Conferences and Symposia
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Conference papers presented at Conferences and Symposia organized by the Faculty of Medicine are collected under this subcommunity
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Item Stem cells and its clinical applications(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Patel, H.The concept of stem cells was introduced by Alexander Maximow in the year 1909. Stem cells comprise of "primitive cells" that have the ability to divide indefinitely and give rise to specialized cells under specific conditions. Because of these two distinct characteristics they have received particular attention in recent decades. Stem cells have very potent clinical application in treating cardiovascular, pulmonary, spinal cord, skin, burns and wounds, gynaecological and orthopaedic disorders. Stem cells have proven to be a very good source for treating thin endometrium that could be one of the factors for infertility in women. Endothelial progenitor cells (EPCs) improve vascular blood supply and incorporated into neovessels at sites of damage and significantly improved blood flow. EPCs regenerate the endometrial epithelium with its vascularity and make it mature enough for implantation. Recent findings suggest that ovaries contain stem cells which form new oocytes in adulthood and these can be cultured in-vitro to form mature oocytes. These findings provide new hope for fertility preservation. Even the advances in the technology has achieved to develop germ cells from pluripotent stem cells through iPS. Currently there are limited established clinical application though the research is going on using different type of cells for various different clinical conditions.Item Household air pollution research and policy: a worked example(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sathiakumar, N.OBJECTIVES: 1) To describe the importance of scientific evidence in policy development in the area of household air pollution 2) To present a framework on designing evidence based interventions and policy on exposure reduction related to household air pollution The future of policy development in the area of household air pollution (HAP) depends on credible scientific data that documents the health risks associated with HAP. In most instances, it is necessary to base decisions on the evidence generated elsewhere and to make inferences about the extent to which this evidence is generalizable to another location or country. The ways in which elements of the structural, physical, social and/or cultural environmental factors can influence HAP and how these factors may influence the effectiveness of interventions to reduce HAP exposure are discussed. A framework to be used by public health professionals who are designing, executing, reporting and synthesizing research on HAP, designing and implementing interventions for HAP exposure reduction or formulating policy is suggested.Item Evidence-based recommendations for functional constipation in infants and children(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Benninga, M.Chronic constipation is a common problem in childhood with an estimated prevalence of 3% in the Western world and is probably the most common gastrointestinal complaint in children. According to the ROME-III criteria, functional constipation is defined as a child experiencing 2 or more of the following symptoms: 1) two or fewer defecations in the toilet per week, 2) at least one episode of fecal incontinence per week, 3) stool retentive posturing, 4) painful or hard bowel movements, 5) presence of a large fecal mass in the rectum or 6) large diameter stools that may obstruct the toilet without objective evidence of a pathological condition. Infants up to 4 years of age have to fulfill two or more criteria for at least 1 month while children older than 4 years need at least 2 months of symptoms. Only less than 5% of children with constipation have an underlying disease. In the majority of patients, constipation is difficult to treat and often a long-lasting problem. Up to 50% of children followed for 6-12 mo continue to have symptoms and need ongoing laxative use. Two evidence-based guidelines (the Netherlands and Great Britain) have been developed concerning the diagnostic and therapeutic approach for childhood constipation. To assist healthcare workers worldwide in the management of children with functional constipation, only recently the North American Society for Pediatric Gastroenterology and Nutrition (NASPGHAN) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) decided to develop an evidence-based guideline as a joined effort. At present, a thorough medical history and complete physical exam are usually sufficient to confirm the diagnosis of functional constipation. Further laboratory or radiological investigations should only be performed in case of doubt, to exclude an underlying disease. Treatment of childhood constipation consists of four steps: (1) education, (2) disimpaction, (3) prevention of re-accumulation of faeces and (4) follow-up. Surprisingly, there is only limited evidence that laxative treatment is better than placebo in children with constipation. According to the available evidence, lactulose is recommended for children <1 year as first-choice treatment. For children older than 1 year, both lactulose and polyethylene glycol (PEG) with or without electrolytes can be used as first-choice treatment.Item Genomic medicine in NCDs: findings from Asians/ South Asians to global collaboration(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kato, N.Recently, non-communicable diseases (NCDs), in particular, lifestyle-related diseases have become a key issue of public health in the developing countries. A new understanding of NCDs has emerged from genome-wide association (GWA) studies over the past decade. Despite the paucity of clear physiological evidence on the target phenotypic traits, the GWA findings were expected to provide clues to the precise biological mechanisms. However, human biology is so complex that proving their validity and translating the findings in GWA studies into clinical application require a lot more information (e.g., fine mapping and functional analysis of causative genes) than initially assumed. Along this line, highly sophisticated bioinformatics