SLMA Medical Congress 2013 Programme Book by Sri Lanka Medical Association

Sri Lanka Medical Association 126th Anniversary Scientific Medical Congress “Towards continuing enhancement of quality and safety in healthcare”

09th – 13th July 2013 Waters Edge, Battaramulla

Principal Sponsors

World Health Organization State Pharmaceuticals Corporation of Sri Lanka

This book of proceedings is hereby dedicated to the researchers and their subjects. STEERING COMMITTEE

Dr. B. J. C. Perera (Chairman) Dr. Samanmali Sumanasena (Convenor) Dr. Palitha Abeykoon Dr. Kalyani Guruge Dr. B. Kumarendran Dr. Navoda Atapattu Dr. Shyamalee Samaranayake Dr. Sanjeeva Gunasekera Dr. Leenika Wijeratne Dr. Deepal Wijesooriya Professor Chandrika Wijeyaratne Dr. Ruvaiz Haniffa Dr. S. Sridharan Dr. Amitha Fernando

ORATIONS COMMITTEE Dr. B. J. C. Perera Dr. Palitha Abeykoon Dr. Anuruddha Abeygunasekera

Table of contents STEERING COMMITTEE.......................................................................................................................................................... i ORATIONS COMMITTEE........................................................................................................................................................ ii THE SRI LANKA MEDICAL ASSOCIATION 1887 to 2013.........................................................................................1 COUNCIL OF THE SRI LANKA MEDICAL ASSOCIATION 2013...............................................................................3 PAST PRESIDENTS OF THE SRI LANKA MEDICAL ASSOCIATION......................................................................6 MESSAGE FROM THE PRESIDENT OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA........8 .......................................................................................................................................................................................................... 8 MESSAGE FROM MINISTER OF HEALTH OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA........................................................................................................................................................................................... 9 MESSAGE FROM THE PRESIDENT OF THE SLMA................................................................................................... 10 MESSAGE FROM THE HONORARY SECRETARY OF THE SLMA.........................................................................11 MESSAGE FROM THE CHIEF GUEST.............................................................................................................................. 12 MESSAGE FROM THE GUEST OF HONOUR................................................................................................................. 13 PROGRAMME AT A GLANCE.............................................................................................................................................. 14 PROGRAMME IN DETAIL.................................................................................................................................................... 17 Abstract of the Keynote Address..................................................................................................................................... 44 Abstracts of Symposia.......................................................................................................................................................... 46 Abstracts of Principal Symposia...................................................................................................................................... 66 ABSTRACTS OF LUNCHEON EVENTS............................................................................................................................ 69 Abstracts of Guest Lectures............................................................................................................................................... 70 ABSTRACTS OF ORAL AND POSTER PRESENTATIONS.........................................................................................74

LIST OF ORAL PRESENTATIONS..................................................................................76 ABSTRACTS OF ORAL PRESENTATIONS....................................................................82 LIST OF POSTER PRESENTATIONS............................................................................104 ABSTRACTS OF POSTER PRESENTATIONS..............................................................111 PARTNERS AND SPONSORS........................................................................................................................................... 144

THE SRI LANKA MEDICAL ASSOCIATION 1887 to 2013

The historic Wijerama House The Sri Lanka Medical Association (SLMA) is the oldest national organisation of medical professionals in Asia and Australasia. It brings together medical practitioners of all grades, from all branches of medicine in Sri Lanka. The SLMA started life as the "Ceylon Branch of the British Medical Association" on 17 th December 1887 with 65 members on its roll, and Dr P D Anthoniz as its first President. However, the moving force behind its inception was Dr W R Kynsey (later Sir William Kynsey), who persuaded 15 doctors to meet on 26 February 1887, at the Colonial Medical Library on Maradana Road, Colombo and resolve to form that Association. He had declined to be the first President as he was going abroad on furlough. The change of name to "Ceylon Medical Association" came in 1951, and in 1972 when Sri Lanka became a Republic, the name changed again to the "Sri Lanka Medical Association". The SLMA office is at "Wijerama House", named after Dr E M Wijerama, who formally gifted the house he lived in at McCarthy Road (now Wijerama Mawatha) to the Association in 1964. Although his offer was made in writing in October 1957, resolution of the many issues that arose took 7 years! The Ceylon Medical Journal, was first published in August 1887, and fittingly, the first article in the first issue was authored by Dr W R Kynsey. The name changed to Journal of the Ceylon Branch of the British Medical Association in 1904, but changed to its pristine appellation in 1952, and continues to be published as the Ceylon Medical Journal (CMJ). At its 126 th year, it is the oldest surviving English medical journal in Asia and Australasia, and the leading scientific journal in Sri Lanka. The CMJ is indexed in BIOSIS, CAB International, EMBASE and the Index Medicus. CMJ's editorial policies and quality are of international standards, and it is listed by the International Committee of Medical Journal Editors as conforming to their editorial guidelines.

Page 1 of 142

The historic Sri Lanka Medical Library, which is over 169 years old, is also accommodated in Wijerama House. The Sri Lanka Clinical Trials Registry, started as recently as 2006, has achieved recognition from the World Health Organisation by being selected as a WHO Primary Clinical Trials Registry. The Anniversary International Medical Congress is the most important activity of the SLMAâ&#x20AC;&#x2122;s calendar. It has been held uninterrupted every year since it was started in 1937 to mark the 50 th anniversary of the association. The SLMA today is a vibrant organization. It is run by the President and the Council. There are many committees dealing with its day to day affairs. These include the Finance, Management and Housing Committee; Corporate Planning Committee; Ethics Review Committee; Ethics Committee; Honours Committee; Research Promotion Committee; the Sri Lanka Clinical Trials Registry Management Committee; and the Ceylon Medical Journal Editorial Board. The SLMA also has Expert Committees which deals with various subject areas. They include Expert Committees on Communicable Diseases; Disabilities; Ergonomics; Health Equity; Health Management; Herbal Medicine; Medicinal Drugs; Non Communicable Diseases; Prevention of Road Traffic Crashes; Snake Bite; Tobacco, Alcohol and Illicit drugs; and Womenâ&#x20AC;&#x2122;s Health.

Page 2 of 142

COUNCIL OF THE SRI LANKA MEDICAL ASSOCIATION 2013 President President Elect Immediate Past President Honorary Secretary Vice Presidents Honorary Assistant Secretaries

Honorary Treasurer Honorary Assistant Treasurer Public Relations Officer Past Presidentsâ&#x20AC;&#x2122; Representative Council Members

Dr B J C Perera Dr Palitha Abeykoon Professor Vajira HW Dissanayake Dr Samanmali P Sumanasena Prof Rohan Jayasekara Dr Kalyani Guruge Dr Navoda Atapattu Dr Sanjeeva Gunasekera Dr B Kumarendran Dr Shyamalee Samaranayaka Dr Ruvaiz Haniffa Dr Leenika Wijeratne Dr Deepal Wijesooriya Dr Malik Fernando Dr Dennis J Aloysius Dr Shihan Azeez Dr Uditha BulugahapitiyaProfessor Asita de Silva Dr S D Dharmaratne Dr Amitha Fernando Dr V R Gunasekera Professor Ranjanie Gamage Dr Achala Upendra Jayatilleke Dr Lucian Jayasuriya Professor Saroj Jayasinghe Dr Kapila Jayaratne Dr Indika Karunathilake Professor S P Lamabadusuriya Dr Niroshan C Lokunarangoda Dr Lasantha Malavige Dr Ajith Nagahawatte Dr J B Peiris Professor Antoinette Perera Dr W M A Rathnayake Dr S Sridharan Dr Sunil Seneviratne Epa Dr Pramilla Senanayake Dr Rikaz Sheriff Dr W M A Wijekoon

Social Secretaries

Dr Suriyakanthie Amarasekera Dr Gamini Walgampaya

Co-Editors (CMJ)

Professor Janaka de Silva Dr Anuruddha Abeygunasekera

Page 3 of 142

COUNCIL OF THE SRI LANKA MEDICAL ASSOCIATION 2013

Page 4 of 142

Seated Left - Right:Dr Dennis J Aloysius, Deshamanya Vidyajyothi Dr J B Peiris, Prof Rohan Jayasekara (Vice President), Dr Palitha Abeykoon (President Elect), Dr B J C Perera (President, SLMA), Prof Vajira H W Dissanayake (Immediate Past President, SLMA), Dr Kalyani Guruge (Vice President), Dr Ruvaiz Haniffa (Honorary Treasurer), Dr Samanmali P Sumanasena(Honorary Secretary) Standing Left – Right (2nd Row):Dr Leenika Wijeratne (Honorary Assistant Treasurer), Dr Navoda Atapattu (Honorary Assistant Secretary), Dr. Amitha Fernando, Dr Sanjeeva Gunasekera (Honorary Assistant Secretary), Dr Gamini Walgampaya (Social Secretary), Dr Sunil Seneviratne Epa, Dr Suriyakanthie Amarasekera (Social Secretary), Prof Sanath P Lamabadusuriya, Prof Janaka de Silva (Co Editor CMJ), Dr Shyamalee Samaranayaka (Honorary Assistant Secretary) Standing Left – Right (3rdRow):Dr W M Arjuna Wijekoon, Dr Uditha Bulugahapitiya, Dr Sathasivam Sridharan, Dr Niroshan C Lokunarangoda, Dr Malik Fernando (Past President Representative), Dr M Shihan Azeez, Dr Ajith De Silva Nagahawatte, Dr Achala Upendra Jayatilleke, Dr Indika Karunathilake, Dr Deepal Wijesooriya (Public Relations Officer) Standing Left – Right (3rdRow):Dr Pramilla Senanayake, Dr W M A Rathnayake, Dr V R Gunasekera, Prof Ranjanie Gamage, Dr B Kumarendran (Honorary Assistant Secretary), Dr Kapila Jayaratne, Prof Asita de Silva Absent:Dr S D Dharmaratne, Dr Lucian Jayasuriya, Prof Saroj Jayasinghe, Dr Lasantha Malavige, Prof Antoinette Perera, Dr Rikaz Sheriff, Dr Anuruddha Abeygunasekera (Co Editor CMJ)

Page 5 of 142

PAST PRESIDENTS OF THE SRI LANKA MEDICAL ASSOCIATION 1887/88 & 89/90 Dr P D Anthonisz 1890/91 Sir William Kynsey 1891/92 Dr James Loos 1892/93 Dr J L Vanderstraaten 1893/94 & 94/95 Sir William Kynsey 1895/96 Dr J D Macdonald 1896/97 & 97/98 Sir William Kynsey 1898/99 & 99/00 Sir Allan Perry 1900/01, 01/02 & 02/03 Dr W G VanDort 1903/04 Dr T F Garvin 1904/05 Hon W G Rock wood 1905/06 Sir Marcus Fernando 1906/07 Dr C T Griffin 1907/08 Dr A J Chalmers 1908/09 Dr M Sinnetamby 1909/10Dr H G Thomasz 1910/11 Sir Aldo Castellani 1911/12 Sir Allan Perry 1912/13 Dr S C Paul 1913/14 Dr G J Rutherford 1914/15 Sir Marcus Fernando 1915/16 Dr Frank Grenier 1916/17 Dr M Sinnetamby 1917/18 Dr E V Ratnam 1918/19 Dr R L Brohier 1919/20 Dr Lucian de Zilwa 1920/21Dr L D Parsons 1921/22 Dr S D Boylan Smith 1922/23 Dr E Garvin Mack 1923/24 Dr I David 1924/25 Dr Andreas Nell 1925/26 Dr P J Chissell 1926/27 Dr H M Peiris 1927/28 Dr J H G Bridger 1928/29 Dr Vanlangenberg 1929/30 Dr S Muttiah 1930/31 Dr S T Gunasekera 1931/32 Sir Frank Gunasekera 1932/33 Prof. W A E Karunaratne 1933/34 Dr H O Gunewardena 1934/35 Dr S L Navaratnam 1935/36 Dr E C Alles 1936/37 Prof. John R Blaze 1937/38 Sir Nicholas Attygalle 1938/39 Dr J H F Jayasuriya 1939/40 Dr G A W Wickramasuriya

1940/41 Dr S V Gabriel 1941/42 Dr Gunaratnam Cooke 1942/43 Dr S F Chellappah 1943/44 Dr May Ratnayake 1944/45Dr R L Spittel 1945/46 Dr V P de Zoysa 1946/47 Dr G S Sinnatamby 1947/48 Dr E M Wijerama 1948/49 Dr Cyril F Fernando 1949/50 Prof. C C de Silva 1950/51 Prof. Milroy Paul 1951/52 Prof. M V P Peiris 1952/53 Dr A S Rajasingham/ Prof. P B Fernando 1953/54 Prof. P B Fernando 1954/55 Dr L O Abeyratne 1955/56 Prof. Gerald H Cooray 1956/57 Dr M C M Kaleel 1957/58 Prof. O E R Abhayaratna 1958/59 Dr Richard Caldera 1959/60 Prof. V Sivalingam 1960/61 Dr W A Karunaratna 1961/62 Dr P R Thiagarajah 1962/63 Dr A D P A Wijegonawardena 1963/64 Dr G R Handy 1964/65 Dr Stanley de Silva 1965/66 Dr F de S Goonawardena 1966/67 Dr P R Anthonis 1967/68 Dr W D L Fernando 1968/69 Dr M P M Cooray 1969/70 Dr E H Mirando 1970/71 Dr W D Ratnavale 1971/72 Dr LDCAustin 1972/73 Dr O R Medonza 1973/74 Dr S Rajanayagam 1974/75 Dr S A Cabraal 1975/76 Dr P Sivasubramaniam 1976/77 Prof. Daphne Attygale 1977/78 Dr H B Perera 1978/79 Dr S E Wijetilake 1979/80 Dr B AV Perera 1980/81 Dr N J Walloopillai 1981/82 Dr Stella de Silva 1982/83 Dr Dennis J Aloysius 1983/84 Dr C G Uragoda 1984/85 Dr Lakshman Ranasinghe

Page 6 of 142

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Dr S JStephen Dr G W Karunaratne Dr Nihal Perera Prof. Priyani Soysa Prof. W A S de Silva Dr A T W P Jayawardene Dr Malik Fernando Prof. W S E Perera Dr J B Peiris Dr Lucian Jayasuriya Prof. Colvin Goonaratna Dr S Ramachandran Dr D N Atukorala Prof. Nimal Senanayake

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Dr Kumar Weerasekera Prof. Anoja Fernando Dr Preethi Wijegoonewardene Dr Sunil Seneviratne Epa Prof. Ravindra Fernando Prof. A H Sheriffdeen Dr Suriyakanthie Amarasekera Prof. Gita Fernando Prof. Lalitha Mendis Prof. Rezvi Sheriff Dr Narada Warnasuriya Prof. Sanath P Lamabadusuriya Prof. Vajira H W Dissanayake

Page 7 of 142

MESSAGE FROM THE PRESIDENT OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA

I am pleased to send this message of felicitation to the Sri Lanka Medical Association (SLMA) on the occasion of its 126th anniversary being celebrated with a Scientific Medical Congress in Colombo. The history of the SLMA is one of a most valuable contribution to uplift standards of the medical profession in Sri Lanka, thereby playing a significant role in improving the healthcare services in the country. It has a commendable record of concerted efforts to keep the standards of the medical profession at the highest levels. In the current post-conflict era of peace, the SLMA has recognized and accepted its larger role in improving the quality and standards of heath in all parts of the country, especially those that were affected by the prolonged conflict. This has enabled the SLMA to expand its many initiatives to take its activities to greater heights of achievement. The Scientific Medical Congress with the theme â&#x20AC;&#x153;Towards Continuing Enhancement of Quality and Safety in Healthcareâ&#x20AC;? is most timely when the health sector is taking important steps towards the improvement in the healthcare throughout the country with the establishment of a Secretariat for Healthcare Quality and Safety under the Ministry of Health. The participation of foreign medical personnel at this conference would help much in sharing their experience and knowledge with Sri Lankan counterparts to further develop the health sector in our country. I trust that all members of the SLMA would continue their service to the improvement of the health sector under the challenging situation of the identification of new diseases, assisted by new knowledge and technology for diagnosis and cure. I wish the SLMA and its 126th anniversary celebrations every success.

Mahinda Rajapaksa President of the Democratic Socialist Republic of Sri Lanka

Page 8 of 142

MESSAGE FROM MINISTER OF HEALTH OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA

I am very happy to send this message for the 126 th Anniversary Scientific Medical Congress of the Sri Lanka Medical Association (SLMA). I am well aware of the contribution made by this esteemed organization towards progressive improvement of the health of the people of our country. The theme this year â&#x20AC;&#x153;Towards continuing enhancement of quality and safety in healthcareâ&#x20AC;? is of paramount relevance in the context of provision of healthcare and my ministry is greatly pleased to be associated with your efforts towards such a venture. The SLMA has had a very cordial rapport with my ministry and we immensely value their contribution towards our common goals. I bring you all good wishes from my ministry and have immense pleasure in wishing all your deliberation great success.

Maithripala Sirisena Minister of Health

Page 9 of 142

MESSAGE FROM THE PRESIDENT OF THE SLMA

It is with the greatest pleasure that I welcome each and every one of the participants to the 126 th Anniversary Scientific Medical Congress of the Sri Lanka Medical Association (SLMA) in July 2013. An extra-special greeting is also communicated to all participants from abroad, headed by the President of The British Medical Association, Professor Sir Sabaratnam Arulkumaran. The SLMA is the apex academic medical institution in Sri Lanka. It brings together doctors from all grades and different specialities under one roof and it is an institution like no other. The Anniversary Congress is designed to bring state-of-the-art information on a variety of disciplines to enable an array of Continuing Professional Activities to be presented over the few days of the Congress. A Health Run & Walk, many Pre-Congress Workshops, four Scientific Orations, Free Paper Sessions, Poster Presentations, Congress Symposia, Guest Lectures and even a Debate are incorporated into the programme. They are designed for the discerning scholastic penchant of a medical gathering of diverse professional interests. The Steering Committee of the Congress has included many issues of current interest into the deliberations of the Congress and tried very hard to have something for everybody. I do hope that as many health professionals as possible would be inclined to make use of this marvellous opportunity to enhance their knowledge through this shimmering pedagogic endeavour. We do look forward to your active participation in this grand academic event and hope that you would enjoy the scholastic extravaganza together with the social fare served up to you. With the very best of wishes.

