST) as a screening test. Patients who fail to suppress serum cortisol less than 50nmol/l were further tested by Low-dose-dexamethasone-suppression test (LDDST). A third step midnight cortisol measurement was performed in patients who were failed to suppress cortisol less than 50nmol/l on LDDST. Fourth step imaging studies with pituitary MRI, abdominal-CT or CT-scan of chest abdomen and pelvis depending on the ACTH levels were performed. RESULTS: Out of 287, 46.18% (133) patients failed to suppress cortisol to less than 50nmol/l on ODST. Among these 133, 23(11.49% of total) patients failed to suppress cortisol less than 50nmol/l on LDDST. Nine out of 23 patients had cortisol more than 140nmol/l on midnight cortisol test, confirming true CS. Further investigations with imaging revealed one with pituitary adenoma, one with adrenal adenoma and 6 had normal imaging. CONCLUSION: Considering the prevalence of definitive CS of 3.18% among poorly controlled T2DM patients with hypertension and obesity suggest that CS is not rare as previously thought. But in our Asian population with T2DM and high prevalence of co-morbidities, taking overnight dexamethasone suppression test alone as a screening test would not be a suitable test to screen CS.