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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    The socio-demographic and economic profile of patients attending emergency services in a private hospital
    (Sri Lanka Medical Association, 2018) Abeysuriya, V.; Chandrasena, L.G.; Wickremasinghe, A.R.
    INTRODUCTION AND OBJECTIVES: Studies have highlighted that the private sector contributes a major share in outpatient healthcare and a small proportion in inpatient care in Sri Lanka. There is little or no information on the contribution of the private health sector in emergency care. METHODS: A descriptive cross sectional study was carried out on patients admitted to an emergencytreatment unit of a private hospital in Colombo from October 15th to December 15th 2016. Data were abstracted from medical records, verbal interviews, and the computerized database maintained by the hospital. Data were analyzed using the SPSS 16. RESULTS: 2395 patients (1426 men; 59.2%) were admitted during the study period. The majority of patients were 61 to 70 years (30.4%) and 80.3% were employed. 61.6% of patients had a health insurance policy; 67.3% of these were private insurance policies. 38.4% of insurance policies were self-financed. The monthly income ranged between Rs.15, 000 and Rs.150, 000 (mean Rs.41, 800±26,180). Persons less than 60 years were more likely to have insurance cover (1.58 times in state policies and 1.34 times in private insurance) as compared to patients 60 years and over. Persons with an education less than A-Levels were more likely (OR=l.78) to have private insurance cover as compared to a person with a higher education.CONCLUSION: Persons with varying economic backgrounds seek emergency health care in private hospitals. A large percentage of patients seeking emergency health care in private hospitals have to bear out-of-pocket expenditure. The older the person, the less likely that (s)he has health insurance cover.
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    Characteristics of patients admitted to an emergency treatment unit of a private sector hospital
    (Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Senanayake, M.G.B.; Wickremasinghe, A.R.
    BACKGROUND: Studies have highlighted that the private sector contributes a major share in outpatient healthcare and a small proportion in in-patient care in Sri Lanka. There is little or no information on private health sector emergency care. OBJECTIVES: To determine the socio-economic characteristics of patients admitted to an emergency treatment unit (ETU) in a private hospital in Colombo. METHODS: A descriptive cross sectional study was carried out on patients admitted to the ETU of a private hospital in Colombo from October 16th to December 15th 2015. Data were abstracted from medical records, verbal interviews, and the computerized data base maintained by the hospital. RESULTS: 2395 patients (1426 men; 59.2%) were admitted during the study period. The majority of patients were 61 to 70 years (30.4%). 80.3% were employed. 61.6% of patients had an insurance policy of which, 41.5% were private insurance policies. The monthly income ranged between Rs.15, 000 and Rs.150, 000 (mean Rs.43, 700±19,020). The commonest admissions were due to diseases of the digestive system (27.4%). Persons with an educational level of
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    Clostridium difficile infection in inflammatory bowel disease patients in Sri Lanka
    (Sri Lanka Medical Association, 2012) Waraketiya, P.R.; de Silva, A.P.; Wijesinghe, N.T.; Waraketiya, P.R.; Wijewantha, H.S.; Chandrasena, L.G.; Pathmeswaran, A.; de Silva, H.J.
    INTRODUCTION: Over the last decade an increase in Clostridium difficile associated diarrhoea (CDAD) has been observed among Caucasians (1%). The frequency of CDAD is very high in Caucasian IBD patients; 8.7% in one study of IBD patients in remission. This has led to guidelines recommending routine screening for CDAD in IBD. Clinical impressions are that CDAD is rare among Sri Lankans. AIMS: This study was conducted to determine the frequency of CDAD in a cohort of Sri Lankan IBD patients and healthy controls. METHODS: Cases [n=154] were histologically confirmed IBD patients, in clinical remission. The controls [n=100) were non-IBD patients who presented to medical clinics without diarrhoea and with no exposure to antibiotics for up to 8 weeks prior to recruitment. Immunoassays for Clostridium difficile toxins A and B were performed on stool samples obtained from both groups. RESULTS: The frequency of CDAD was 0.7% (n=l) and 0% (n=0) in IBD patients and controls respectively. CONCLUSIONS: Compared to Caucasians, CDAD was very rare in this cohort of Sri Lankans, including those with IBD. Routine screening for CDAD does not seem necessary in our setting.
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    Survival of patients treated with Percutaneous Transluminal Coronary Angioplasty following ST segment elevation myocardial infarction
    (Sri Lanka Medical Association, 2013) Abeysuriya, V.; Kasturiratne, A.; Chandrasena, L.G.; Hettiarachchi, V.S.; Wickremasinghe, A.R.