Dr. B.J.C.Perera MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, FCGP(SL) President, Sri Lanka Medical Association. 10th July 2013

Page 10 of 142

MESSAGE FROM THE HONORARY SECRETARY OF THE SLMA

I warmly welcome all of you to the 126 th Anniversary Scientific Medical Congress of the Sri Lanka Medical Association (SLMA) at the Waters Edge, Capital City. It is indeed an honour to be a member of the Council for the year 2013 and a pleasure to be a member of the team organizing this grand event. This annual event marks one of the much awaited highlights of the calendar of the SLMA because it brings together doctors of all grades from all over the country under one roof for a comprehensive Continuing Professional Development activity. In keeping with the theme of this year, â&#x20AC;&#x153;towards continuing enhancement of quality and safety in health careâ&#x20AC;? we have attempted to enrich the congress programme with a multi-sectoral approach to a miscellany of health and medical related topics aiming to strengthen skills and competencies amongst doctors and other allied health care workers. This will also give the participants an opportunity to forge new networks and enhance fellowship. My sincere thanks go to Professor Sir Sabaratnam Arulkumaran, who graciously accepted our invitation to be the Chief Guest. I also greatly appreciate the contribution by all the other foreign delegates and local speakers. I also take this opportunity to thank all of you for your presence at the conference today. My gratitude is also extended to my colleagues who worked tirelessly to make this congress a success and to those who contributed behind the scene, including the team at the SLMA office for making this event a reality. I wish all of you a pleasant and a fruitful time. With best wishes.

Dr. Samanmali P. Sumanasena Secretary, SLMA

Page 11 of 142

MESSAGE FROM THE CHIEF GUEST

BMA House, Tavistock Square, London, WC1H 9JP S 020 7387 4499 T 020 7383 6101 F 020 7554 6101

From the President Dear Dr BJC Perera, Council Members and Friends, I am greatly honoured and humbled to attend the prestigious Anniversary Congress of the Sri Lanka Medical Association (SLMA), in July 2013, as the Chief Guest. This National Meeting would provide an opportunity for us to listen, interact and learn about better practice, based on the latest in science, medicine, technology and health policies. I am proud of SLMAâ&#x20AC;&#x2122;s contribution to improve health services in Sri Lanka for several decades. Each and every one of you has contributed to improve the health of the citizens of Sri Lanka. Sri Lanka enjoys the highest life expectancy in South East Asia and has low perinatal, child and maternal mortality rates. My congratulations to you, for your contributions, to achieve this. However we face new challenges; how to extend HEALTHY life expectancy and reduce the period of frailty; how to maintain the dignity and self-respect of the patient and make it a patient centred care that will provide maximal patient satisfaction; and how the doctors practise within the legal, ethical and moral framework of our profession. Needless to say that SLMA will and should take a lead on these issues. The medical world is moving at a fast pace because of improved communication, sophisticated medical equipment and ever expanding scientific knowledge. This conference will help us to learn from experts about these recent advances even before publications appear in journals. This will help us to meet the higher expectation of the patients and the public. Conferences are good opportunities to have personal interaction with the speakers and establish future collaboration. Doctors in Sri Lanka are always hard working and eager to learn. I sincerely hope that this conference will allow time for you to relax and enjoy some social life. Please renew old friendships and make new friends. Certainly I look forward to attending what I think would be an exciting scientific meeting. With my sincere and kindest regards,

Professor Sir Sabaratnam Arulkumaran President â&#x20AC;&#x201C; British Medical Association 10th July 2013

Page 12 of 142

MESSAGE FROM THE GUEST OF HONOUR

I have great pleasure in sending this message to the 126 th Anniversary Scientific Medical Congress of the Sri Lanka Medical Association. The Sri Lanka Medical Association, the oldest professional medical association in Asia and Australasia, with a proud history dating from 1887 brings together medical practitioners of all grades and branches of medicine. I am sure the multitude of activities including a Health Run & Walk, Pre-Congress Workshops, Scientific Orations, Free Paper Sessions, Poster Presentations, Congress Symposia and Guest Lectures will enrich the 126th Anniversary Congress. The Congress theme related to healthcare quality and safety is very timely. Quality and patient safety is one of WHO's priorities in the health systems work. WHO is committed to continue its focus on quality, patient safety, systems and procedures. This conference will be an opportunity to showcase diverse expertise in health care quality and patient safety. I wish all success the congress.

Dr. Firdosi Rustom Mehta WHO Representative to Sri Lanka

Page 13 of 142

PROGRAMME AT A GLANCE Thursday 4 July 2013

8.45 – 1.00 pm

Sunday 7 July 2013

6.00 am

Workshop I

9.45 – 3.00 pm

Workshop II

8.00 – 4.00 pm

Workshop III

8.30 – 5.00 pm

Workshop I

9.00 – 1.15 pm

Workshop II

8.00 – 4.15 pm

Workshop III

8.00 – 2.15 pm

Workshop IV

8.30 – 1.35 pm

Workshop V

7.00 -1.30 pm

Building Key Competencies of Field Health Staff to Promote Family Wellbeing National Institute of Health Sciences, Kalutara SLMA 126th Anniversary Run and Walk Starting at the BMICH Front Lawn Tuesday 9th July 2013 Pre Congress Workshops Building Effective Teams in Diabetes Care in Sri Lanka: An Evidence Based Approach Eagle Room, Waters Edge, Battaramulla Healthcare Quality & Safety National Blood Transfusion Service Auditorium, Narahenpita Optimising Care for Children with Disabilities New Auditorium, Lady Ridgeway Hospital for Children, Borella Wednesday 10th July 2013 Pre Congress Workshops Inculcating Ergonomics in the Sri Lankan Settings The Winchester, The Kingsbury, Colombo 01 Communication Skills for Doctors SLMA Auditorium, Colombo 07 Improving the Quality of Journals Albatross, Waters Edge, Battaramulla Cancer Genetics – Diagnostics, Prognostication and Pharmacogenomics Grand Ball Room, Waters Edge, Battaramulla Sports Medicine for Coaches & Trainers Sports Science Auditorium, Independence Square, Colombo 07

Wednesday 10th July 2013

6.00 pm

Time

Thursday, 11th July 2013 HALL A HALL B Meet the Expert Breakfast Session “Physical activity for doctors”

7.40pm

Inauguration The Grand Ball Room, Waters Edge, Battaramulla SLMA Oration –“Epidemiology of snakebite: Investigating the burden” Vidyajyothi Prof.H. Janaka de Silva

PROGRAMME AT A GLANCE 7.15 – 8.15 am 8.30 -9.30 am

9.30 – 10.00 am

10.00 – 10.30 am

10.30 – 11.00 am 11.00 – 11.45 am

11.45 – 12.45 pm 12.45 – 1.00 pm 1.00 – 2.00 pm 2.00 -3.00 pm

3.00 – 4.00 pm

Symposium 1 Leprosy: the neglected disease

Symposium 2 Respiratory medicine

Keynote Address Clinical governance to improve safety and quality in healthcare Professor Sir Sabarathnam Arulkumaran Guest Lecture 1 Guest Lecture 2 Ergonomics applications in Utilising the window healthcare settings and for periods in care for healthcare professionals childhood disabilities: the impact Tea Dr S Ramachandran Memorial Oration “Chronic kidney disease of uncertain origin in Sri Lanka: The past, present and future” Dr Tilak Abeysekera Free Paper 1 Free Paper 2 Infectious diseases and Occupational & Genetics Environmental health Pre Luncheon Event Convention Bureau Luncheon Event – Debate Patient safety is the responsibility of the individual healthcare provider Free Paper 3 Free Paper 4 Paediatrics Miscellaneous

Symposium 3 Cardiovascular risk assessment

Symposium 4 Dermatology for family physicians

Friday, 12th July 2013 HALL A HALL B Meet the Expert Breakfast Session “Coping with stress”

Time 7.15 – 8.15 am

Symposium 5 Stroke neuro rehabilitation

Symposium 6 Providing services to survivors of gender based violence

8.30 – 9.00 am

Symposium 7 Innovative approaches in clinical teaching

Symposium 8 Practical aspects of addressing harm from tobacco, alcohol and drug use

9.00 – 10.00 am

Tea Professor N D W Lionel Memorial Oration “Paradigm shift in osteoporosis management: Diagnostic to intervention thresholds” Professor Sarath Lekamwasam Free Paper 5 Free Paper 6 Non Communicable Toxicology & Elderly medicine Diseases Pre Luncheon Event Sri Lanka Clinical Trials Registry Luncheon Event Symposium on Herbal medicine Free Paper 7 Free Paper 8 Psychiatry & Gastroenterology and Parasitology Haematology Symposium 9 Scaling up nutrition: multisectoral approach

Symposium 10 Familial adenomatous polyposis coli (FAP)

Saturday, 13th July 2013 HALL A HALL B Meet the Expert Breakfast Session “Electronic self-monitoring devices in healthcare: the M2M era ” Guest Lecture 3 Guest Lecture 4 Bone marrow Managing a patient transplantation with family history of colorectal cancer Symposium 11 Symposium 12 Health in the elderly Migrant health

10.00 – 10.30 am

Tea

10.30 – 11.30 am

Case Based Interactive Symposium 13 Seminar Sexual and Stemming the tide of reproductive health metabolic disease in Sri beyond basics Lanka – a womb to tomb approach Principal Symposium 1 Hepatology Luncheon Event Oncology

11.30 12.30 pm 12.30 – 1.30 pm 1.30 – 3.00 pm

3.00 – 3.30 pm

3.30 pm

Principal Symposium 2 Maternal mortality

Guest Lecture 5 Surgical options in end stage heart failure

Guest Lecture 6

One size does not fit all: time to turn to personalised genomic medicine

Tea

4.00 pm

Tea 7.30 pm Doctors Concert “PANACEA” Waters Edge

Tea 5.00 pm Dr S C Paul Memorial Oration “Development of paediatric oncology in Sri Lanka as a specialilty: Illustrated by improvement in the outcome of childhood acute lymphoblastic leukaemia (ALL) Dr Damayanthi Pieris

7.30 pm Banquet Waters Edge

PROGRAMME IN DETAIL Thursday, 04th July 2013 Pre Congress Workshop BUILDING KEY COMPETENCIES OF FIELD HEALTH STAFF TO PROMOTE FAMILY WELLBEING (In collaboration with UNICEF) National Institute of Health Sciences, Kalutara Chairpersons: Dr. Lakshman Gamlath

Dr. Nalika Gunawardane

08.45 am

Registration and Tea

09.00 am

Welcome and introductory remarks Dr. Nalika Gunawardena

09.15 am

Techniques to enhance the psycho-social wellbeing of the family Dr. Piyanjali de Zoysa

10.00 am

Empowering parents to protect children Ms. Chrishara Parnavithana

10.45 am

Tea

11.00 am

Promoting parentsâ&#x20AC;&#x2122; role in early childhood care and development Dr. Deepika Attygalle

11.45 am

Enhancing good parenting skills Dr. Enoka Wickremasinghe

12.30 pm 12.50 pm

Discussion Vote of thanks Representative NIHS

Page 17 of 148

Sunday, 07th July 2013

126th Anniversary Celebrations HEALTH RUN & WALK Exercise today for a healthier tomorrow

06.00 am onwardsHealth Check 06.30-06.45 am

Warming up session

06.45-07.30 am

Run (in 3 groups)

07.45-08.30 am

Walk

08.30-10.00 am

Yoga session, Physiotherapy, Health Messages, Fellowship with healthy snacks

• Free participation • Valuable gifts • Free lung function tests • Free medical check-up • Free sports physiotherapy • Free T-shirts and caps

Tuesday, 09th July 2013 Pre-Congress Workshop BUILDING EFFECTIVE TEAMS IN DIABETES CARE IN SRI LANKA: AN EVIDENCE BASED APPROACH (In collaboration with NIROGI Lanka â&#x20AC;&#x201C; Phase II) Eagle Room, Waters Edge Chairpersons: Dr. Lakshmi Somatunga, Dr. Ananda Gunasekara, Dr. Sunil de Alwis, Dr. Thalatha Liyanage, Dr. Deepthi Perera, Dr. Neelamani Hewageeganage, Dr. Prasad Katulanda, Dr. Mahen Wijesuriya, Dr. Udaya Ranawaka, Prof. Ranil Fernando, Dr. Susie Perera, Dr. K Chandrasekher Moderators: Component Coordinators - Prof. Chandrika Wijeyaratne and Prof. Mandika Wijeyaratne 10.00 am

Registration National Anthem Lighting of the oil lamp Welcome address Prof. Chandrika Wijeyaratne Chairperson, NIROGI Lanka Project Address by chief guest Dr. P G Mahipla Director General of Health Services

10.30 pm

Effective teams for diabetic care Diabetic foot management

12.15 pm

Lunch

12.45 pm

Effective teams for diabetic care Diabetes in pregnancy

02.45 pm

Evening tea

Tuesday, 09th July 2013 Pre-Congress Workshop HEALTHCARE QUALITY & SAFETY National Blood Transfusion Service Auditorium, Narahenpita (Sponsored by World Health Organization) 08.00 am

Registration

08.30 am

Welcome Address Dr. Palitha Abeykoon

08.40 am

Address by chief guest Dr. P .G. Mahipala Director General of Health Services

08.50 am

Address by guest of honour Dr. Lakshmi C. Somatunga Deputy Director General (Medical Services)

Symposium on Hospital Accreditation Chairperson: Dr. Palitha Abeykoon 09.00am

Hospital accreditation – international perspective Dr. Desmond Yen

09.30am

Importance of hospital accreditation Dr. Yash Paul Bhatia

10.00am

Practical aspects of hospital accreditation Dr. Aruna Rabel

10.20am

Hospital accreditation – a Sri Lankan experience Dr. Samanthi de Silva

10.40am

Hospital accreditation – from a clinician’s perspective Dr. Priyankara Jayawardana

11.00 am

Barriers and challenges in hospital accreditation Dr . K T Iraivan

11.20 am

Tea

Symposium on Patient Safety Chairperson: Dr. Ranjan Dias

11.30am

Introduction to patient safety Dr. S Sridharan

11.50pm

Patient safety – from WHO perspective Dr. Sunil Senanayake

12.40pm

Practicality of implementing a patient safety programme Dr. Aruna Rabel

1.00pm

Lunch

Experience of Implementation of Quality Improvement Programme in Peripheries Chairperson: Dr. Lakshmi C Somatunga – DDG (MS) 1 1.45 pm

Improvement of healthcare quality – A PDHS’s experience Dr. R M S K Ratnayake

2.10 pm

Improvement of healthcare quality – An RDHS’s experience Dr. A Ketheeswaran

2.30 pm

Improvement of healthcare quality – An experience from a peripheral hospital Dr. S Prakashan

2.45 pm

Improvement of healthcare quality – An experience from a peripheral hospital Dr. W Wasantha Kumarasiri

3.15 pm

Discussion on way forward Dr. P G Mahipala Dr. Lakshmi C Somathunga Dr. Sunil Senanayake Dr. Desmond Yen Dr. Yashpal Bhatia Dr. Samanthi de Silva Dr. Aruna Rabel Dr. R M S K Ratnayake Dr. A Ketheeswaran

Tuesday, 09th July 2013

Pre-Congress Workshop OPTIMISING CARE FOR CHILDREN WITH DISABILITIES New Auditorium, Lady Ridgeway Hospital for Children, Colombo Chairpersons: Prof. Hemamali Perera Dr. Jithangi Wanigasinghe 08.30 am

Welcome & Introduction Dr. Kalyani Guruge

08.35 am

Opening services to children with special needs Miss.Catherine McNamara

08.50 am

Medical needs Dr. Eeva-Liisa Langille

09.10 am

Nursing care Miss.Helen Maunton

09.30 am

Tea/Coffee

09.45 am

Speech and language Mrs.Nuzha Izhaq

10.05 am

Educational concerns Miss.Minna Selmgren

10.25 am

Feeding &nutrition Ms. Loven Pillay

10.45 am

Discussion (Q &A)

11.45 am

Lunch

12.30 pm

Group Work

02.30 pm

Tea/Coffee

02.45 pm

What can children with disabilities achieve in the Sri Lankan context? Group work and panel discussion

03.30pm

Discussion with the parents

Wednesday, 10th July 2013 Pre-Congress Workshop

INCULCATING ERGONOMICS IN THE SRI LANKAN SETTINGS The Winchester, The Kingsbury, Colombo 01 Chairperson:

Dr. Kapila Jayaratne

09.00 am

Welcome & Introduction Dr. Kapila Jayaratne

09.20 am

Ergonomics: The broader perspective Prof. David Caple

09.50 am

Ergonomics, an evolving speciality: Applicability in Sri Lankan context Dr. Kapila Jayaratne

10.15 am

Ergonomics as a health & safety measure in occupational settings Dr.S.M. Arnold

10.35 am

Industrial ergonomics Dr. Champika Amarasinghe

10.55 am

Tea

11.10 am

Child health and ergonomics Prof. Karen Jacobs

11.40 pm

Computer ergonomics Dr. Nishan Siriwardane

12.00 pm

Road safety - child helmets Dr. Diana Samarakkody

12.20 pm

Home ergonomics Prof. John Abeysekara

12.40 pm

Ergonomics in hospital settings Dr. Chandana Gajanayake

01.00 pm

Health consequences of mismatched ergonomics: Musculoskeletal pain Dr. Inoka Suraweera

01.15pm

Panel Discussion

01.45pm

Lunch

Wednesday, 10th July 2013 Pre-Congress Workshop

“COMMUNICATION SKILLS FOR DOCTORS” SLMA Auditorium

Knowledge makes us powerful. When combined with sound communication, it makes one an accomplished professional. This workshop will introduce techniques to manage situations better within the noble profession of medicine. Chairperson: Dr. Kalyani Guruge

Conducted by Mr.Niroshan Silva (CEO, Training Consortium Pvt. Ltd) 08.00 am

Communication and generations

09.00 am

Inner self investigation – Belbin Profiling

10.00 am

Tea/Coffee

10.30 am

Managing one’s emotions and corresponding. Tool - EQ actions

12.00pm

Lunch

12.45pm

Working with difficult internal & external people. Tool – PQ Grid.

