Browsing by Author "Arangala, D.M.P."

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Development of cardiovascular disease risk prediction model for Sri Lankans
(Sri Lanka Medical Association, 2021) Mettananda, K.C.D.; Thampoe, R.S.; Batagoda, B.M.S.M.; Arangala, D.M.P.; Abeysena, H.T.C.S.
INTRODUCTION AND OBJECTIVES: There are no Cardiovascular (CV) risk prediction models derived from Sri Lankans. Therefore, we aimed to develop a model to predict the risk of cardiovascular diseases (CVD) among Sri Lankans. METHODS: We developed a model to predict the risk of developing CVDs among Sri Lankans by comparing risk factors of patients who have had and haven’t had acute CVDs. Risk factors were selected depending on the odds ratios of each risk predictor and the feasibility of using those in clinical practice. Two separate models were developed for diabetics and non-diabetics. A scoring system [diabetics; 0-23 and non-diabetics 0-14] was designed based on weighted scores of each risk predictor. Predictive validity of the model was tested by calibration and discrimination. Receiver Operator Characteristic (ROC) curve was used to determine the cut-off value. RESULTS: The model consisted of five predictors; sex, current-smoking status, premorbid systolic blood pressure > 140 mmHg, antihypertensive medication usage and high-density-lipoprotein(HDL) < 45 mg/dL. Discrimination of the model was measured by the area under the ROC curve (diabetics; 0.76, 95% Confidence Interval: 0.68-0.84, non-diabetic; 0.91, 0.86-0.96). Calibration with goodness of fit by Hosmer and Lemeshow test (diabetics; p=0.75, non-diabetics; 0.66) was satisfactory. The tool demonstrated a good predictive ability with sensitivity and specificity of 71.1% (95%CI: 61.3% - 80.8%) and 68.4%(65.3% - 80.5%) in diabetics and 82.2% (95%CI: 72.7% - 91.7%) and 90.9% (95%CI: 84.9% - 96.9%) in non-diabetics. CONCLUSION: The model demonstrated good discrimination and well calibration. It can be used in screening high-risk Sri Lankans for developing cardiovascular diseases.
Prevalence and associations of polypharmacy among Sri Lankans: A hospital-based study
(Sri Lanka Medical Association, 2021) Mettananda, K.C.D.; Fernando, R.K.R.; Peiris, H.H.I.; Arangala, D.M.P.
Introduction and Objectives Polypharmacy is a global health problem but the prevalence in Sri Lanka is not known. Therefore, we studied the prevalence and associations of polypharmacy in Sri Lanka. Methods We conducted a cross-sectional study of all medical clinics of Colombo North Teaching Hospital from 15 August 2020 to 15 February 2021. 50 patients of each clinic were randomly selected. Data were collected using an interviewer-administered questionnaire by interviewing patients and perusing medical recodes. Polypharmacy was defined as being on five or more medications regularly for one month before enrolment. Data were analyzed using SPSS-22. Results 504 patients; 215(42.7%) males, mean age 59.7+14.3 years were studied from 4 general-medical and 8 speciality clinics. 352(69.8%) were on polypharmacy. 159(46%) were on allopathic and complementary medicines. Polypharmacy prevalence was not different between general-medical (71.3%) and speciality clinics (69.2%), p=0.67. Prevalence was more in patients above 60 years (77.3%), p<0.0001. Polypharmacy was associated with diabetes (OR 3.3, p<0.0001), hypertension (OR 2.5, p<0.001), chronic kidney disease (OR 3.9, p<0.0001) and ischaemic heart disease (OR 3.3, p<0.002) but was not associated with gender (OR 1.1, p=0.776), dyslipidemia (OR 1.2, p=0.407) or stroke (OR 1.2, p<0.521). Of patients on polypharmacy, 68(47.7%) were not complaining while others were worried due to different reasons; kidney/ liver damage (46(13,1%), high-cost (21(6.0%)), side effects (22(6.3%)), frustration (16(4.5%). 72((20.5%) had more than one worry. Conclusion Polypharmacy is a common problem in this hospital-based urban/ semi-urban cohort of Sri Lankans and is more with old age, diabetes mellitus, hypertension, kidney disease and ischemic heart disease.