    INTRODUCTION AND OBJECTIVE: Objective was to determine the survival of patients treated with Percutaneous Transluminal Coronary Angioplasty (PTCA) following ST segment elevation myocardial infarction (STEMI) and factors affecting survival. METHOD: A retrospective study was conducted among patients diagnosed with STEMI and treated with PTCA in a private hospital in Colombo from 1st January 2009 to 1st November 2012. Details of patients were collected from the medical records and survival status, cause and date of death where relevant, were obtained from medical records, patients or next of kin. RESULTS: Data of 197 patients were obtained. Of them 153 (77.7%) were males. The mean age of males was 55.30 ± 9 30 years and of females 58.80 ±7.10 years. Twenty three pat (11.7%) had died due to all causes and 13 (6.6%) due to cardiovascular diseases. Of the sample 82.7 % (95% CI 77.9-90.5) survived for 3 years. Survival was associated with (unadjusted) history of smoking, diabetes, dyslipidemia, hF ABP positivity, not being on regular medication, occlusion site of LAD and regular follow up. Based on Cox proportional hazards model (adjusted), site of arterial occlusion (proximal vs distal segment of left anterior descending artery [HR 10.98; 95% CI 1.096- 110.205] was significantly associated with survival of patients after ontrolling for other risk factors. CONCLUSION: The three year survival of patients with STEMI who underwent PTCA was 83%. Patients with proxM LAD occlusion were 11 times more likely t< years of PTCA as compared to those who had a distal LAD occlusion.
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    Is the length of hospital stay in the private sector longer if the patient has insurance?
    (Sri lanka Medical Association, 2015) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Wickremasinghe, A.R.
    INTRODUCTION AND OBJECTIVES: Hospital length of stay (LOS) describes the duration of a single episode of hospitalization. The aim of this study was to determine the association between hospital LOS in a private hospital in Colombo and presence of insurance cover among patients admitted between 2009 and 2014. METHOD: A retrospective study was conducted at a private hospital in Colombo. All admissions between 2009 and 2014 had been computerised; data pertaining to length of stay, age, sex and availability of insurance cover were extracted for all patients from the database. RESULTS: There were 188,557 admissions (98,116 men; 52%) between 2009 and 2014. The mean LOS gradually declined from age less than 10 years to 30 to 40 years and then increased with increasing age. Men had a significantly higher LOS than females (2.7 vs 2.4 days). The average length of stay significantly declined in both sexes from 2009 to 2014 [P<0.05]. 19% of hospital days were in the age group less than 20 years and 40% are in the age group 21-50 years. 61% of the patients had insurance and 17% of them were in the age group 51 to 60 years. More than 50% of the admissions among insured and non- insured were men. The LOS among the insured was significantly higher than the non-insured (2.7 vs 2.2 days) [PO.05]. CONCLUSION: Higher LOS was associated with older age, male patients and availability of insurance. The most of the insured patients were in the age group of 51 to 60 years.
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    Glutathione peroxidase and severity of ischaemic heart disease in a cohort of Sri Lankan patients
    (Sri Lanka Medical Association, 2010) Perera, P.P.R.; Chandrasena, L.G.; Indrakumar, J.; Peiris, H.
    OBJECTIVES: To study the association between glutathione peroxidase (GPx) levels in relation to severity and extent of cardiac ischemia and age in a cohort of Sri Lankans. METHODS: Seventy nine patients with ischaemic heart disease (IHD) awaiting coronary artery bypass grafting (CABG) were recruited to the study. GPx was measured before CABG. The severity and extent of myocardial ischemia were measured by the vessel, stenosis and extent scores by perusing the coronary angiograms. RESULTS: The mean GPx concentration of the study sample was 120.44 units GPx/mg Hb which is below the normal value of 275 units GPx/mg Hb. The mean vessel, stenosis and extent scores of the study sample were 2.04 (out of a possible 3) 9.86 (out of a maximum of 32) and 46.42% respectively. The GPx levels showed a significant inverse correlation with the vessel, stenosis and extent scores (p < 0.01), No significant correlation was observed between the GPx levels and age in the study population. CONCLUSIONS: GPx may be a predictor of severity and extent of ischaemia in ischemic heart disease patients. GPx levels did not change with the age.
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    Association between homocysteine, vitamin B12, folate, MTHFR polymorphisms and ischaemic heart disease
    (Sri Lanka Medical Association, 2010) Perera, P.P.R.; Chandrasena, L.G.; Indrakumar, J.; Peiris, H.
    OBJECTIVES: The present study investigated the association between homocysteine and ischaemic heart disease (IHD) and the factors influencing homocysteine levels. METHODS: A case control study involving 221 patients with IHD and 221 age and sex matched controls admitted to Colombo South Teaching Hospital and an analytical study involving 79 patients awaiting coronary artery bypass grafting at Nawaloka Hospitals PLC were done. RESULTS: Hyperhomocysteinaemia was a significant predictor of IHD after controlling for hypertension and hypercholesteroleamia (adjusted odds ratio 2.38). Hyperhomocysteinaemia was a significant predictor of IHD in the young but not in the elderly. Among persons below 50 years, persons with hyperhomocysteinaemia were 4.5 times more likely to develop IHD as compared to those with normohomocysteinaemia. Vitamin B^ and folate levels showed a negative correlation with serum homocysteine concentrations. The homocysteine concentration did not differ significantly with the genotypes of Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms. CONCLUSIONS: People with hyperhomocysteinaemia have a 2-3 fold increase in risk of developing IHD. Hyperhomocysteinaemia is a predictor of IHD in the young but not in the elderly. A decrease in either vitamin B12 or folate concentrations in serum is associated with higher homocysteine concentrations whereas MTHFR A1298C and C677T gene mutations do not have an effect on the homocysteine concentrations.