02.00pm

Professional listening. Tool – 3 Step model

03.00pm

Tea/Coffee

03.15pm

Body language

Wednesday, 10th July 2013 Pre-Congress Workshop IMPROVING THE QUALITY OF JOURNALS

(In collaboration with the International Network for Availability of Scientific Publications (INASP), Oxford, UK) Albatross,Waters Edge Chairperson: Dr. B J C Perera

Conducted by Mrs. Sioux Cumming Programme Manager, Journals-on-Line, International Network for Availability of Scientific Publications (INASP), Oxford, UK 08.00 am

Registration

09.00 am

Introduction to INASP with particular reference to SLJOL and AuthorAID

09.30 am

Design elements of a journal

10.30 am

Interactive discussion on the requirements for the different elements of a journal

11.00 am

Tea/Coffee

11.30 am

Evaluation of Sri Lankan journals with an interactive discussion

12.30 pm

Introduction to copy editing with an interactive discussion

01.30 pm

New developments in journal publishing

02.15 pm

Lunch

Wednesday, 10th July 2013 Pre-Congress Workshop CANCER GENETICS â&#x20AC;&#x201C; DIAGNOSTICS, PROGNOSTICATION AND PHARMACOGENOMICS (Organised by the Human Genetics Unit, Faculty of Medicine, University of Colombo in Collaboration with the Sri Lanka College of Oncologists)

Grand Ball Room, Waters Edge 08.30 am

Registration

08.50 am

Welcome address Prof. Rohan W Jayasekara

09.00 am

Epidemiology of cancer in Sri Lanka Dr. Suraj Perera

09.30 am

Cancer is a genetic disease Prof. Vajira H. W. Dissanayake

09.45 am

The challenges of identifying a molecular biomarker for oral cancer the current status and future directions Prof. WM Tilakaratne

10.15 am

Genetics of breast cancer Dr. Dulika Sumathipala

10.45 am

Genetics of colorectal cancer Dr. Nirmala Sirisena

11.15 am

Tea break

11.30 am

Genetics of haematoloical malignancies Dr. Lallindra Gooneratne

12.00 pm

Genetics of polycythaemia Dr. Hemali Gunasekara

12.30 pm

A Clinicians perspective of genetics in cancer care today Dr. Damayathi Peiris

01.00 pm

A clinicianâ&#x20AC;&#x2122;s perspective of genetics in cancer care in the future Dr. Mahendra Perera

01.30 pm

Vote of thanks Dr. Prasad Abeysinghe

1.35 pm

Lunch

Wednesday, 10th July 2013 Pre-Congress Workshop Sports Medicine for Coaches & Trainers In collaboration with the Institute of Sports, Ministry of Sports Sports Science Auditorium, Independence Square, Colombo 07

Chairperson: Prof. Arjuna de Silva 07.00 am

Registration

08.15 am

Introductory remarks Prof. Arjuna de Silva

08.30 am

Coaching, training, over-training and burnout Dr. Harindu Wijesinghe Q&A

09.00 am 09.15 am 09.45 am

On field attention to injuries, concussion, major injuries etc Dr. Hilary Suraweera Q&A

10.00 am

Tea / Coffee

10.30 am

Death in sporting arenas Dr. Asanga Dunuwille Q&A

11.00 am 11.15 am 11.45 am 12.00 noon 12.30 pm 12.45 pm 01.15 pm

Children and adolescents in sport Dr. B J C Perera Q&A Doping: The global menace Prof. Arjuna de Silva Q&A The roles of medical teams and team physicians Dr. C Thurairajah Q&A

01.30 pm

Practical demonstration of on-field evacuation and CPR Dr. Shirani Hapuarachchi

02.15 pm

Lunch

Wednesday, 10th July 2013 Inauguration 05.45 pm

Guests take their seats

06.00 pm

Arrival of the Chief Guest

06.05 pm

Introduction of Council Members to the Chief Guest

06.15 pm

Ceremonial Procession

06.20 pm

National Anthem

06.25 pm

Lighting of the Oil Lamp

06.30 pm

Welcome Address Dr. B. J. C. Perera President, SLMA

06.45 pm

Address by the Guest of Honour Dr. Firdosi Rustom Mehta WHO Country Representative in Sri Lanka

07.00 pm

Address by the Chief Guest Professor Sir Sabaratnam Arulkumaran MBBS (Cey) Hons, DCH (Cey), LRCP & MRCS (UK), FRCOG, FRCS Ed, FAMS (Sing), MD, PhD; Hon. FSOGC, FACOG, FSCOG, FCPS, FSACOG, FSLCOG, FICOG, FDGG

President, British Medical Association 07.20 pm

Award of Research Grants

07.30 pm

Vote of Thanks Dr. Samanmali Sumanasena Honorary Secretary, SLMA

07.40 pm

The SLMA Oration 2013 “Epidemiology of snakebite: Investigating the burden” Vidyajyothi Professor H. Janaka de Silva MBBS (Col), MD (Col), D Phil(Oxon), FRCP(Lond), FRCP, FNAS (SL), Hon. FRACP, Hon. FRCP (Thailand), Hon. FCGP (SL)

Chair and Senior Professor of Medicine Faculty of Medicine, University of Kelaniya, Ragama 08.25 pm

Cultural Display

08.40 pm

The Procession Leaves the Hall

08.45 pm

Reception

Thursday, 11th July 2013 7.15 – 8.15 am

MEET THE EXPERT BREAKFAST SESSION Chairperson: Dr. C Thurairajah

(HALL A)

Physical activity for doctors Professor Arjuna de Silva

8.30 – 9.30 am

SYMPOSIUM 1

(HALL A)

LEPROSY: THE NEGLECTED DISEASE (Sponsored by Fairmed Foundation, Sri Lanka) Chairpersons: Prof. Jennifer Perera Dr. Palitha Abeykoon 8.30am

Recent trends in epidemiology of leprosy Dr. Nilanthi Fernando

8.45am

Challenges in leprosy control in Sri Lanka Dr. Nayani Suriyarachchi

9.00am

Pitfalls in diagnosis of leprosy Dr. Indira Kahawita

9.20am

Discussion

8.30 – 9.30 am

SYMPOSIUM 2 RESPIRATORY MEDICINE (Sponsored by Sri Lanka College of Pulmonologists) Chairpersons: Dr. Amitha Fernando Dr. Keerthi Gunasekera

8.30am

The unified airway Dr. Anoma Siribaddana

8.45am

Update on pleural effusions Dr. G Muhundan

9.00am

What is new in COPD Dr. Eshantha Perera

9.15am

Discussion

9.30–10.00 am

KEYNOTE ADDRESS Chairperson: Dr. B J C Perera

(HALL B)

(HALL A)

Clinical governance to improve safety and quality in healthcare Professor Sir Sabaratnam Arulkumaran

10.00–10.30 am

GUEST LECTURE 1 Chairperson: Dr. Malik Fernando

(HALL A)

Ergonomic applications in healthcare settings and for healthcare professionals Prof. David Caple

10.00–10.30 am

GUEST LECTURE 2 Chairperson: Dr. Kalyani Guruge

(HALL B)

Utilising the window periods in care for childhood disabilities: The impact Dr. Eeva-Liisa Langille 10.30–11.00 am

Tea

11.00–11.45 am

DR S RAMACHANDRAN MEMORIAL ORATION Chairperson: Dr. B J C Perera

(HALL A)

Chronic kidney disease of uncertain origin in Sri Lanka: The past, present and future Dr. Tilak Abeysekera MBBS (Colombo), MD (Colombo), MRCP (UK)

Consultant Physician, Kandy

11.45–12.45 pm

FREE PAPER SESSION 1 INFECTIOUS DISEASES AND GENETICS Chairpersons: Prof. A Pathmeswaran Prof. Vajira Dissanyake

(HALL A)

OP 1:

Genetic polymorphism among rifampicin resistant Mycobacterium tuberculosis CP Adikaram, SMP Senavirathne, WSS Wijesundere, J Perera

OP 2:

Mycobacteria growth indicator tubes (MGIT) for isolation of Mycobacterium species from bone marrow CP Adikaram, HR Jayalatharachchi, J Perera

OP 3:

Effectiveness of single dose intravenous methyl prednisolone in reversing ongoing vascular leakage in dengue R Premaratna, C Abeyrathna, K de Alwis, HA de Silva, HJ de Silva

OP 4:

Natural fluid requirement in dengue haemorrhagic fever and dengue fever SAM Kularatne, KGAD Weerakoon, KR Munasinghe,

OP 5:

Blood pressure drop in dengue without fluid leakage JKND Miththinda, R Premaratna, R Ragupathy, HJ de Silva

OP 6:

Seroprevalance and serotype specific T cell responses in dengue viral infections in healthy individuals in Colombo KC Jeewandara, GN Malavige, TN Adikari, RH Fernando, BSM Fernando, D Ariyaratne, M Salimi, M Peellawate, V Jayasuriya, GS Ogg

11.45–12.45 pm

FREE PAPER SESSION 2 (HALL B) OCCUPATIONAL MEDICINE AND ENVIRONMENTAL MEDICINE Chairpersons: Dr. Upul Dissanayake Dr. Dennis J Aloysius OP 7:

Silicosis among employees of a silica crushing site AD Siribaddana, K Wickramasekara, RD Wijetunga, A Upul

OP 8:

Noise levels of vehicles in the city of Colombo NS Nagodawithana, A Pathmeswaran, AS Pannila, RD Gurusinghe, C Kalansuriya, N Sathiakumar, AR Wickramasinghe

OP 9:

Occupational health services provided to export processing zone workers SM Arnold, SJ Senanayake, NC Pallewatta

OP 10: Environmental noise levels in the city of Colombo, Sri Lanka NS Nagodawithana, A Pathmeswaran, AS Pannila, RD Gurusinghe, C Kalansuriya, N Sathiyakumar, AR Wickramasinghe OP 11: Prevalence of occupation related musculoskeletal pain among tea pluckers in a selected tea estate in Ratnapura district IA Wanniarachchi, A de Abrew OP 12: The effects of the angle between the sole and the heel of heeled footwear on single and double support time, stride duration and toe off plantar flexion of females SAR Darshika, TDMSB Dassanayake

12.45–1.00 pm

PRE LUNCHEON EVENT SRI LANKA CONVENTION BUREAU

1.00–2.00 pm

LUNCHEON EVENT – DEBATE (HALL A) PATIENT SAFETY IS THE RESPONSIBILITY OF THE INDIVIDUAL HEALTHCARE PROVIDER Moderator: Dr. Palitha Abeykoon Proposing Team Prof. Jennifer Perera Dr. Dilantha Dharmagunawardena Dr. Sarada Kannangara Opposing team Prof. Sujeewa Amarasena Dr. Alan Ludowyke Dr. KHD Mahesh

(HALL A)

Judges Prof. Rohan Jayasekara Prof. Manique Gunasekara Dr. Amal Harsha de Silva

2.00â&#x20AC;&#x201C;3.00 pm

FREE PAPER SESSION 3 PAEDIATRICS Chairpersons: Prof. S P Lamabadusuriya Prof. Sujeewa Amarasena

(HALL A)

OP 13: Translation and validation of Patient Practitioner Orientation Scale into the Sinhala language RM Mudiyanse, RW Pallegama, T Jayalath, S Dharmarathna, E Krupat OP 14: Acute poisoning in the paediatric age group in North-Central province of Sri Lanka MBKC Dayasiri, SF Jayamanne, YC Jayasinghe OP 15: Rheumatic fever on the rise: an experience from Teaching Hospital, Jaffna MG Sathiadas, P Kalaventhan OP 16: Prevalence and risk factors for childhood wheezing in Ragama Medical Officer of Health area: an ongoing, community based study YC Jayasinghe, KAW Karunasekera, B Kumarendran OP 17: Randomised clinical trial comparing prednisolone and ACTH in reversal of hypsarrhythmia in untreated epileptic spasms J Wanigasinghe, C Arambepola, GM Attanapola, LSD Liyanage, CB Liyanage, PSK Silva, PKSJ Kankanamge, S Sumanasena, S S Ranganathan, B Dissanayake, M E C Muhandiram OP 18: Defining obesity in children using a biological end point VP Wickramasinghe, C Arambepola, P Bandara, M Abeysekera, S Kuruppu, P Dilshan, BS Dissanayake

2.00 â&#x20AC;&#x201C; 3.00 pm

FREE PAPER SESSION 4 MISCELLANEOUS Chairpersons: Dr. Eugene Corea Dr. Lucian Jayasuriya

(HALL B)

OP 19: Review of ancestry of the major ethnic group in Sri Lanka through Craniometric data: a preliminary study UCP Perera, S Cordner, C Briggs, R Wright OP 20: Security, privacy and confidentiality of patient information in electronic health information systems: a systematic review DBAS Jayawardena OP 21: Prevalence of malnutrition and its impact on outcome in patients with cardiac disease NC Lokunarangoda, AK Pathirana, R Jayawardena, I Ranathunga, MMSP Premaratne, WS Santharaj

OP 22: Geographical Information Systems (GIS) for monitoring of Millennium Development Goal 5 (MDG): a study from Badulla district PVDS Dharmagunawardene, HMJR Herath, NSR Hewageegana OP 23: Patients’ views on health system responsiveness at primary care level NDW Widanapathirana, T Ranasinghe, HSR Perera, R Jayasuriya OP 24: Organizational culture of a hospital and its association with patient safety management system SR Kumar, S Sridharan

3.00–4.00 pm

SYMPOSIUM 3 CARDIOVASCULAR RISK ASSESSMENT Chairperson: Dr. Sarath Samarage Dr. Carukshi Arambepola

3.00pm

Novel risk markers of blood pressure: Focus on blood pressure variability Prof. Rifdy Mohideen

3.20pm

Recent developments in the prevention and control of NCD Dr. Lanka Dissanayake

3.35pm

Cardiovascular risk assessment: The way forward for Sri Lanka Dr. Padma S Gunaratna Discussion

3.50pm

3.00 – 4.00 pm

SYMPOSIUM 4 DERMATOLOGY FOR FAMILY PHYSICIANS Chairpersons: Prof. Antoinette Perera Dr. D N Atukorala

3.00pm

Bacterial and viral infections Dr. Dananja Ariyawansa

3.15pm

Fungal infections Dr. Sriyani Samaraweera

3.30pm

Parasitic infestations Dr. Sharnika Abeyakirthi

3.45pm

Discussion

4.00 pm

Tea

(HALL A)

(HALL B)

7.30 pm

DOCTORS CONCERT “PANACEA” An evening of entertainmnet

Please join us. It is free of charge.

Friday, 12th July 2013 7.15– 8.15 am

MEET THE EXPERT BREAKFAST SESSION Chairperson: Dr. B J C Perera

(HALL A)

Coping with stress Prof. Diyanath Samarasinghe

8.30–9.30 am

SYMPOSIUM 5 STROKE – NEURO REHABILITATION Chairpersons: Dr. J B Peiris Dr. Harsha Gunasekera

8.30am

Hemiplegic shoulder pain Dr. Charitha Perera

(HALL A)

8.45 am

Contemporary issues in acute ischaemic stroke Prof. Tissa Wijeratne

9.05 am

Challenges in stroke rehabilitation in Sri Lanka Dr. Gunendrika Kasthuriratne

9.20 am

Discussion

8.30–9.30 am

SYMPOSIUM 6 (HALL B) PROVIDING SERVICES TO SURVIVORS OF GENDER BASED VIOLENCE (GBV) (Sponsored by UNFPA) Chairpersons: Dr. Lakshman Senanayake Dr. Lasantha Malavige

8.30am

Provision of care:Why is it still a dilemma for some? Dr. Sardha Hemapriya

8.40am

Emotional support: The missing link in the management Dr. Prabath Wickrama

8.50am

Survivors of GBV: Some aspects of the medico-legal response Dr. Muditha Vidanapathirana

9.00am

Survivors of GBV: What are we doing for them? Dr. Netthanjali Mapitigama

9.20am

Discussion

9.30 – 10.30 am

SYMPOSIUM 7 INNOVATIVE APPROACHES IN CLINICAL TEACHING Chairpersons: Prof. Janaka de Silva Prof. Saroj Jayasinghe

9.30am

Introduction of work place based learning Dr. Gominda Ponnamperuma

9.40am

Innovative approaches in bed side teaching Prof. Aloka Pathirana

10.00am

The role of simulation in clinical teaching Dr. Indika Karunathilake

10.20am

Discussion

9.30 – 10.30 am

SYMPOSIUM 8

(HALL A)

(HALL B)

PRACTICAL ASPECTS OF ADDRESSING HARM FROM TOBACCO, ALCOHOL AND DRUG USE (Sponsored by National Dangerous Drugs Control Board) Chairpersons: Dr. Narada Warnasuriya Prof. Lalini Rajapaksha 9.30am

Current situation of substance use and abuse in Sri Lanka Mr. K Pradeep Kumara

9.45am

Addressing tobacco use Dr. Sajeeva Ranaweera

10.00am

Prevention of alcohol use Prof. Diyanath Samarasinghe

10.15am

Discussion

10.30 am

Tea

11.00 – 11.45 am

PROFESSOR N D W LIONEL MEMORIAL ORATION Chairperson: Dr. B J C Perera

(HALL A)

Paradigm shift in osteoporosis management: Diagnostic to intervention thresholds Prof. Sarath Lekamwasam MD, FRCP, PhD, FCCP, FRACP (Hon), Hon FCP(SA), FCPSP (Hon)

Professor in Medicine, Faculty of Medicine, University of Galle

11.45–12.45 pm

FREE PAPER SESSION 5 NON COMMUNICABLE DISEASES Chairpersons: Prof. P Wickramasinghe Dr. T Chang

(HALL A)