tools have become indispensable for medical geneticists to analyse the high-throughput experiment data. Thus, in-depth examination and integration of individual molecules are also required to give an overall picture of NCDs, by forming a multi-centre, trans-ethnic (or global) collaboration. The importance of racial or ethnic differences will be discussed in this presentation. At present, a major part of genetic loci associated with cardiovascular phenotypes, which could have been reported in ‘trans-ethnic’ meta-analyses of GWA studies, appear to be common across 3 ethnic groups—Europeans, east Asians, and south Asians. We believe that such ‘trans-ethnic’ meta-analysis will be useful not only for revealing more novel susceptibility loci and pathophysiological pathways but also for facilitating the fine mapping of common causal variants and eventually identifying the factors underlying ethnic differences in the prevalence and phenotypic presentation of NCDs when it is performed by the genetic epidemiology study. Sri Lankans are substantially contributing to the global collaboration in this evolving field, together with east Asians.Item Understanding medical professionalism: insights into identity and cultural implications(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Monrouxe, L.OBJECTIVES : 1. To understand the different ways in which medical professionalism is understood across country cultures 2. To understand what professional identity is and how this related to the different conceptualisations of professionalism 3. To consider how these issues impact upon the teaching and learning of professionalism and the extent to which this can ever be uniform across different country cultures. The term Medical Professionalism is said to signify a set of values, behaviours and relationships that underpin the role of a doctor. The concept of professional identity relates to the degree to which an individual has assimilated their professional role in terms of who they are, rather than just what they do. But these values, behaviours and relationships necessarily differ according to the cultural context in which we live. Drawing on her international programme of research in professionalism across the England, Wales, Australia, Taiwan and Sri Lanka, and the wider international literature around professionalism, Lynn will outline different ways of conceptualizing professionalism and how this can shed light onto the development of professional identities. This work ultimately leads her to ask questions around the education of professionalism and to question the one-size-fits-all approach so often adopted within medical education.Item Advances in lipid-modification for the prevention of vascular disease(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Armitage, J.OBJECTIVES : 1. To understand the importance of different lipids to vascular disease risk and how genetics have helped 2. To reiterate the value and safety of statins as a first line therapy for lipid modification 3. To explain the potential role of newer lipid-lowering agents: PCSK9 inhibitors, cholesterol ester transfer protein inhibitors and small interfering RNAs to block lipid-related protein synthesis Observational studies indicate a clear, positive and continuous relationship between coronary heart disease risk and blood LDL- cholesterol levels and inverse associations with HDL-cholesterol. Recent genetic evidence also supports a causal role for CETP, lipoprotein (a) [Lp(a)], apoC3, ANGPLT3 and PCSK9 in vascular risk. Large, well-designed randomized trials of statins and meta-analyses of trials show that reductions of 20-25% in the risk of vascular events are seen per 1 mmol/L reduction in LDL-cholesterol, with larger reductions producing greater benefits. Statins are safe and well tolerated although the risk factors for the rare side-effect of myopathy need to be understood to allow their use most safely and effectively. The results of trials of HDL-raising have so far been disappointing, both because older drugs were toxic (niacin) and other studies may have been underpowered to detect plausible effects. An alternative explanation is that HDL-cholesterol is not causally related to vascular disease but only associated and there is supportive genetic data for this view. Newer agents such as monoclonal antibodies against PCSK9 and CETP inhibitors are currently in Phase 3 trials and clearly reduce LDL levels substantially with CETP inhibitors also increasing HDL-cholesterol and show promise for vascular risk reduction but are likely to be very expensive and are not yet proven. Results will emerge in the next couple of years.Item The Global Challenge of Snakebite: where are we in 2016?(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Lalloo, D.OBJECTIVE: To understand the ongoing challenges to improving outcomes following snakebite around the world. The existing state of our knowledge about the epidemiology and management of snakebite around the world will be reviewed, including identifying the major contributions made to the literature by Sri Lankan researchers. The future research agenda and the inherent challenges in achieving improved outcomes will be highlighted and discussed.Item Hypertension – what’s in a name?(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Patel, A.Medical students worldwide are still taught that “hypertension” is a disease, and that if a person develops this disease, they now have a major risk factor for cardiovascular diseases (CVD). However, in countless epidemiological studies, the association between blood pressure and vascular diseases has been shown to be continuous and log-linear, and that this association persists well below traditional cut-points that have historically been used to define “hypertension”. Utilising threshold blood pressure values to define the presence or absence of a disease state is a false dichotomy that has resulted in the definition of “hypertension” being a moving target over the past 50 years. Exposing and eliminating this false dichotomy is not just an intellectual exercise or a matter of semantics. While more and more guidelines for CVD prevention adopt the “absolute risk” approach, hypertension guidelines also still persist in most countries, which is detrimental to clinical and public health approaches to CVD control. In this