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    Age, sex variation among patients treated with percutaneous transluminal coronary angioplasty (PICA) in Sri Lanka: a retrospective study
    (Sri Lanka Medical Association, 2014) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Hettiarachchi, V.S.; Wickremasinghe, A.R.
    INTRODUCTION AND OBJECTIVES: Coronary heart diseases (CHD) remain a major cause of death worldwide, ft is a growing burden for the Sri Lankan health sector. Age and sex has been identified as risk factors for CHD. The private health sector contributes significantly to curative care of CHD. The aim of this study was to determine the variation of age and sex of patients who have been treated with PTCA during the last decade at a private hospital in Colombo. METHODS: A retrospective study was conducted on patients treated with PTCA in a private hospital in Colombo from 2003 to 2013. Details of patients were extracted from medical records and age and sex variations were analyzed. RESULTS: 4578 patients (3315 men; 72.4%) were included. There was significant reduction in mean age at PTCA from 2003 to 2013 (p<0.01). Overall it had declined from 56.4 years (SD=10.5) in 2003 to 50.9 years (SD=12.4) in 2013. From 2003 to 2013 the mean ages of men had reduced by 7 years (p<0.01), while in females the mean age had reduced by 2.2 years (p<0.01) Male to female ratio was 2.58 in 2003 and 2.45 in 2013- Linear regression analysis showed that with each increment year the age at PTCA reduced by 0.54 years (95%Ci =0.64 to -0.44). CONCLUSIONS: Higher proportions of patients were men. Age at PTCA had decreased in both males and females. But sex ratio of patients had not significantly changed during the last decade.
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    Hemoglobin variants in patients with type-2 diabetes mellitus
    (SEAMEO Regional Tropical Medicine and Public Health Project, 2010) Chandrasena, L.G.; Peiris, H.; Williams, S.; Siribaddana, S.H.
    Measurement of HbA1c levels in diabetic patients is an established procedure for evaluating long-term control of diabetes. Despite its usefulness, conditions that effect hemoglobin concentration, such as hemoglobinopathies give rise to inappropriate HbA1c values. Since information about hemoglobinopathies in the diabetic population in Sri Lanka is limited, a prospective cross-sectional study was carried out among 2,695 diabetic subjects attending the diabetic clinic at Nawaloka Hospital, Sri Lanka. Hemoglobin type and HbA1c were measured by the HPLC method. The results reveal among 2,695 diabetic subjects, 53 (2%) had abnormal hemoglobin types (HbF and HbS). HbA1c concentrations in diabetic patients without Hb abnormalities show a higher correlation with fasting blood glucose than those with hemoglobin abnormalities. This study emphasizes that patients with inappropriate HbA1c values should be investigated for hemoglobinopathies.
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    Biochemical changes associated withnreperfusion after off-pump and on-pump coronary artery bypass graft surgery
    (Institute for Clinical Science., 2009) Chandrasena, L.G.; Peiris, H.; Waikar, H.D.
    A prospective study was performed to monitor the postoperative changes in biochemical markers associated with reperfusion injury following (i) cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplagia (CABG); (ii) CPB with a tissue stabilizing device (SUP.CPB); or (iii) surgery on beating heart (off-pump CABG or OPCABG). Of the 48 patients, 16 were subjected to CABG, 16 to SUP.CPB, and 16 to OPCABG. Arterial and venous blood samples drawn 10 min preoperatively and 0.2, 4, 24, and 48 hr after surgery were assayed for plasma lactate, total calcium, and ionized calcium and erythrocyte glutathione peroxidase (GPX) and superoxide dismutase (SOD). Results revealed that ionized calcium, SOD, and GPX levels of all patients increased at 4 hr following surgery but returned to baseline levels at 24 or 48 hr after surgery. Increased postoperative GPX levels reflect a cellular defense mechanism against oxidative damage during reperfusion, while lactate levels during reperfusion reflect delayed recovery of aerobic myocardial metabolism. The postoperative release of lactate, GPX, and SOD in patients undergoing the CABG (on-pump) technique was significantly higher compared to those subjected to OPCABG or SUP.CPB. There were no significant differences in postoperative patterns of release of biomarkers in patients with OPCABG vs SUP.CPB, suggesting that these surgical techniques are equally acceptable
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