OP 25: National survey on tobacco use among school teachers in Sri Lanka IK Liyanage, AP De Silva, STGR De Silva, JMWJ Bandara OP 26: Lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital TM Wijesuriya, MM Weerasekera, J Kottahachchi, SSN Fernando, U Bulugahapitiya, MSS Dissanayake, S Prathapan, KNP Ranasighe, TDCP Gunasekera, A Nagahawatte, LD Guruge OP 27: Evaluation of the accuracy of glucometers currently used in Sri Lanka JH Liyanage, P Katulanda,HA Dissanayake, KKK Gamage, GSP Keerthisena, PN Weeratunga, WA Wijesundara, WMUA Wijetunga, S Subasinghe, TAD Tillakaratne, G Katulanda OP 28: Influence of age on body mass index (BMI) and body fat percentage of Sri Lankan adults

DC Ranasinghe, P Gamage, P Katulanda, N Andraweera, S Thilakarathne, ACR Ranasinghe OP 29: Serum Cystatin C as a marker in the assessment of renal function in diabetic nephropathy in type 2 diabetics in Sri Lanka: a preliminary study NN Wijayatunga, PPR Perera, K Wanigasuriya, H Peiris OP 30: Comparison of system delays during and after working hours affecting primary percutaneous coronary interventions at the National Hospital of Sri Lanka NC Lokunarangoda, AK Pathirana, WS Sanatharaj, KKAO Walawwatta, SP Premaratne, KGV Saranga,KKS Chinthanie

11.45â&#x20AC;&#x201C;12.45 pm

FREE PAPER SESSION 6 TOXICOLOGY & ELDERLY MEDICINE Chairpersons: Prof. Ravindra Fernando Prof. Gita Fernando

(HALL B)

OP 31: Discovery of a deadly scorpion (Hottentotta tumulus) in the Jaffna peninsula and its clinical importance NP Dinamithra, S Sivansuthan, KB Ranawana, SAM Kularathne, KGAD Weerakoon OP 32: Prevalence and factors associated with cataract among the elderly in Mahara Divisional Secretariat Division AAN Nishad, MS Amaratunga, J de Silva, KTAA Kasturiratne, AR Wickramasinghe, J Mallawarachchi OP 33: Upper urinary tract urothelial carcinoma, 15-year experience and survival data RMPS Ratnayake, SAS Goonewardana OP 34: Some characteristics related to falls among the elderly in the district of Colombo AD Ranaweera, P Fonseka, AP Arachchi, SH Siribaddana OP 35: Community incidence of snakebite in the Anuradhapura district A Kasturiratne, NK Gunawardena, BA Wijayawickrama, SF Jayamanne, A Pathmeswaran, G Isbister, A Dawson, HJ de Silva OP 36: Improvement of perceived quality of life with a reinforcement programme on lifestyle modification in patients with knee joint osteoarthritis LPK Senaratne, TSP Samaranayake, LS Wijayaratne

12.45-1.00 pm

PRE LUNCHEON SESSION Chairperson: Prof. S P Lamabadusuriya SRI LANKA CLINICAL TRIALS REGISTRY Dr. Ashwini de Abrew

(HALL A)

1.00–2.00 pm

LUNCHEON EVENT SYMPOSIUM ON HERBAL MEDICINE (Sponsored by Link Natural Products (Pvt.) Limited) Chairperson: Prof. Tuley de Silva

(HALL A)

CLINICAL RESEARCH WITH TRADITIONAL HERBAL MEDICINES Vidyajyothi Dr. R. O. B. Wijesekara Professor Colvin Goonaratna

2.00–3.00 pm

FREE PAPER SESSION 7 PSYCHIATRY & PARASITOLOGY Chairpersons: Prof. Nalaka Mendis Dr. Nadira Karunaweera

(HALL A)

OP 37: A new people-friendly epidemiological approach to confirm the elimination of lymphatic filariasis in Sri Lanka TC Yahathugoda, MV Weerasooriya, F Nagaoka, H Takagi, E Kimura, WA Samarawickrema, M Itoh OP 38: Rickettsial infections in acute coronary syndromes P Ranjan, KCD Mettananda, DST Danansuriya, NKBKRGW Bandara, HJ de Silva OP 39: Intramuscular haloperidol vs. olanzapine for rapid tranquillization: a double blind randomised controlled trial WMH Wijesundara, R Hanwella, J Mendis, VA de Silva OP 40: Meeting challenges of microscopic diagnosis in malaria surveillance under field conditions in Sri Lanka SD Fernando, RL Ihalamulla, J Tillekeratne, R Wickremasinghe, P Wijeyaratne, NL de Silva, R Premarathna OP 41: Prolonged internal displacement and common mental disorders in Sri Lanka: the COMRAID study C Siriwardhana, A Adikari, S Siribaddana, A Sumathipala OP 42: Prevalence of psychological morbidity in an urban population: Is it related to modifiable physical risk factors? SS Williams, MJ Pinidiyapathirage, LT Wijeratne, A Kasturiratne, MUPK Peris, HSA Williams, AR Wickremasinghe

2.00–3.00 pm

FREE PAPER SESSION 8 GASTROENTEROLOGY AND HAEMATOLOGY Chairpersons: Dr. S D Atukorala Dr. Dilani Lokuhetti

(HALL B)

OP 43: Association of genetic variants with non-alcoholic fatty liver disease in an urban Sri Lankan community MA Niriella, A Kasturiratne, F Takeuchi, K Akiyama, AS Dassanayake, AP De Silva, AR Wickremasinghe, N Kato, HJ De Silva OP 44: Chracterisation of beta globin mutations in Sri Lankan patients with betathalassaemia intermedia P Anuja, S Perera, DPSI Silva, M Hapugoda, MN Wickramarathne,

I Wijesirwardhena, DG Efremove, CA Fisher, DJ Weatherall, AP Premawardhena OP 45: Hepatocellular carcinoma in Sri Lanka: Where do we stand? RC Siriwardana, CAHL Liyanage, DSP Jayatunge, A Dassanayaka,MG Gunetileke, MA Niriella, C Sirigampola,A Upasena,,HJ de Silva OP 46: Role of red cell distribution width in screening for Hb E trait in population screening for haemoglobin disorders AAN Nishad, IS de Silva, HL Perera, A Pathmeswaran, AP Premawardhena OP 47: The clinical profile of adult Sri Lankans with microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe OP 48: Demographic and clinical profile of adult Sri Lankans with hepatocellular carcinoma admitted to medical units of a tertiary referral center IGI Dissanayake, RL Satarasinghe, NS Jayasinghe, PJ Rathnayake, R Wijesinghe

3.00–4.00 pm

SYMPOSIUM 9 (HALL A) SCALING UP NUTRITION: MULTISECTORAL APPROACH (Sponsored by UNICEF) Chairpersons: Dr. E. Majeed Dr. Deepthi Perera

3.00pm

Scale of the problem and multisectoral action plan Dr. Lalith Chandradasa

3.10pm

Package of interventions Dr. Renuka Jayatissa

3.25pm

Lessons learnt in the past Dr. Shanthi Gunawardana

3.40pm

Role of mothers’ groups and civil society in improving the nutrition status of children under 2 years of age Ms. Visakha Tillekeratne

3.55 pm

Discussion

3.00 – 4.00 pm

SYMPOSIUM 10 FAMILIAL ADENOMATOUS POLYPOSIS COLI (FAP) (Sponsored by Premium International Pvt Ltd) Chairpersons: Prof. Dayasiri Fernando Prof. Kemal Deen

3.00pm

The genetics of FAP and the future Dr. Andrew Latchford

(HALL B)

3.20pm

Maintaining a FAP registry –The Sri Lankan experience Dr. Amal Priyantha

3.35pm

Surgical management of patient with FAP Prof.Nandadeva Samarasekera

3.50pm

Discussion

4.00 pm

Tea

5.00 pm

DR S C PAUL MEMORIAL ORATION Development of paediatric oncology in Sri Lanka as a speciality: Illustrated by improvement in the outcome of childhood acute lymphoblastic leukaemia (ALL) Dr. Damayanthi Pieris MBBS, MD

Senior Consultant in Paediatric Oncology, National Cancer Institute, Maharagama

Saturday, 13th July 2013 7.15–8.15 am

MEET THE EXPERT BREAKFAST SESSION Chairperson: Prof. Vajira H. W. Dissanayake

(HALL A)

Electronic self-monitoring devices in health care: The M2M era Dr. Manodha Gamage

8.30–9.00 am

GUEST LECTURE 3 (Sponsored by Fortis Healthcare Limited, India) Chairperson: Dr. Lallindra Gooneratne

(HALL A)

Bone marrow transplantation Dr. A K Dhar

8.30–9.00 am

GUEST LECTURE 4 Chairpersons: Prof. A H Sheriffdeen Dr. Jayantha Balawardena

(HALL B)

Managing a patient with family history of colorectal cancer Dr. Andrew Latchford

9.00– 10.00 am

SYMPOSIUM 11 HEALTH IN THE ELDERLY Chairpersons: Dr. Shiromi Maduwage

(HALL A)

Dr. Dilhar Samaraweera

9.00am

Preventing depression and ageing gracefully Dr. Shehan Williams

9.20am

Prevention of osteoporosis-related fractures Prof. Sarath Lekamwasam

9.50am

Discussion

9.00 –10. 00 am

SYMPOSIUM 12 MIGRANT HEALTH (Sponsored by International Organization for Migration) Chairpersons: Prof. Lalitha Mendis Dr. Susie Perera

9.00am

Introduction by the Chairperson

9.05am

Migration health in Sri Lanka: Successes and challenges Dr. Sharika Peiris

9.25am

Questions & Answers

9.30am

Migration health: The forgotten agenda in our health services Dr. Kolitha Wickramage

9.50am

Questions & Answers

10.00am

Tea

10.30 – 11.30 am

CASE BASED INTERACTIVE SEMINAR (HALL A) STEMMING THE TIDE OF METABOLIC DISEASE IN SRI LANKA – A WOMB TO TOMB APPROACH Chairperson: Prof. Rezvi Sheriff

(HALL B)

Moderators: Dr. Navoda Atapattu Dr. Asanka Jayawardena Dr. Prasad Katulanda Panelist: Dr. Hemantha Perera Prof. P Wickramasinghe Prof. R Mohideen Dr. Susie Perera

10.30 – 11.30 am

SYMPOSIUM 13 (HALL B) SEXUAL AND REPRODUCTIVE HEALTH BEYOND BASICS (Sponsored by The Family Planning Association of Sri Lanka) Chairpersons: Dr. Pramilla Senanayake Dr. Ajitha Wijesundara

10.30am

Gender Dysphoria, issues from the practice Dr. Kapila Ranasinghe

10.45am

Premature ejaculation and its management Dr. Lasantha Malavige New technologies in contraception Prof. Harsha Seneviratne

11.00am 11.20am

Discussion

11.30 – 12.30 pm

PRINCIPAL SYMPOSIUM 1 HEPATOLOGY (Sponsored by Global Hospitals, Chennai, India) Chairpersons: Prof. Janaka de Silva Prof. Janaki Hewavisenthi

(HALL A)

Long term management of liver transplant patients Dr. Gomathy Narasimhan Acute liver failure Prof. Mohamed Rela

12.30- 1.30 pm

LUNCHEON EVENT – ONCOLOGY (Sponsored by Global Hospitals Chennai, India) Chairpersons: Dr. Mahendra Perera Dr. Kanishka Karunaratne Recent advances in the management of breast cancer Dr. Jayanthi Thumsi

(Hall A)

Women and cervical cancer Dr. S Nirmala

1.30- 3.00 pm

PRINCIPAL SYMPOSIUM 2 MATERNAL MORTALITY Chairpersons: Prof. Harsha Seneviratne Dr. Kapila Jayaratne

(HALL A)

1.30pm

Postpartum haemorrhage (PPH): Lessons from confidential inquiries Prof. Sir Sabarathnam Arulkumaran

2.00pm

Lessons learnt from the Sri Lankan Maternal Mortality Review Prof. Hemantha Senanayake

2.20pm

The role of gender-based violence in maternal deaths in Sri Lanka Dr. Sardha Hemapriya

2.40pm

Discussion

3.00–3.30 pm

GUEST LECTURE 5 (Sponsored by Fortis Healthcare Limited, India) Chairpersons: Dr. Duminida Samarasinghe Dr. Panna Goonaratne

(HALL A)

Surgical options in end stage heart failure Dr. K R Balakrishnan

3.00 – 3.30 pm

GUEST LECTURE 6 Chairpersons: Prof. Rohan Jayasekera Dr. B J C Perera

(HALL B)

One size does not fit all: Time to turn to personalized genomic medicine? Prof. Vajira H. W. Dissanayake 3.30 pm

Tea

7.30 pm

BANQUET Grand Ballroom, Waters Edge

ABSTRACT OF THE KEYNOTE ADDRESS Clinical Governance to Improve Safety and Quality of Care Prof. S Arulkumaran Professor Emeritus of Obstetrics & Gynaecology, St George’s University of London Clinical Governance is defined as "A framework through which Health Service organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”. It aims to merge managerial, organisational, and clinical approaches to improving quality of clinical care by developing systems and processes that would provide us with an opportunity to safeguard existing good clinical practice, while enabling us to improve our care. It will asses capacity and facilities of the work place, numbers and fitness of health care providers, existence of evidence based clinical guidelines, multisource training to deliver care, audit of adherence to guidelines, analysis of risk incidents and response to complaints. Benchmarking is about setting standards, against which we could monitor our performance, which can be assessed using clinical indicators (e.g. Health improvement, Fair access, Effective delivery of appropriate healthcare, Efficiency, Patient and carer experience, Health outcomes of care). This should enable us to appreciate and safeguard our high standards of care, while at the same time, identify areas that need improvement. The overall aim is to develop and sustain an environment that facilitates, encourages, promotes and values clinical excellence. Clinical Performance and Governance Score Card or the ‘Maternity Dashboard’ is a tool that could be employed to monitor the implementation of principles of clinical governance ‘on the ground’. It helps us to benchmark our activity and monitor our performance against the standards we have set for our maternity unit (i.e. locally), on a monthly basis. It is just like a ‘Dashboard’ of a car, which gives us contemporary information about the amount of fuel in the tank, speed, battery, temperature of the engine, etc., so that we could take appropriate action, if indicated. The purpose of the Score Card is to provide us with contemporary information about our resources,

clinical activity, risk management issues, user views etc., enabling us to identify and respond to â&#x20AC;&#x2DC;deviations from our goalsâ&#x20AC;&#x2122; in time and appropriately, so as to avoid patient safety incidents and to improve clinical care. Individual Maternity Units could set local goals for each of the parameters monitored and to set upper and lower thresholds. A suggested approach is to use Green (when the goals are met, i.e. within the lower threshold), Amber (when the goals are not met. i.e. above the lower threshold, but still within the upper threshold) and Red (when the upper threshold is breeched). If a parameter is in Amber, it indicates that action is needed, if one is to avoid entering the red zone. If it is in the red zone then immediate action is needed from the highest level to maintain safety and to restore quality. Increasingly hospitals are monitoring clinical governance using this system to improve services.

ABSTRACTS OF SYMPOSIA SYMPOSIUM 1 LEPROSY: THE NEGLECTED DISEASE Recent trends in epidemiology of Leprosy Dr Nilanthi Fernando Director, Anti Leprosy Campaign Leprosy is a unique and enigmatic disease. It was one of the first diseases to be linked with a specific infectious agent, Mycobacterium leprae. Yet, even now the organism cannot be cultured in vitro and important gaps are present in our understanding of the biology and epidemiology of the disease. Although contact with known cases of leprosy is a major risk factor for contracting the disease, scientist are not certain how the organism is transmitted from one individual to another nor do they know when through the period of incubation and clinical disease an individual is particularly infectious. These limitations have prevented the development of highly effective control methods. Sri Lanka managed to achieve the leprosy elimination target i.e. one case per 10,000 population in 1995. However it has been noticed that the new case detection rates are increasing gradually from 2009 and the Multibacillary (infective type of leprosy) rate has increased from 35% in 2001 to 49% in 2012. The grade 2 deformity rate which is 7-8% in Sri Lanka is also considerably high compared to the other leprosy prevailing countries in the region. Forty two percent of the new cases are from theWestern province. Eastern and the Southern provinces follow. There are 12 districts where the new case detection rates are higher than the national new Case Detection Rate.

Challenges in Leprosy control in Sri Lanka Dr Nayani Suriyarachchi Regional Epidemiologist, Colombo Leprosy (Hansen disease) is a human infectious disease whose aetiological agent Mycobacterium leprae was identified in the 19th Century by G.H.A. Hansen. Despite the high efficacy of multi drug therapy, transmission of the disease has been persistent and continues to be a major public health problem in the country. Majority is reported from the district of Colombo. In the year 2012, 261 new cases were detected from the District of Colombo which contributed to about 20% of the total number of cases detected in the country. Along with this the Multi-bacillary rate was 44% and the Grade 2 deformity rate was 5%. Many pockets of cases have been identified in the district. Many activities are conducted in the district to reduce the lag time of leprosy patients, as well as to increase the knowledge, attitudes and practices among the clients. In spite of all these efforts and the best of care provided in the district, the situation is yet not under control. The responsibility of detection, treatment and follow up lies with many stakeholders. Also it is important that Leprosy is made an important topic in discussion as many are complacent regarding the burden of the disease. It should be a main agenda item in all forums and an effort should be made to build a better partnership with the clients by supporting them in many different ways.

Pitfalls in diagnosis of Leprosy

Dr Indira Kahawita Consultant Dermatologist, Base Hospital, Karawanella Leprosy is a chronic infection of the skin and nerves. The diagnosis is usually made on clinical grounds but a skin smear or a biopsy may be useful in doubtful cases. Doctors in primary health care institutions are expected to suspect cases of leprosy and refer them to the nearest Dermatology Clinic for confirmation of diagnosis. Therefore knowledge in clinical presentations of leprosy is essential for all doctors in Sri Lanka. Even though the hypo-pigmented anesthetic patch is the commonest and the most well known clinical presentation, leprosy may present in diverse ways. The skin lesions of multi bacillary leprosy are usually multiple and skin coloured. Such lesions may not show sensory impairment. Facial changes due to leprosy are also seen. Some may present with neurological features like nerve palsies and peripheral neuropathy only. In addition to the usual clinical presentations some unusual features may complicate the diagnosis further. The presence of large lesions, pure neural leprosy, plaques and nodules without sensory impairment are such instances. Some skin coloured lesions are difficult to differentiate from other conditions like urticaria, cutaneous tuberculosis and sarcoidosis. Some may present with features of lepra reactions, immunological phenomena due to the release of antigens. Type 1 reactions present with inflammation of the existing lesions which may mimic generalized oedema. Sudden acute nerve palsy may be the first presentation of a type a lepra reaction. Erythema nodosum leprosum (ENL/ type 2) reaction presents with tender subcutaneous nodules which may be accompanied by systemic features. Sometimes ENL may present with no preceding clinical features of leprosy. A high degree of suspicion is necessary to make an early diagnosis of leprosy and doctors should consider leprosy as an important differential diagnosis of skin lesions.