presentation, I will challenge the very notion of hypertension and make the case that until this term is eradicated from the medical vocabulary, huge numbers of high risk individuals will be denied treatment that has the potential to substantially impact on their disease risk. At the same time, many individuals at low risk who may have little to gain will be preferentially treated. This is particularly an issue in resource-constrained environments, where prioritising treatment for those who are likely to benefit the most is critically important. Key to addressing this issue is shifting from a paradigm of hypertension control to one of blood pressure lowering.Item Global Burden of Haemoglobin Disorders(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Rees, D.C.OBJECTIVES: 1. To describe the world distribution of haemoglobin disorders 2. To describe the health burden of haemoglobin disorders Haemoglobin disorders are the commonest, severe inherited disorders in the world, particularly prevalent in low- and middle-income countries. The two main conditions caused by mutations in globin genes are sickle cell disease (SCD), and thalassaemias. Approximately 300 000 children are born each year with sickle cell disease, with estimates suggesting this will reach 400 000 per year by 2050. The largest numbers of SCD births are estimated to occur in Nigeria (90 000 births/year), Democratic Republic of Congo (39 700 births/year) and India (44 000 births/year). Worldwide there are approximately 30 000 most of these occurring in Asia and the Middle East. The relative importance of haemoglobin disorders is increasing in many countries as deaths from infectious diseases decrease, and both thalassaemia and SCD are recognised as global health problems by the World Health Organisation. Antenatal and neonatal screening programmes are important in managing haemoglobinopathies and are established in some high-income countries, including UK, USA and parts of the Middle East. However there are very few national screening programmes in lower-income countries in which these conditions are most prevalent. Local screening programmes are established in areas of many countries and are revealing important information about the microdistribution of these conditions. In SCD, relatively simple measures, such as vaccination, penicillin prophylaxis, antimalarial measures and treatment of infections are thought to significantly reduce the otherwise very high childhood mortality, although these are not available in many areas. Hydroxyurea is relatively cheap, and has been shown to alter the natural history of SCD, although its role in Africa and India is yet to be established. The treatment of severe thalassaemia relies largely on the availability of safe blood transfusions and iron chelation, which are available in relatively few Asian countries unless a patient is able to pay. Stem-cell based treatments are becoming increasingly important, and although expensive may be cost-effective in some settings. Overall haemoglobin disorders cause significant morbidity and mortality across the world. More research is needed to define the prevalence and natural history of these conditions in different countries, and to develop clinical trials and interventions appropriate to low- and middle-income settings.Item Developing a research agenda in a less-than-research-friendly environment: the Ragama story(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, J.Universities should be engines for knowledge generation. Although there are signs of change, a research culture is not widespread in Sri Lankan universities. It was in this environment that the Faculty of Medicine was established at the University of Kelaniya, in 1991. The private North Colombo Medical College, that was its physical forerunner, had virtually no recognized research output. The major strength of the new faculty was the quality of its academic staff. It soon had a critical mass of restless high-achievers with excellent postgraduate training. As with most institutions with a short history, making a mark nationally and internationally depended on drive, commitment, pragmatism and, most importantly, innovation - adapting to research in a resource poor setting. The strategy had to be simple and feasible: not to compete internationally in laboratory-based basic sciences, but to focus on diseases that were relevant locally but rare in the West, and on diseases of affluence that were emerging in the developing world, concentrating on their epidemiology and clinical aspects, and seeking foreign collaboration for their detailed study. Research was undertaken while developing new study programmes, curricula and timetables for the newly established faculty, and servicing one of the busiest teaching hospital in the country. There was a freedom to follow individual research interests, and as each department initially had few staff, inter-departmental, multi-disciplinary research was not just a philosophy, but a necessity. Though there were a few skeptics, research was encouraged at every level, including in the undergraduate curriculum, and achievements publicly acknowledged. International collaborations with leading researchers and institutions followed. Faculty members were recognized for their research and many were soon in influential academic, editorial and administrative positions nationally and internationally. Research infrastructure was built gradually: a molecular medicine unit, a clinical trials unit participating in ground-breaking international trials, a national reference laboratory for thalassaemia, a community cohort for the longitudinal study of non-communicable diseases, and one of the only four WHO-recognized ethics committees in the country, to name a few. At 25 years, and starting from zero, our measureable institutional research output stands at about 1,000 Google Scholar and 500 PubMed publications, with over 10,500 citations and an h-index of 46. Compared to the first five years (1991-1996), publications and citations have increased nearly 10-fold during the last four (2012-2015). Work in some areas has led to implementation or changes in clinical practice and health policy internationally. The output is one of the best in this country, but challenges remain and the impetus needs to be sustained, and the research agenda more ambitious.