SYMPOSIUM 2 RESPIRATORY MEDICINE The unified airway Dr Anoma Siribaddana Consultant Chest Physician/ President, Association of Pulmonologists of Sri Lanka The increasing recognition that allergic rhinitis and allergic asthma frequently co-exist has led to the concept that these apparently separate disorders are manifestations of the same disease, expressed to a greater or lesser extent in either the upper or the lower airways. In some patients rhinitis predominates and asthma is undiagnosed or sub-clinical, in others it is reversed, while in many, both are clinically expressed. This concept has important implications for both the diagnosis and the management of these common and potentially disabling illnesses. As a result, new disease terminologies have been introduced, namely "United Airways Disease," "Allergic Rhinobronchitis," or "Combined Allergic Rhinitis and Asthma Syndromeâ&#x20AC;?. Rhinitis is often defined as a "risk factor" for the development of asthma. But rhinitis may also represent an early stage of Combined Allergic Rhinitis and Asthma Syndrome. It has been shown that persistent rhinitis is an independent risk factor for asthma, even in the absence of any marker of atopic status. The coexistence of sinusitis and asthma, especially in children, is known, and infection of the para-nasal sinuses is frequently implicated in the development of disease of the lower respiratory tract in allergic patients. Sinusitis and/or adenoiditis have been shown by endoscopic assessment to occur in more than 50% of children with asthma.

Inflammation of the nasal and bronchial mucosa plays a critical role in the pathogenesis of allergic asthma and rhinitis. Both upper and lower airways demonstrate a similar inflammatory cell mucosal infiltrate although differences exist in the extent of the inflammatory indices in allergic rhinitis and asthma. The immune-pathologic response, chronic allergic inflammation, is similar in the upper and lower airways. Therefore the treatment for Combined Allergic Rhinitis and Asthma Syndrome should be directed at the underlying inflammatory processes common to allergic rhinitis and asthma.

What is new in COPD Dr Eshanth Perera Consultant Respiratory Physician, Teaching Hospital, Kurunegala COPD is characterized by airflow obstruction that is not fully reversible and does not change markedly over months. It is usually progressive in the long term.The symptoms often do not appear until significant lung damage has occurred, and usually worsen over time. Many persons who truly do have COPD are not diagnosed until the disease is far advanced and interventions are less effective. COPD is commonly misdiagnosed too. Former smokers are often told they have COPD when in reality have another lung condition. In the vast majority, COPD is caused by long-term smoking which could be in the forms of cigarette, cigar, pipe or secondhand smoke. Only about 20 percent of smokers develop COPD possibly due to genetic factors. Other irritants that cause COPD include air pollution, workplace exposure to dust, chemical fumes and vapors. In the developing world, COPD often occurs in women exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. In about 1 percent of patients, a genetic deficiency of alpha-1-antitrypsin production in the liver could be the cause. A diagnosis of COPD should be considered in patients over the age of 35 with risk factors and clinical features of it. There is no single diagnostic test for COPD. The presence of airflow obstruction should be confirmed by performing post-bronchodilator spirometry. On the latest guidelines recommendations have been added on spirometry, assessment of prognostic factors, and on inhaled therapies. Health professionals involved in the care of COPD should have access to spirometry and be competent in its interpretation. As damage to lungs from COPD cannot be reversed,pharmacological and other therapieshave limited or no impact on the airflow obstruction, but they help to control symptoms, disability and impaired quality of life and minimize further damage.

SYMPOSIUM 3 CARDIOVASCULAR RISK ASSESSMENT Novel risk markers of blood pressure: Focus on blood pressure variability Prof. Rifdy Mohideen Senior Professor, Department of Medicine, Faculty of Medicine, University of Ruhuna

Diagnosis, risk classification and management of hypertension have been traditionally guided by the assessment of usual blood pressure with office blood pressure measurement, ambulatory blood pressure monitoring and home blood pressure determination. In hypertensive patients, the risk of developing new cardiovascular events and complications, depends not only the magnitude of blood pressure elevation, but on associated cardiovascular risk factors, target organ damage and concomitant disease, leading to the development of a total cardiovascular risk approach in many recent clinical practice guidelines. There is emerging evidence that besides usual blood pressure, other parameters contribute to target organ damage in hypertensive patients. The presence of novel risk factors such as inflammatory markers, endothelial dysfunction, small artery pathology, arterial stiffness and myocardial fibrosis add to the risk.

Blood pressure variability (BPV) has emerged as the most recent parameter of interest, which may impact on cardiovascular outcome. Increased short-term and long-term BPV are associated with the development, progression, and severity of cardiac, vascular, and renal damage and with an increased risk of cardiovascular events and mortality. Of particular interest are the findings from wide spectrum of clinical populations and post-hoc analyses of large intervention trials in hypertension, showing that within-patient visit-to-visit BPV is strongly prognostic for cardiovascular morbidity and mortality. These findings have prompted discussion on whether antihypertensive treatment should be targeted not only towards reducing mean blood pressure levels but also to stabilizing BPV, which might favour cardiovascular protection. The effectiveness of calcium channel blockers over beta-blockers and drugs acting on the RAAS system on blood pressure variability is also striking. Prospective studies are needed to confirm these observations and future trial design on antihypertensive effects may have to include its effects on short and long term BPV.

Recent developments in the prevention and control of NCD Dr Lanka Jayasuriya Dissanayake National Professional Officer, Non Communicable Diseases, World Health Organization Non Communicable diseases (NCDs) constitute a major challenge for health and development in the 21 st Century. Recent Global events, particularly the high level meeting of the UN General Assembly on NCDs held in September 2011, have galvanized global momentum and commitment to address NCDs. The main outcome of the UN high level meeting on NCDs was the adoption of the political declaration on NCDs, which acknowledges the rapidly growing magnitude of NCDs in developing countries and its increasingly devastating health and socioeconomic impact. The political declaration calls for concrete and comprehensive actions to address NCDs. Today another exciting World Health Assembly (WHA) comes to an end. This year there were several agenda items of importance for the NCD community. Below are some of the highlights, resolutions adopted, and links to interesting speeches and webcasts from the week. Also we provide the date for our next NCD Alliance webinar, where the NCD community can hear more and discuss next steps. At the 66th World Health Assembly which concluded in May 2013 all member states unanimously adopted and supported an omnibus resolution on NCDs which fulfils some of the commitments made in the UN Political Declaration on the Prevention and Control of NCDs. The key decisions taken include: • To endorse the WHO global action plan for the prevention and control of NCDs 2013–2020 • To adopt the global monitoring framework on NCDs, including the 9 global targets and 25 indicators • To develop a global coordination mechanism by the end of 2013 to coordinate activities and promote engagement of all actors in the global NCD response. These developments at the global level have transcended to the regional and country level where initiatives have commenced to finalize action plans that will assist countries to priorities the interventions for NCDs ensuring maximum cost effectiveness during implementation.

Cardiovascular risk assessment: The way forward for Sri Lanka Dr Padma S Gunaratne Consultant Neurologist, National Hospital of Sri Lanka Cardiovascular Diseases (CVD) are leading causes of mortality and morbidity in low and low middle income countries such as Sri Lanka. More than 79% of CVD deaths in these countries occur in people less than 70 years of age when they are still in the productive period of their life. A significant proportion of these attacks could be prevented through population based strategies and by making cost effective interventions accessible and affordable, both for people with diagnosed CVD and for those at high risk of developing CVD. However

population-wide public health strategies alone will not have an immediate tangible impact on CVD morbidity and mortality. A combination of population-wide strategies and strategies targeted at high risk individuals is essential to reduce the CVD burden. As per estimates, 50% of Sri Lankans between 40 â&#x20AC;&#x201C; 80 years are either with high blood pressure (>140/90) or high cholesterol (>6mmol/l). However, the total CVD risk in situations with multiple risk factors is far beyond the total sum of the risk created by individual risk factors. In this context, WHO/ISH risk prediction charts enable health care professionals predict the total risk of CVD of their patients and also allows the government to stratify the CVD risk of its population and to differentiate the highest risk category. Risk stratification is essential to intensify treatment for the highest risk category, thereby causing a significant impact on the CVD burden. If the baseline risk is higher, treatment would be more beneficial in terms of number of attacks prevented. Therefore treatment decision based on level of risk determined by risk prediction charts would be with higher cost benefits for developing countries. Risk prediction charts are cheap and user friendly and also enables primary health care doctors to determine the best form of management for their patients. Further, the cost of treatment for Sri Lankan population with total risk more than 20% per annum would be four times less expensive than single risk factor approach. Savings made by practicing total risk approach could be invested on other competing priorities such as managing already established CVD.

SYMPOSIUM 4 DERMATOLOGY FOR FAMILY PHYSICIANS Bacterial and viral infections Dr Dananja Sanjeevi Ariyawansa Consultant Dermatologist, Sri Jayawardenepura Hospital Normal healthy skin has a commensal flora of harmless microorganisms including bacteria,yeasts and mites. Viruses are not a component of the resident flora. Skin bacteria are a mixture of harmless and poorly classified micrococci and diphtheroids.Overgrowth of diphtheroids can cause three conditions; Trichomycosis axillaris,Pitted keratolysis and Erythrasma. Predisposing factors to skin infections include minor trauma, pre existing skin disease, poor hygiene and rarely impaired host immunity. Bacterial infections accounts for 17% of all clinic visits. Staphylococcus aureus is not part of the resident flora except in a minority who carry it in some parts of the body. Staphylococci cause Impetigo, Ecthyma, Furunculosis, Carbuncles and Streptococcus pyogenes cause Impetigo, Ecthyma, Cellulitis, Erysipelas, Necrotizing fascitis. Both these organisms would cause toxin mediated diseases on the skin. There are chronic bacertail infetions on skin out of which Mycobacterial infections are common in Sri Lanka, mainly M.leprae and M.tuberclosis Viruses do not contribute to normal skin flora. Viral infections on skin may occur as a primary involvement due to barrier dysfunction or poor host immunity on skin in conditions such as viral warts, Herpes simplex, Molluscum contagiosum or as a secondary skin involvement of a systemic viral infection such as Measles, Chicken pox, Hand foot and mouth disease.

Fungal infections of skin Dr Sriyani Samaraweera Consultant Dermatologist, District General Hospital, Kegalle

Cutaneous fungal infections are broadly divided into those that are limited to stratum corneum, hair and nails (superficial fungal infections) and those that involve the dermis and the subcutaneous tissues (subcutaneous and deep mycoses).Superficial fungal infections are often due to dermatophyte infections, pityrosporum infections and candidiasis. Commoner subcutaneous mycoses are mycetoma and chromoblastomycoses. Deeper fungal infections are due to extensions from underlying structures or due to haematogenous spread. In the immunocompromised host opportunistic fungi eg.Aspergillus ,Mucor spp can lead to both cutaneous and systemic infections.

Dermatophyte infections are due to filamentous fungi which affect keratinized tissue. They cause anular lesions with an active edge. Clinical diagnosis can be confirmed by skin scrapings, nail clippings and hair for direct microscopy and culture. For few lesions topical antifungals alone can be attempted. Extensive disease needs oral antifungals. Pityriasis infections cause pityriasis versicolor and pityrosporum folliculitis. Pityriasis versicolor can cause hypopigmented or hyperpigmented macules .Pityrosporum folliculitis is a monomorphic follicular eruption occurring on the back and upper chest. Skin scrapings for direct microscopy and culture will confirm the clinical diagnosis. Localized pityrosporum infection can be treated with topical antifungals but extensive disease needs oral antifungals. Candida infection is caused by the opportunistic pathogen a yeast, Candida albicans. Different presentations of candida infection include mucocutaneous candidiasis, intertrigo, genital infections and candidal paronychia. Direct microscopy and culture of skin scrapings and swabs will confirm the clinical diagnosis. If the response to topical antifungals is inadequate oral antifungals should be given. Common subcutaneous mycoses are mycetoma and chromoblastomycoses. Diagnosis is confirmed by fungal studies, bacterial culture and histology on tissue specimens. Treatment of both conditions needs topical therapy with longterm oral antifungals.

Parasitic infestations Dr Sharnika Abeyakirthi Consultant Dermatologist, Base Hospital Avissawella There are many parasites that infest human skin. Here we focus on the most common conditions; Scabies, Pediculosis, Cutaneous Larva Migrans and Leishmaniasis. Human scabies is caused by the mite Sarcoptes scabie var. hominis. A hypersensitivity reaction to the mite is responsible for its main symptom, the intense pruritus. The clinical features include pruritic papules. Burrows are characteristic but less frequently seen. Many scabicidals are available but the effective management requires proper application, disinfection of clothing and treatment of all contacts. There are 3 varieties of Pediculosis that affect humans; the head louse, the body louse and the pubic louse. Pediculicides as well as good personal hygiene is important in the management of this condition. Larva migrans eruption occurs when the larvae of dog or cat hook worm (Ancylostoma caninum and A. brazilliense respectively) penetrate intact exposed skin and begin migrating through the epidermis. Albendazole or Thiabendazole is the treatment of choice. Leishmaniasis is an emerging health problem in Sri Lanka. It is a chronic protozoal infection caused by Leishmania spp. and transmitted by the bite of an infected female sandfly. Few imported cases were reported initially from Middle East returnees in 1990’s. Since year 2000, increasing numbers of patients have been reported from many parts of the country. Local transmission cycle is well established now. It is endemic in the Northern, Eastern, North Central, Central and Southern provinces with “pockets” identified all over the country. Cutaneous leishmaniasis represents the main clinical form in Sri Lanka. However a few cases of muco cutaneous and visceral leishmaniasis have been reported. Long standing, asymptomatic papule or nodular ulcerative lesion is the main clinical form. Sodium stibogluconate is the treatment of choice in Sri Lanka.

SYMPOSIUM 5 STROKE – NEURO REHABILITATION Hemiplegic shoulder pain Dr Charitha Perera

Senior Consultant Physician in Rehabilitation Medicine at the Repatriation General Hospital in Adelaide More than 50% of stroke survivors suffer Hemiplegic Shoulder Pain (HSP) giving rise to significant impact on their rehabilitation and functional recovery. It is important to identify the causes of HSP, take steps to prevent it and to manage the symptoms in order maximise the recovery. Proper positioning of the hemiplegic upper limb to prevent excessive adduction and internal rotation should be educated to all care givers. Simple and cost effective new procedures such as suprascapular nerve blocks may also provide longer lasting pain relief with less adverse effects.

Contemporary issues in acute ischaemic stroke Prof. Tissa Wijeratne Associate Professor, Neurologist and the Director of the Stroke Unit, Neuroscience Research Unit, Movement disorders program at Western Hospital, Melbourne Stroke is the leading cause of adult disability in Australia and probably in Sri Lanka also. Annually, 16 million strokes occur globally. One in every six seconds someone somewhere dies from a stroke. One in six of the world population will suffer from stroke during their lifetime. Stroke is preventable. Stroke is treatable. There are four established therapies for acute ischemic stroke at present. These include; 1). Stroke Unit care (Management of stroke in a geographically co localized unit rather than a general medical or general neurology ward.) 2). Aspirin or other Antiplatelet therapy within 48 hours of onset of acute ischemic stroke 3). Thrombolytic therapy with tissue plasminogen activator within 4.5 hours of onset of symptoms of acute ischemic stroke 4). Hemicraniectomy for malignant MCA syndrome for selected patients who are younger than 60 years of age. The mainstay of acute ischemic stroke therapy includes revascularization (restoration blood flow) and stroke unit care. Intravenous tissue plasminogen activator (rtPA) is the only accepted acute treatment proven by randomized double blind clinical trials improving patient outcomes. Current evidence showed benefit up to four and half hours of symptom onset. Time is brain. Rapid treatment with reperfusion treatment leads to better patient outcomes. In the setting of IV rtPA, the number needed to treat (NNT) to prevent death or disability is three within one hour, eight within three hours, and fourteen within 180 to 270 minutes. It is calculated that every thirty minute delay to successful reperfusion led to an approximate 10% worsening in good clinical outcome. Organized stroke unit care throughout Sri Lanka and access to neurorehabilitation from day one is a top priority in Sri Lanka at present. This can be done and should be done. Dr. Darshana Sirisena, Neurologist, Teaching hospital, Anuradhapura and Dr Nirodha De Silva , Physician, Base hospital, Anuradhapura lead successful stroke unit care program in these two hospitals respectively.

Challenges to management of stroke in Sri Lanka Dr Gunendrika Kasthuriratne Consultant in Rheumatology & Medical Rehabilitation, District General Hospital, Negombo

Stroke is the leading cause for adult disability in Sri Lanka. Annual occurrence of new cases exceeds 25000. Although post stroke rehabilitation is critical, most of the acute care providers are compelled to discharge stroke patients home prematurely due to non availability of adequate facilities for institutionalized rehabilitation. Dedicated stroke units are seen in few major hospitals which provide short term rehabilitation care. In Sri Lanka, only few institutions localized in a few provinces provide long term multidisciplinary rehabilitation care for stroke patients. Although not dedicated for stroke patients, peripheral rehabilitation hospitals in Jayanthipura and Kendagolla and Maliban Hospital in Galle have mainly cared for stroke patients during year 2012. It is very important to note that numbers of stroke patients admitted to these units keep increasing annually. There are many obstacles for proper rehabilitation of stroke patients in Sri Lanka. Lack of wide spread network in rehabilitation is perceived as the major obstacle by many rehabilitation professionals. Awareness about the benefits of rehabilitation after stroke is lacking among the general public as well as among the healthcare personals. Cultural beliefs and misconceptions among the community significantly prevent these patients from utilizing the available services. They also stand as a barrier for proper community inclusion of the rehabilitated patients. There are more issues pertaining to social reintegration of rehabilitated patients. Inability to carry out the recommended home modifications due to financial difficulties and community inaccessibility may make rehabilitation efforts futile. A concerted effort is required from stake holders to address the present gaps in rehabilitation of stroke patients and to integrate the rehabilitee in to the society in a productive manner. The existing facilities need to be used efficiently while making them available in all provinces.

SYMPOSIUM 6 PROVIDING SERVICES TO SURVIVORS OF GENDER BASED VIOLENCE Emotional support: The missing link in the management Dr Prabath Wickrama Acting Psychiatrist, General Hospital Trincomalee Gender Based violence is widespread in Sri Lanka. Psychological morbidity in survivors is enormous and serious. Mostly it is unreported, under diagnosed and ignored. Worst, it may be accepted as a socio- cultural norm and denied even by the health professionals. As doctors we should be vigilant to uncover the possibility of violence. This is more critical as the presentations are mostly nonspecific and can present at various levels within the health sector. The ability to listen and provide support at the presenting setting becomes important.

Both local and international studies show favourable results with interventions both at community settings and at crisis centres. Emotional support appears to be a uniform intervention worldwide. Emotional support consists of active listening allowing expression of emotions, expression of personal views of the problem and assessing the social consequences. This provides a survivor with an opportunity to pour out the emotions and contemplate a solution. Optimum support to victim will ensure her safety as well as give her ample time to make her own decision. Due to various factors at present doctors generally appear to have less and less time to talk to patients. This leads to a crucial loss of our aim to help the victims. We may strive to achieve an attitudinal shift among the doctors and/ or look for alternatives. Considering the enormity of the problem it is rational to conclude that we professionals alone would not be able to intervene. There should be an effective integrated intervention at community level. Community efforts should aim to tackle the root causes such as effects of alcohol. We could only be encouraged by the positive results of community intervention programs in the country with this regard.

Survivors of GBV: Some aspects of the medico-legal response Dr Muditha Vidanapathirana Senior Lecturer, Department of Forensic Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Majority of the survivors of physical Gender Based Violence (GBV) including Domestic Violence (DV) are reported to the Forensic Medical Officers. The main objective of the medico-legal examination is to collect the evidence for prosecution of the suspects in court of law. When providing medico-legal services, need of focusing beyond satisfying the legal requirement is reiterated. “Care provision centres” for cases of GBV in our set up are very few. It is important to establish such a centre in each hospital. The medico-legal officers can make use of such a centre for psycho-social rehabilitation, follow up and holistic management. Forensic Pathologist is a Medical Officer before a technical expert and I strongly believe that our fraternity is prepared to accept such a position very positively. It is also needed to understand the importance of sticking to the routine guiding principles in providing services such as confidentiality etc. Re-victimization in the health system could be prevented by developing a “joint examination system” among the stake holders such as judicial medical officers, psychiatrists, gynaecologistsetc, while upholding the patient’s choice of refusing an examination etc. In cases of sexual abuse, the first contact medical officer should introduce emergency contraceptive pills (ECP), STI prophylaxis etc. Such victims should be referred for medico-legal examination at the earliest opportunity. Medical professionals both in government and private sector have a responsibility of reporting these survivors to an identified centre at the nearest hospital. There, the survivor’s choice in taking legal action should be retained considering the implications.

Survivors of GBV: What are we doing for them? Dr Netthanjali Mapitigama Consultant Community Physician, National Programme Manager, Gender and Women’s Health, Family Health Bureau, Ministry of Health, Responding to Gender Based Violence has been recognised as an essential responsibility of the government sector in the National Policies/Visions. “Mahinda Chinthana” the document describing the vision of the President of Sri Lanka proposes the necessity of a mechanism to be developed to respond to GBV. Ministry of Health has in cooperated responding to GBV as one major goal in some of their policies and plans. Family Health Bureau is the nodal agency at National Level responsible for Women’s Health inclusive of GBV. Family Health Bureau has developed some programmes to respond to GBV.

Some of these programmes focus on prevention of GBV and some concentrate on responding to GBV. Programmes under the prevention of GBV are 1.

Package for newly married couples. The newly married couples are encouraged to attend 2 sessions at the Medical Officer of Health (MOH) office, where they would be sensitised on some important topics which would enable them to have a good marital life. This sensitisation would empower the couple to improve their marital relationship without violence which would improve the health and wellbeing of the couple.

Package for migrant workers and their family members This package has been developed to create awareness among the migrant workers and their family members on the negative consequences of migration.

This programme would create awareness among migrant workers and their family members to address (prevent and manage) their reproductive health issues and problems including the sexual/ mental and physical abuse faced by the migrant worker in her destination and the children at home. Also, the preventive and curative health workers are empowered on their roles and responsibilities on prevention and management of GBV. Further, a centre called â&#x20AC;&#x153;Mithuru Piyasaâ&#x20AC;? is established in hospitals to provide emotional support to survivors of GBV. This is a friendly shelter in the hospital, which is operated by the hospital staff- mainly MOO and nurses working in the out patients department. This centre provides befriending and counselling services.

SYMPOSIUM 7 INNOVATIVE APPROACHES IN CLINICAL TEACHING Introduction of work place based learning Dr GomindaPonnamperuma Senior Lecturer in Medical Education, Faculty of Medicine, University of Colombo Clinical teaching and learning is rightly considered as the ultimate goal of medical education. In fact medical education started with clinical teaching and learning as its sole component. With the advancement of the basic and clinical sciences, however, a strong scientific foundation has to be introduced to strengthen clinical learning. Similarly, with the necessity to certify the fitness-to-practise, clinical assessment has to be introduced. All these advancements, however, if not synergistically combined with the core activities of clinical teaching and learning, may not necessarily contribute towards a meaningful impact on clinical education. To circumvent such a possibility, innovative clinical teaching and learning methods have been introduced. This symposium first introduces clinical teaching and learning, by tracing the historical evolution of the clinical teaching from its inception to the modern concepts and practice. Such historical tracing will provide the justification as to why innovative clinical teaching and learning approaches are necessary. Then, based on this backdrop, some of the cutting-edge methods of clinical teaching and learning such as workplace-based teaching with core clinical problems, competency-based education through entrustable professional activities, simulation-assisted teaching, and teaching and learning of clinical reasoning will be discussed. In particular, how the above methods will integrate the learning of scientific foundations of clinical practice and the effects of clinical assessment to drive clinical learning will be explored. Also, how such harmonious integration will effectively thwart any possibility of dampening the full potential of clinical teaching due to the introduction of the newer sciences and competencies

will be highlighted. Finally, the implications of innovative approaches of clinical teaching and learning to the Sri Lankan context will be considered.

The role of simulation in clinical teaching Dr Indika Karunathilake Director, Medical Education Development and Research Centre, Faculty of Medicine, University of Colombo Health care is becoming increasingly complex, making clinical teaching requirements challenging and sophisticated. These challenges include the need to train an increasing numbers of students, need for regular and frequent training and legal, accountability and patient safety issues. Simulation Based Medical Education (SBME) offers several advantages helpful in overcoming many of these challenges. Simulation, which is founded on the principle of doing and practicing, is a technique to replace or amplify reallife experiences with artificially contrived guided experiences. Simulation can provide a reproducible, standardised, objective setting for both teaching and assessment and also recreate scenarios that are challenging, but not frequently experienced in routine clinical setup. Several competencies including clinical skills, procedure-based skills, communication skills, leadership, team work, decision-making, interpersonal skills and professionalism can be trained through simulation. SBME can enhance patient safety by removing the patient from the studentâ&#x20AC;&#x2122;s learning curve and providing a safe and educationally orientated environment. A wide range of teaching options are available in SBME, including simulated patients, virtual patients, basic and interactive manikins, task trainers, computer-based simulations and gaming. These options can range from lowcost to high cost and low fidelity to high fidelity. High-tech simulators are of high-fidelity and exciting. However many advances in simulation have been made through low-fidelity, low-cost approaches. In the Sri Lankan setting, low-fidelity simulation has huge potential to be used widely with a significant impact on training and patient safety. However simulation is not a panacea to solve all the challenges within the health system. High cost, possibility of negative learning and false confidence are concerns in SBME. It is unlikely that simulation will replace the importance of real life clinical experiences. An understanding of the cost-effectiveness of simulation shall certainly enable more informed choices regarding SBME. It is important to understand that simulation is a tool, not an end in itself. A rational approach of integrating SBME can lead to a paradigm shift in clinical teaching

SYMPOSIUM 8 PRACTICAL ASPECTS OF ADDRESSING HARM FROM TOBACCO, ALCOHOL AND DRUG USE Current situation of substance use and abuse in Sri Lanka Mr Pradeep Kumara Koholanegedara Counselor â&#x20AC;&#x201C; National Dangerous Drugs Control Board Substance abuse has been increasing among the young generation throughout the world. Sri Lanka is no exception. Is the risk higher in the younger generation that include school drop outs and young school leavers? Just how strong is the social, community, family and individual safety net in Sri Lanka, compared with other countries? At National Dangerous Drugs Control Board (NDDCB), research is carried out on the recent trend in substance abuse. National Dangerous Drugs Control Board and its stakeholders attempt to offer a safety net for

the younger population. One strategy isreducedrug trafficking and supply by strengthening law enforcement at both local and international levels. NDDCB joinshands with stakeholders to maximise opportunities to build a substances free nation by employing strategies like becoming involved in School Quality Societies and Youth Societies and building resilience in the vulnerable groups. NDDCB is also constantly engaged in designing new preventive measures to achieve this goal. Current research reports on contemporary drug using patterns of Sri Lanka published by the Research Division of NDDCB, have highlighted that the demand for certain types of psychoactive substances specially cannabis and few pharmaceuticals items have accelerated among young population. Psychoactive substances use continues to be a global problem. It is a problem in Sri Lanka too. The yearly Hand Book compiled by NDDCB, reports that there were 14 440 arrests for heroin use in 2012. This is a 34% increase from 2011. â&#x20AC;&#x153;Illicit substancesâ&#x20AC;? include opioids, cannabis, cocaine, other amphetamine type stimulants, hallucinogens, and ecstasy. However problems caused by legal substances too need to be considered. A significant number of people who are using legal substances particularly tobacco and alcohol products ,develop considerable problemsrelated to substance use. Recent findings show the growing problem of using pharmaceutical products among the younger generation. Studying the pattern of substance use needs to be carried out by all organizations involved in reducing substance use. Consumption of cannabis is widely seen today in every social stratum and in various geographical areas in the country. A similar trend was seen with the demand for tobacco products some time back. The tendencies have changed to cannabis production now.

Addressing tobacco use Dr Sajeeva Ranaweera External Lecturer, MPH Programme, University of Kelaniya and External Lecturer, Diploma of Drug Abuse Management, University of Colombo Tobacco use is the leading cause of preventable deaths in the world. Tobacco related diseases affect both the users and those exposed to tobacco smoke. Currently, around 5 million tobacco users and 600,000 non-users die each year due to tobacco use and exposure to second-hand smoke worldwide. It is estimated that the number killed by tobacco will increase to 8 million a year by 2030. There are around one billion smokers worldwide, with 80% of them living in low and middle income countries. Disturbingly, in 2004, children accounted for 28% of the deaths attributable to second-hand smoke. In Sri Lanka tobacco-attributable mortality has been estimated to be between 12,000 to 20,000 annually. There is no safe level of consumption for tobacco. Therefore, scientifically, there is no basis for allowing tobacco use to continue legally. A total ban on production, distribution and sale of tobacco will be the most effective and scientifically supported policy to address the enormous economic, social and health harms caused by tobacco. Until such a ban comes into place, the two main strategic approaches for tobacco control are demand reduction and supply reduction. Though these approaches appear distinct, there are interrelations among them - the demand affecting the supply and vice-versa. In the current context, the main evidence-based approaches to address tobacco related harm are discontinuation of promotions, price measures, establishing smoke-free environments, promotion of cessation of use and creating awareness of populations of the determinants which promote initiation and maintenance of tobacco use. The short to medium term harm from tobacco occurs due to its current users. Therefore, promoting cessation is one of the most important components of a comprehensive effort. Effective cessation can bring about immediate changes in prevalence rates and tobacco related illnesses, and other associated harms.

Besides direct interventions on individuals, factors such price increases, pictorial health warnings, smoke-free environments, advertising bans and changes in social perceptions of smoking, promote cessation. How health professionals can practically address determinants of tobacco cession of individuals and promote cessation in communities is illustrated in this session.

Prevention of Alcohol Use Prof. Diyanath Samarasinghe Associate Professor in Psychiatry, Faculty of Medicine, University of Colombo The title given for this session – ‘Helping people quit alcohol use’ – begs the question, ‘Is promoting abstinence a justifiable public health goal?’ Numerous medical conditions and overall mortality are reportedly higher among abstainers than among light drinkers. If the relevant studies are accurate, and the conclusions from them correct, we should encourage people to keep reducing their current consumption but not quite quit. We must continue to examine dispassionately the evidence for claims that light alcohol consumption is better for health than abstinence, while we give this fuzzy advice, for we have no choice but to be guided by what our profession deems is proper. We still have to persuade many among our patients to change their alcohol habits one way or another. An ignored, but effective, strategy is to help them test different approaches and learn from the results. People are able to determine the ideal personal relationship with alcohol when they discover how to overcome the influence of habitual company and routines. For individuals of low intelligence, and those with brains too far damaged by alcohol, the standard medical managements are still available – and recommended.

SYMPOSIUM 9 SCALING UP NUTRITION: MULTI-SECTORAL APPROACH Scale of the problem and multi-sectoral action plan Dr Lalith Chandradasa National Nutrition Secretariat Coordinator, National Nutrition Promotion Programme Sri Lanka has entered a phase of rapid growth and development since the end of the conflict in 2009. Accordingly our health indicators have also shown significant improvements in the recent past. However, the nutrition indicators do not match those of health; the nutritional status of children, women and adolescents have remained stagnant for over a decade and do not match with the present levels of socio economic development. His Excellency the President, thereby having recognised the importance of addressing the current nutrition situation, launched a special programme titled ‘Vision 2016: Sri Lanka, A Nourished Nation’ indicating the priority given to nutrition by the current Government, and commissioned the National Nutrition Council, comprising 17 ministries, to develop a suitable plan to achieve this vision supported by the National Nutrition Secretariat of Sri Lanka, which was specially set up within the President’s Secretariat. This resultant Multi-sector Nutrition Action Plan will be implemented from 2013 onwards to achieve the set results. Special budget lines have been set up by the Treasury and commitments for technical and financial support have also been received from international agencies. The Government of Sri Lanka is committed to achieving these results by 2016.

Package of interventions Dr Renuka Jayatissa Consultant Medical Nutritionist, Ministry of Health The evidence highlights the need for adolescent, prenatal, and early life interventions, including counsel ling about breastfeeding and complementary feeding; fortification and supplementation with iron, iodine, vitamin A, and zinc and interventions to improve nutrition of women, especially maternal nutrition and health during pregnancy. This investment could generate high economic returns.

Nutrition-specific interventions, could provide up to 36% reduction in stunting if scaled to the high burden areas. These interventions, largely targeting pregnant and lactating women and children under two years of age, focus on the support and promotion of breastfeeding within the first hour after birth, and exclusive breastfeeding for the first six months of life; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of hand washing and strategies to reduce the burden of malaria in pregnancy). Nutrition-sensitive approaches, while a growing area of focus, are emerging to address the longer-term determinants of malnutrition and enhance the coverage and effectiveness of nutrition specific interventions. These include approaches in agriculture, social safety nets, early childhood development, and classroom education. The multi-factorial determinants of malnutrition make it clear that while intervention during the 1,000 days is essential, it is not sufficient.

Lessons learnt in the past Dr Shanthi Gunawardana Consultant Community Physician and the Director of Nutrition Coordination Division, Ministry of Health Healthy population is an asset in the forward march towards socio-economic development of a country. Proper nutrition is undoubtedly a pre-requisite for such a healthy nation. Despite having many achievements in health sector, Sri Lanka is still showing suboptimal progress in nutritional status. Prevalence of low birth weight babies, wasting, stunting and underweight among children under 5 years is still high as 16.6%, 14.7%, 17.3% and 21.7% respectively (DHS 2006/2007) ,while pregnant and lactating mothers with BMI less than 18.5 is 16%. Moreover, anaemia and Vitamin A deficiency also have become public health issues. In terms of overcoming those issues, vast inter district variation, emergence of NCD, lack of coordination among key partners and gaps in service provision in plantation and other sectors have been identified as challenges. To overcome these challenges National Nutrition Policy was formulated and National Nutrition Council was established. It is identified an improvement of nutritional status is a multi sectoral effort. Therefore advocacy at central, provincial, district and divisional levels were done and coordinating committees were formed at all these levels. At grass root level, services of four officers namely, Pubic Health Midwife (PHM), Grama Niladari, Agriculture Officer and Samurdhi Officer were obtained. Families with malnourished children under 5 years and pregnant mothers with a BMI less than 18.5 were selected from PHM registers. Underlying factors for the above conditions were identified through a survey with the help of the above grass root level officers. This plan was implemented in Nuwaraeliya and Monaragala districts in 2011. Special attention was given to target families, while other interventions were at field level. Supervision was strengthened and monthly coordinating meetings were carried out at all levels.

It was found at the end of 6-9 months period there was an improvement of nutritional status among children under 5 years as well as pregnant mothers. Concept of community responsibility, coordination between sectors on nutrition was improved although it was a difficult task at the beginning.

Role of mothers’ groups and civil society in improving the nutrition status of children under 2 years of age Ms Visakha Tillekeratne Independant Consultant, World Bank Mobilising mothers to act in the interest of their own children as well as those of others, was one of the 4 major components of the project entitled “Community Nutrition Initiatives in the Northern Province”. The objective of setting up mothers’ groups was to examine if the nutrition status of children under age 2 and under age 5, could be further improved and sustained as an addition to tried and tested nutrition initiatives such as supplementary feeding, therapeutic feeding, growth monitoring and promotion within the public health sector, nutrition and health education talks and food preparation demonstrations. 1100+ mothers’ groups were thus formed mainly among the resettled community in the Northern Province of Sri Lanka approximately a year ago. This study aims to examine the performance of mothers’ groups formed under the Northern Project areas in the improvement of nutritional practices and community self help activities after a year of formation. The performance of a sample of 50 mothers’ groups has been studied. The findings point out to the fact that though community mobilisation and self help is possible within a short time, the deeper process of community problem analysis and solution building for sustained nutrition improvement takes much longer.

SYMPOSIUM 10 FAMILIAL ADENOMATOUS POLYPOSIS COLI (FAP) The genetics of FAP and the future Dr Andrew Latchford

Consultant Gastroenterologist and Assistant Director Polyposis Registry, St Mark’s Hospital Familial adenomatous polyposis (FAP) is caused by a germline mutation in the adenomatous polyposis coli (APC) gene. Mutations in APC are inherited in an autosomal dominant manner but around 20% of FAP cases arise as a result of a new mutation. The syndrome is rare and has a population prevalence of between 1 in 7500 and 1 in 13000. It is characterised by the development of multiple adenomatous polyps in the colon and rectum, however there are a number of important extra-colonic manifestations. There is good evidence of a genotype-phenotype correlation in FAP; namely the position of the germline APC mutation correlates with the clinical manifestations of FAP. In this talk I will cover the function of the APC gene and how mutations are inherited. The genotype phenotype correlation will be reviewed and I will discuss how the knowing the position of the germline APC mutation can influence decision making in the management of these patients. Finally I will briefly review some of the more recently described genetic syndromes that may mimic FAP and how genetic testing can be used to differentiate them.

Maintaining a FAP registry - Sri Lankan experience Dr T G Amal Priyantha Gastrointestinal Surgeon, Teaching Hospital, Colombo South FAP is a genetic disorder resulting from a mutation in the adenomatous polyposis gene (APC) gene. It is characterised by the development of more than a hundred adenomatous polyps in the colon and rectum which

can undergo malignant change. Since FAP is an autosomal dominant inherited disorder children of an affected individual are at 50% risk of inheriting the predisposing gene.Therefore individuals with a family historyof FAP should be screened. The aim of establishing a polyposis register is to reduce the prevalence of colorectal cancer and prolong the life of the patients with polyposis. The establishment of a polyposis register included the following stages (1) registration of patients and their family members; (2) initiation and coordination of screening of family members at risk and (3) treatment of those diagnosed as being affected The St Markâ&#x20AC;&#x2122;s Hospital Polyposis Registry was founded in 1925. It is the first polyposis register in the world. Since then several national and regional polyposis registries have been established around the world. Over the last decade national polyposis registers have been established in Europeand Japan.Several regional registers have been founded in Europe,North America,and Australasia. In Sri Lanka first polyposis register was reported from the Department of Surgery, University of Kelaniya (Ceylon Med J. 2011 Jun;56(2):66-9). Currently they are working on establishing a national polyposis register. However, establishing a polyposis register is not without problems. Identifying an asymptomatic person at-risk, leading to diagnosis and follow-up could lead to social problems. In addition losing a job and medical and life insurances have been issues in other countries. These fears inhibit the patient's cooperation and therefore have to be addressed by legislation.

Surgical management of patient with FAP Prof. D.N.Samarasekera Professor of Surgery and Head, Department of Surgery, Faculty of Medicine, University of Colombo Familial adenomatous polyposis (FAP) is an autosomal dominant disease caused by germline mutation in the APC gene. Individuals with FAP carry a 100% risk of colorectal carcinoma (CRC) and therefore prophylactic surgery is recommended. Surgery is carried out usually in the late teens or early twenties. Although the main presentation is adenomatous polyps in the colon, FAP is a multisystem disease with exracolonic manifestations such as, intra-abdominal desmoids and polyps involving the stomach, duodenum and the small bowel. Therefore surgical management of FAP is complex and requires expertise and technical skills. In addition to the technical expertise, many other factors such as age at presentation and patient requirements also need to be considered when selecting the surgical procedure. Therefore, the type of surgical procedure needs to be tailored individually considering many factors. The surgical procedures are aimed at cancer prevention or treatment and at the same time maximising the quality of life. The surgical options for colonic polyps include, total procto-colectomy (with restoration of continuity by ileo-anal pouch anastomosis or end colostomy) or colectomy with ileo-rectal anastomosis. Duodenal adenomatosis is associated with a significant risk of duodenal carcinoma. Therefore, sometimes prophylactic duodenectomy is indicated to prevent carcinoma or pancreatico-duodenectomy for established malignancy. Therefore, careful planning and meticulous techniques are the factors that affect successful surgical outcome. Each patient is different and patient factors should be considered when selecting the surgical procedure.

SYMPOSIUM 11 HEALTH IN THE ELDERLY Preventing depression and ageing gracefully Dr Shehan Williams

Senior Lecturer, Department of Psychiatry, Faculty of Medicine, University of Kelaniya Old age is often portrayed as a time of rest, reflection and opportunities to do things that were put off while raising families and pursuing careers. Unfortunately, the aging process is not always so idyllic. Physical and mental limitations curtail the fulfillment that can be achieved in later life. Depressive disorder is the most frequent psychiatric illness of older people (Beekman et al, 1999). It has a negative impact on quality of life and adds significantly to disability from physical disorder (Penninx et al, 2000). It is also an independent predictor of mortality (Cuijpers & Smit, 2002). There are neurobiological links between depression and stroke, Parkinsonâ&#x20AC;&#x2122;s disease and the dementias. There is also a high rate of depressive symptoms in a range of chronic medical disorders, including heart disease (Ariyo et al, 2000) and chronic obstructive pulmonary disease (Yohannes et al, 1998). The prevention of depression is important as depression in not a natural consequence of ageing. By the year 2025, every fifth person in Sri Lanka will be over 60 years ( IPS, 1998).The burden of depression can take monstrous proportions if we do not address this issue adequately as Sri Lanka is ageing.

Prevention of osteoporosis-related fractures Prof. Sarath Lekamwasam Department of Medicine, Faculty of Medicine, Galle Osteoporosis-related fractures have become a major health issue due to the associated mortality, physical dependence and health care cost. Of major osteoporosis-related fracture types, hip fracture is the most sinister fracture which makes nearly half of survivors physically dependent at one year. Although all hip fractures cannot be prevented, considerable proportion of hip fractures can be prevented. According to the available data, nearly 50% of hip fracture patients report a previous fragility fracture. Furthermore, studies have shown that most of these patients do not receive a satisfactory secondary prophylaxis. They have neither undergone a proper assessment nor received a drug with proven anti-fracture efficacy to prevent subsequent fractures. Calcium and vitamin D are the only drugs prescribed to the majority of these patients. All major guidelines on osteoporosis are unanimous that all postmenopausal women and older men presenting with fragility fracture should be treated with a specific osteoporosis drug together with adequate vitamin D (800 IU/day). This should be done irrespective of their age or baseline BMD values. The main objective of such treatment is to prevent subsequent fractures especially at the proximal femur. Treatment of older men and postmenopausal women who have not sustained a fracture needs to be carefully decided. They should be assessed, clinically, to detect the presence or absence of major clinical risk factors such as age, low BMI, parental history of fracture, rheumatoid arthritis, use of systemic glucocorticoids and underlying secondary causes of bone loss. Based on these clinical risk factors, the risk of major osteoporotic fracture and hip fracture can be estimated using the FRAX algorithm. Treatment should be offered only for those with higher fracture probabilities in the next 10 years. Although many drugs are currently available, their fracture efficacy varies. Bisphosphonates are considered the first line therapy due to their ability to prevent hip as well as vertebral fractures in postmenopausal women, older men and in long term glucocorticoid users. Teriparatide and PTH are reserved drugs for selected cases due to their high cost. Raloxifene (a SERM) has no proven benefits in hip fracture prevention and calcitonin, as a treatment for osteoporosis, has been banned in the Europe. Prevention of falls is the other aspect of fracture prevention. Patients should be encouraged to engage in suitable physical activities and their living environment should be safe. Sedatives which can induce falls should not be prescribed to these patients.

SYMPOSIUM 12 MIGRANT HEALTH Migration health in Sri Lanka: Successes and challenges Dr Sharika Peiris Public Health Specialist, National Programme Officer, International Organization for Migration, Sri Lanka Today more people are on the move than in any other time in human history. Health conditions in one country or region assume a greater capacity to influence those in other parts of the world. Indeed, population mobility has peaked in Sri Lanka, where there are three types of migration flows: inbound, internal and out bound. Currently, there are over 1.8 million Sri Lankans employed overseas which constitutes around 16% of the total labour force. It is projected that Sri Lanka will not only increase its labour outflow, but increasingly become a labour receiving country as well. Fuelled by the major development projects throughout the island, there are around 41,000 annual resident visa applicants. The country is also actively promoting tourism and expects 2.5 million arrivals by 2016. Rural - urban population movement internally is also a key feature in the country with around 450,000 migrants with the majority being labour migrant workers in the Export Processing Zones (EPZ).

With the aim of addressing the health impacts and social consequences resulting from such migrant flows, the “Migration Health policy Development Programme in Sri Lanka ” was initiated in 2009 following the World Health Assembly Resolution (WHA) on Health of Migrants. The programme took an evidence based, multistakeholder and comprehensive approach including all three flows of migrants throughout their migration cycle. Sri Lanka now is one of the leading countries in the world advancing the migration health agenda forward. The presentation will underscore the challenges, lessons learnt and the future path of the “National Migration, Health and Development Programme in Sri Lanka ”.

Migration health: the forgotten agenda in our health services Dr Kolitha Wickramage Public Health Specialist, Head - Health Unit, International Organization for Migration, Sri Lanka Sri Lanka’s engine of economic development is driven largely through migration, with remittances from Sri Lanka’s labour migrants being the largest foreign income earner for the country. If one considers the inflow of resident visa holders and other travellers then the important aspects that migration plays to social, economic and cultural development is immense. Despite the increase in such large scale population movements, our health system has been slow to recognize the implication of migration on health and disease. Migration health touches all areas of health care. For instance, on the infectious diseases front, reintroduction of malaria through travellers from endemic areas pose major challenges to vertical control programmes, especially as Sri Lanka enters the elimination phase. On the mental health domain, the psychological impact of protracted ‘cyclical’ migration on migrants and their families is largely unexplored despite nearly 2 in every 3 labour migrants having children under 5 years of age. On the nutritional front, impact of child nutrition and whether there are differences in male vs female headed households remains an untold story. From the forensic medicine perspective, the challenges of determining maid abuse and proper management of dead bodies of Sri Lankan workers remain a challenge. From the health administration side, enforcing a health assessment requirement to screen for diseases such as TB and/or HIV/AIDS for those planning to stay in Sri Lanka for long-periods need to be determined. These are but a few topics in the larger discourse of health issues that emerge at the intersection of migration, health and development in Sri Lanka.

The role of the health professional is then firstly to have enlightenment on the broader social determinants of health for which migration plays a major role. The role of health organizations, health systems, and professional associations in this is regard is also important. For instance, at your institutional setting, what policies do you have for non-citizens to access health services? What are the domestic legal frameworks which govern health access to such individuals? What measures have been taken to ensure that a Sri Lankan rejected on the basis of a diagnosis of TB at a private medical clinic as being ‘unfit’ to travel, be referred for treatment and care. The presentation will aim at addressing some of these questions and propose that health professionals across all specialties in Sri Lanka to have an important role to play in addressing the health of migrants.

SYMPOSIUM 13 SEXUAL AND REPRODUCTIVE HEALTH: BEYOND BASICS Gender Dysphoria, issues from the practice Dr Kapila Ranasinghe Consultant Psychiatrist, National Institute of Mental Health Gender identity dysphoria is a condition in which a male or female feels a strong identification with the opposite sex. This status was earlier identified as gender identity disorder when the evidence for existence of the condition was empirical. However diagnosis of Gender Identity Disorder was a controversial one, not unlike the controversy that arose in the 1970s regarding the DSM's inclusion of homosexuality as a diagnosable mental disorder. The criteria and name of Gender Identity Dysphoria is changing and in the DSM V it is formally recognized as Gender Dysphoria. Formal gender clinics for individuals seeking medical sex reassignment began operating in the 1960s and 1970s, leading to long-term follow-up studies that began appearing in the research literature in the 1980s and 1990s. These studies have examined transsexuals who received clinical approval to undergo reassignment and proceeded to do so.The great majority of patients who met clinics' screening criteria reported being satisfied in the long-term with the results. After these results were available several health clinics in the United States have developed “flexible protocols” for transgender management following a “harm reduction” model which increasing numbers of service providers have adopted. Many experts also suggest a flexible approach based on harm reduction appropriate to the individuals socio cultural back ground. Willingness to provide hormonal therapy and other clinical facilities based on assessment of individual patients needs, history and situation with an overriding goal of achieving the best outcome for patients rather than rigidly adhering to arbitrary rules has been successful. These flexible approaches are applicable to our setting and can implement to the satisfaction of the service users. In our clinic we have registered more than 35 individuals with gender dysphoria and being managed according to the standards of care laid down by the International Gender Dysphoria Association. Once assessment and care planning were done all the patients were managed with an inter-disciplinary approach.

Premature ejaculation and its management Dr Lasantha Malavige

Specialist in Sexual Medicine, Asiri Surgical Hospital Our knowledge on physiology and management of premature ejaculation (PE) has changed drastically over the last two decades. International Society of Sexual Medicine definition of life long PE is characterised by ejaculation which occurs within about one minute of vaginal penetration, and the inability to delay ejaculation, and negative personal consequences. Acquired PE is development of PE after having normal Intra-vaginal Ejaculatory Latency Time (IELT). Two other subtypes of PE include Premature Like Ejaculatory Dysfunction and Natural variable PE. For life long and acquired PE pharmacotherapy is often indicated. Despite the lack of controlled clinical trials a wide range of psychological and behavioural interventions have been developed for the treatment of PE. In addition to increasing IELT psychological therapies help improve the relationship, self confidence and sexual confidence.

The pharmacotherapy can be classified as daily dosing and on demand dosing. The use of SSRI’s have revolutionised the management of PE. There is level 1a evidence to support the efficacy and safety of on-demand dosing of dapoxetine for the treatment of lifelong and acquired PE. Off-label daily dosing of the SSRIs paroxetine, sertraline, citalopram, fluoxetine, and the serotonergic tricyclic, clomipramine has also shown level 1a evidence. There is level 1a evidence for off-label on-demand dosing of clomipramine, paroxetine, and sertraline in the management of PE. The use of topical local anaesthetics such as lidocaine and/or prilocaine as a cream, gel, or spray is well established and is moderately effective in delaying ejaculation (level 1b). PDE5 inhibitors are indicated in the treatment of premature ejaculation only when there is co-existing erectile dysfunction. Two small studies have shown Tramadol to improve IELT significantly; however limited data is available on its safety and efficacy. The combination of psychosexual counselling and behavioural therapy with or without medical management often deliver good outcomes for most patients.

New technologies in contraception Prof. Harshalal R Seneviratne Senior Professor of Obstetrics and Gynaecology and Immediate Past Dean of the Faculty of Medicine, University of Colombo Reproductive health care includes that essential component of family planning services. While family planning encompasses fertility limitation as well as fertility enhancement of individual couples it also has profound implications on national and global socio – cultural – economic interactions. Presently Sri Lanka has reached a high contraceptive prevalence (70% DHSS.SL 2000) leading to a low total fertility rate (TFR 1.91 in 2000 but 2.4 in 2006 – 2007). Access to appropriate contraceptive methods which should be provided on the basis of “informed choice” determines the success of the national family planning programme. What is presented to the public and how it is delivered therefore is of paramount importance. Accepting that the available methods fall short of the ideal the search for more advanced and user friendly methods is an on-going process. The new methods also need to take into account the socio – cultural – religious aspects of the index population which affect their acceptance. The experience gained from the current methods provides the directions for the application of new methods. Contraceptive methods are meant to be safe, cheap and user friendly. Advocacy for family planning over the past decades concentrated on the need to conserve resources by limiting the population load. Non contraceptive medical benefits have been in the background. Advancing the health benefits of contraception is a more realistic strategy which should be adopted by policy makers and family planning service providers.

ABSTRACTS OF PRINCIPAL SYMPOSIA PRINCIPAL SYMPOSIUM 1 HEPATOLOGY Long term management of liver transplant patients Dr Gomathy Narasimhan Consultant, Institute of Liver Disease and Transplantation, Global Hospital and Health City, Chennai, India Liver transplantation is an established treatment option for liver disease for over four decades in the Western world. Over the last decade it has become a well accepted treatment option in our part of the world, in India, Sri Lanka and Pakistan. The expertise among medical professionals in managing patients with liver failure in the pre-operative, intra-operative and post-operative phases have contributed largely to the success of liver transplantation and in building confidence among primary physicians in this modality of treatment. It is now important to focus on the management of the transplant patient after the immediate post-operative period and this involves rehabilitation, orientation and lifestyle modifications to give them a good quality of life and at the same time being able to protect their liver graft. The long term management involves special attention to the effects of immune suppression on the patient and monitoring the recurrence of the original aetiology in some patients. In children, the focus, apart from all of these, is psychosocial support to ensure compliance with medications as they grow into adolescence and adulthood.

Acute liver failure Prof. Mohamed Rela Director, Institute of Liver Disease and Transplantation, Global Hospital and Health City, Chennai, India Acute liver failure (ALF) is a rare but fatal condition, causing rapid deterioration in liver function resulting in hepatic encephalopathy, coagulopathy in someone with no known liver disease. Viral hepatitis and drug induced liver injury (DILI) are the commonest causes of ALF in this part of the world, whereas, Paracetamol overdose is the commonest cause in the West. Paracetamol overdose, viral hepatitis A and ischaemic hepatitis related ALF have better prognosis (60% spontaneous survival). ALF due to DILI carries a poor prognosis (25% spontaneous survival). Sepsis and cerebral oedema are the leading causes of death. Both ammonia and systemic inflammatory response syndrome play a key role in the pathogenesis of intra-cranial hypertension. Excellent intensive care support with a multi-disciplinary team approach is crucial for the management of ALF. Osmotic diuretics (mannitol), hyperventilation, hypertonic saline are used in the management of ICH. N-acetyl cysteine is recommended in all cases of ALF.At least 70% of patients require renal replacement therapy. Liver transplantation is the only cure for majority of patients with ALF. One-year survival following liver transplantation is 70-80%. However, cost and availability of organ are major obstacles in countries like India and Sri Lanka.

PRINCIPAL SYMPOSIUM 2 MATERNAL MORTALITY Postpartum haemorrhage (PPH): Lessons from confidential inquiries Prof. S. Arulkumaran Division of Obstetrics & Gynaecology, St George’s Hospital Medical School, Cranmer Terrace, London The vast majority (>90%) of massive PPH are due to uterine atony. New knowledge and advances in technology/techniques has reduced morbidity and mortality. Prostaglandins (IM/IV/ Rectal) potentiate the action of oxytocin and should be immediately used when there is no response to ergometrine and oxytocin infusions. During PPH, vast amount of clotting factors are utilized and lost with the bleeding (‘wash out phenomenon’). The lack of clotting factors, activation of fibrinolysis, large infusion of fluids, metabolic acidosis and hypothermia lead to coagulopathy and should be controlled with tranexamic acid, fibrinogen concentrate and other clotting factors or 1:1 RBC/PC to Plasma transfusion. Adequate blood and fluids need to be transfused to maintain the circulation and to prevent shock. Shock is proportionate to blood loss - mild 15%, moderate 30%, and severe 45%. This needs to be calculated based on the woman’s blood volume that depends on her weight (approx Blood volume in Litres = 70 X wt in Kg). Failure to arrest haemorrhage by medical therapy should be followed by aortic compression, antishock garment and ‘Tamponade Test’, once trauma and retained tissue are excluded. The Tamponade is by filling a balloon of a Sengstaken, Rusche or Cooke’s catheter with warm saline till the balloon is just visible at the cervical canal. If bleeding stops the balloon can be taken out the next day. Patient should have broad spectrum antibiotics and oxytocin infusion. Vital parameters, fundal height and bleeding per vagina should be monitored. Effectiveness of the test will be known within 5 minutes. If the tamponade fails to stop the bleeding, laparotomy and compression sutures (B- lynch or 2 to 5 vertical) should be employed. Failure of this should lead to systematic devascularisation by tying the infundibulopelvic and uterine vessels and/or anterior branch of the internal iliacs. Arterial embolisation using radiological guidance can be tried where facilities exist. Failure to arrest haemorrhage or deterioration of general condition at any time should prompt sub-total or total hysterectomy. Monitoring during haemorrhage and post immediate management is simplified using the Shock Index (pulse /systolic BP – normal is 0.5 to 0.7 – and > 0.9 indicates onset of shock and further increase indicates increasing shock) or Rule of 30 (rise in pulse >30/min, drop in systolic BP >30 mm Hg, reduced urinary output <30 ml/min, absolute respiratory rate >30/min, drop in haematocrit >30). Confidential inquiries into maternal deaths suggest PPH is best managed by stepwise progression using an algorithm of ‘HAEMOSTASIS’; H - Ask for Help A- Assess (vital parameters, blood loss) and Resuscitate E- Establish etiology. Ensure availability of blood. Ecbolics (Oxytocics) M- Massage Uterus O - Oxytocin infusion / prostaglandins - IV / IM/ per rectal / intra-myometrial S- Shift to theatre/ anti shock garment – Bimanual compression T- Tears/ Tissue exclude Tamponade – Balloon / uterine packing A - Apply compression sutures – B- Lynch or modified S- Systematic pelvic devascularisation – Uterine / Ovarian / Quadruple / internal iliac I - Interventional Radiologist – If appropriate, Uterine artery embolisation S - Subtotal / Total abdominal hysterectomy.

Lessons leant from the Sri Lanka Maternal Mortality Review Prof. Hemantha Senanayake Professor in Obstetrics & Gynaecology, Department of Obstetrics & Gynaecology Sri Lanka has near-complete Maternal Mortality Review coordinated by the Family Health Bureau of the Ministry of Health, with technical inputs mainly from the Sri Lanka College of Obstetricians & Gynaecologists (SLCOG). It takes a well defined course, with an initial investigation in the institution with inputs from the field staff. The data represents 60 deaths that occurred in the years 2011/12 in relation to pregnancy, in which the SLCOG was involved in developing case scenarios and in the district reviews. There were six cases of postpartum hemorrhage (PPH). However, in two of these the bleeding may have been secondary to amniotic fluid embolism as suggested by the clinical picture. Additionally, two women died of complications of histologically proven amniotic fluid embolism. Two women who died due to PPH had it precipitated by acute inversion of the uterus. None of the other women who died had a balloon tamponade to arrest bleeding. There were nine cases of death due to septic abortion, which has consistently featured within the top three causes of maternal deaths in Sri Lanka. This indicates the need to reexamine the unmet need for contraception. Four of the deaths were in married women. The other five included women who were not strictly covered by the 'eligible couples register'. Some deaths attributable to unplanned pregnancy will not enter the maternal mortality statistics - three women carrying 'socially stigmatized' pregnancies committed suicide. Nine died of heart disease complicating pregnancy. Contrary to the expected, only two were due to valvular disease. Both had associated pulmonary hypertension. Of the remaining seven, six died of peripartum cardiomyopathy, which went undetected until the condition became critical. Three women met with violent deaths, where the suspected perpetrator was the husband. I wish to acknowledge the Director, Family Health Bureau for kindly granting permission to use data from the Maternal Mortality Review.

The role of gender based violence in maternal deaths in Sri Lanka Dr Sardha Hemapriya Consultant Obstetrician and Gynaecologist at Teaching Hospital Kandy Gender-based violence has gained prominence around the world as a grave violation of human and legal rights. But it is equally important that it be recognized, and addressed, as a prime barrier to reproductive healthâ&#x20AC;&#x201D;a barrier that prevents women, families, and countries from achieving their full potential. Pregnant women have been found to be at high risk of physical abuse. Earlier studies estimated that 4 to 15 percent of pregnant women have experienced violence, and the 2005 WHO multi-country study found that an astonishing one out of every four women in developing countries have experienced GBV while pregnant. In Sri Lanka 25% maternal deaths due to direct impact of GBV (Homicides and Suicides) Deaths due to violence in general or due to violent mechanisms are more properly referred to as deaths due to external causes of injury. Death due to violence can be accidental or intentional. Intentional death includes selfinfliction (suicide) or infliction by someone else (homicide). Femicide is a term frequently used to designate the murder of a woman by her intimate partner. The monitoring of maternal deaths due to domestic violence should be done through epidemiological surveillance systems. However, expanding and improving the systems so as to generate maternal mortality

estimates that are accurate and that include deaths due specifically to domestic violence will require sustained political will, resources, and commitment to action.

ABSTRACTS OF LUNCHEON EVENTS

LUNCHEON EVENT – SYMPOSIUM ON HERBAL MEDICINE Clinical research with traditional herbal medicines Vidyajyothi Dr R. O. B. Wijesekera, Consultant, Link Natural Products Prof. Colvin Goonaratna, Registrar, Ceylon Medical College Council The consumption of herbal medicines and other herbal products (such as teas, health foods, nutraceuticals, and cosmetics) is expanding exponentially globally. This has major implications for public health policy, clinical care of people’s life and health, health politics and macroeconomics, and the roles of regulatory bodies such as review committees for research ethics, medical councils, and medical science journals. It would be appropriate here to recall that a large number of effective modern allopathic medicinal drugs (eg. aspirin, digoxin, atropine, quinine, artesunate, artemether/lumefantrene, vincristine, vinblastine, and penicillin) have come from plant or fungal sources. Traditional medicines have been described “as a rich source of potentially attractive therapies”, that are likely to have a “favourable risk-benefit ratio”. Hence clinical research with traditional medicines, unrestricted by inflexible hierarchical distinctions, affords vast opportunities. Medical journals and researchers looking for research material ought to welcome it.

LUNCHEON EVENT – ONCOLOGY Recent advances in the management of breast cancer Dr Jayanthi Thumsi Senior Consultant Breast Oncologist, BGS Global Hospital, Bangalore Cancer of the breast is on the rise in Asian countries. The disease in Asian countries is more aggressive and is seen in younger patients, when compared to Western countries. Many advances have taken place in every aspect of management of carcinoma of the breast .There is better understanding of biology now, which has helped in planning treatment in ways that has led to increased survival rates for patients in any stage of the disease. Genetic studies like BRCA-1 & BRCA-2 help us in determining women at an increased risk of developing carcinoma of the breast. Mammogram has revolutionized the treatment of carcinoma of the breast.Mortality rate has decreased by more than 44% because of Mammograms. Early detection and planning of the treatment is possible using Mammograms. Surgical treatment has evolved over the past 35 years. Radical surgical procedures have been replaced by more and more conservative ones. This has led not only to better oncological outcomes but also satisfactory cosmetic outcomes as well. Breast conservation surgery is the most common procedure done now and indication for Breast Conservation Surgery is only expanding with better chemotherapeutic drugs. Even after mastectomy many options are available now with opportunities for breast reconstruction. Breast reconstruction could be either implant based or antilogous. Better Chemotherapeutic drugs, better radiation technology and better understanding of hormone therapy have offered wonderful outcome to the patients with carcinoma of the breast. But as clinicians it is our prime responsibility to bring about awareness in women and emphasize and educate them about the need and advantages of early detection of breast carcinoma.

Women and cervical cancer Dr S Nirmala Senior Consultant & HOD Radiation Oncology, BGS Global Hospital, Bangalore, India Cancer is one of the frequently talked about and most feared diseases that falls under the genre of lifestyle diseases that have evolved, rather rapidly, in the past two decades. Though science has made rapid strides to evolve many preventive and curative strategies to fight cancer, it has not been able to break the fear and confusion that surrounds a person when diagnosed with the disease. One of the recent concerns plaguing the field of cancer study or Oncology is the increasing number of women who are being diagnosed with cancer. Cervical cancer is the 5th common cancer in women worldwide. One-third of the global cervical cancer burden is endured in India, Bangladesh, Nepal and Sri Lanka. Cervical cancer is the second commonest cancer among Sri Lankan women and the commonest cancer in India. This disease affects women in their most productive years. Hesitancy and negligence makes the women approach the doctor at a later stage. All stages put together the 5 yr survival has not crossed 40%. This is one cancer where cause is known. Human papilloma virus(HPV) is the cause of the disease which is sexually transmitted. Effective screening methods like PAP smear can reduce the burden of the disease. HPV vaccine, if administered at the right age and right time, can prevent most of the cervical cancer. Cervical cancer treatment modalities have evolved during the past decade. If detected and presented to the doctor early, Radical trachealectomy done for early cervical cancer, preserving uterus (Fertility Sparing) is an option so that the lady can getpregnant after treatment. Radiotherapy which consists of teletherapy and brachytherapy and chemotherapy can cure the disease. Advances in radiation technologies have decreased the side effects of treatment

ABSTRACTS OF GUEST LECTURES

GUEST LECTURE 1 ERGONOMICS APPLICATIONS IN HEALTHCARE SETTINGS AND FOR HEALTHCARE PROFESSIONALS Prof. David C Caple Director, David Caple & Associates Pty Ltd, Australia The science of ergonomics focuses on the optimisation of human wellbeing and systems performance with a particular focus on the physical, cognitive, and work organisation demands on people in the workplace. Within the healthcare sector, the primary focus of the physical demands relate to the prevention of musculoskeletal disorders for healthcare professionals. This involves considering the design of the healthcare environment to reduce manual handling risks, as well as cumulative disorders arising from prolonged, awkward and static postures. It also relates to the design of medical equipment and tools to suit the anthropometric and biomechanical capabilities of the Sri Lankan workforce. In relation to the cognitive demands of healthcare professionals, there is a growing focus on patient centred care which is dependent on good sources of simply presented accurate information to aid good decision making and consequently, good clinical outcomes. Work organisational arrangements within the healthcare environment requires an understanding of effective communication and team work arrangements to ensure that healthcare professionals are working together in a collaborative way to ensure good clinical outcomes. Ergonomics also considers the cumulative impact of fatigue and excessive workload to minimise the potential for cognitive errors in decision making. It also requires clear feedback loops for event detection, reporting and analysis where systems redesign is required. The essence of the healthcare industry is the focus on the needs of people. This includes the healthcare professionals and workers together with the patients, their families, and friends. Ergonomics provides a systematic approach to understanding the complexities of these interactions and the capacities and needs of the participants to ensure their wellbeing without compromising the integrity of the system performance.

GUEST LECTURE 2 UTILISING THE WINDOW PERIODS IN CARE FOR CHILDHOOD DISABILITIES: THE IMPACT Dr Eeva-Liisa Langille Consultant Paediatrician and Head of Paediatric Department in Burjeel Hospital, Abu Dhabi A disability may be generally defined as a condition which may restrict a person's mental, sensory or mobility functions to undertake or perform a task in the same way as a person who does not have a disability. To overcome the effect of disability we need to look at what can be done with the disability. Primitive reflexes are seen to be the cause children with disabilities cannot learn to progress with their motor development, as the persistence of these primitive reflexes is seen to cause inability to progress into the next level. As much as the persistence of these reflex motor activities prevents children from 'moving on' they can be used in therapies to determine the underlying cause and also the possible remedies not only to follow the normal pattern of development, but in cases like autism to find a pathway by using these developmental windows to break into the mystery of perception and find communication, motor activities that can be used to enhance motor development as well as social and psychological interactions. Primary motor reflexes play an important subordinate role of more complex motor reflex schemes. If the integration of these primary reflex patterns does not mature, or if the primary pattern resurfaces in the later

development it actually can help identify where the neuro-sensori-motor dysfunction is and can be used in therapy to restore or aid into the normal development. The wide windows of developmental steps can be used to find the basis where and how this progress has stepped aside the normal course and plan for therapies that sometimes by using the reflex itself can lock the development into a more normal path again.

GUEST LECTURE 3 BONE MARROW TRANSPLANTATION Dr A K Dhar Director Medical Oncology, Fortis Memorial Research Institute, Gurgaon, India Bone Marrow Transplant (BMT) has been recognised as a standard of care for a number of benign and malignant conditions. The stem cells as a source of graft are usually derived from bone marrow or peripheral blood from the patient, HLA identical sibling or HLA matched unrelated donor. It has got good results in benign conditions like severe aplastic anaemia, thalassaemia major and certain genetic metabolic disorders. The important malignant conditions which can be treated successfully by BMT are acute and chronic leukaemias, multiple myeloma, lymphomas and high risk neuroblastoma. BMT is associated with immediate and late complications. The major immediate complications are regimenrelated toxicities, life threatening infections, acute graft-versus-host disease (GVHD) and failure of engraftment of the bone marrow. The late complications are related to the immunodeficiency that occurs in the posttransplant period. There have been major technological advances which have taken place in the last five decades. The most important of them has been the use of peripheral blood stem cells as a source of graft instead of bone marrow stem cells for both allogeneic and autologous BMT. Newer and gentler conditioning methods (reduced intensity conditioning) for allogeneic BMT has resulted in lower frequency and severity of GVHD and risk of infections. These improvements have extended the age range for treatment of patients to those as old as 75 years and patients with lymphomas, chronic lymphocytic leukaemia and multiple myeloma appear to benefit more with this approach. Availability of donors for allogeneic transplantation is a major area of concern. Unrelated matched donor and haplo-identical transplant is the future of allogeneic BMT. The other areas of research which need attention is reducing the incidence of acute GVHD while maintaining the desired graft-versus-tumour effect and identification of patients who are at increased risk of relapse after autologous transplantation which can be avoided by augmenting graft versus tumour effect by means of biotherapy (interferon and interleukin 2).

GUEST LECTURE 4 HOW TO MANAGE A PATIENT WITH A FMILY HISTORY OF COLORECTAL CANCER Dr Andrew Latchford

Consultant Gastroenterologist and Assistant Director Polyposis Registry, St Markâ&#x20AC;&#x2122;s Hospital, London Individuals develop colorectal cancer as a result of interaction between genotype and the environment to which they are exposed. Colorectal cancer is common so many people by chance alone have at least one affected relative; as the number of affected relatives increases, so does the risk of developing the disease. As far as genetic factors are concerned, there is a spectrum of risk: at one end are those with no particular genetic predisposition and at the other those who will inevitably develop bowel cancer. Between the extremes lie those whose genetic constitution plays some role. While open to error, it is possible to divide the population into three broad categories of risk for colorectal cancer: low, moderate and high risk. In this talk I will describe how to assess and manage an individual with a family history of cancer. I will cover how to categorize an individual to a risk group and how best to screen and manage these patients to help prevent cancer development, with particular emphasis on those I the high risk groups.

GUEST LECTURE 5 SURGICAL OPTIONS IN END STAGE HEART FAILURE: ROLE OF CARDIAC TRANSPLANTATION AND MECHANICAL CIRCULATORY ASSISTANCE Dr K R Balakrishnan Director, Cardiac Sciences, Fortis Malar Hosptal, Adyar, Chennai, India The prognosis for patients with advanced end stage heart failure used to be gloomy with a high probability of death. With recent advances in therapy however, this is changing. The term “end stage” encompasses patients with ischemic and dilated cardiomyopathy, viral myocarditis, post cardiac surgical ventricular dysfunction and cardiogenic shock due to massive heart attacks. If inotropic support and intra aortic balloon pump are not effective,more aggressive management is indicated. In acutely sick patients with cardiogenic shock, mechanical circulatory assistance in the form of extra corporeal membrane oxygenation (ECMO) can be quite effective in tiding over the crisis and give time for decision making, the so called “ bridge to decision “. This can be instituted in the bedside or in a peripheral hospital and can provide support to the circulation and to gas exchange for periods of up to 3 to 4 weeks, using percutaneous “peripheral cannulation“ techniques and the patients can be transported to tertiary care centers even in an air ambulance.If after appropriate procedures like angioplasty, the cardiac function does not recover, long term left ventricular assist devices are available, the most well known being “Heart mate II or Heartwire” pumps which are continuous flow axial blood pumps, implanted completely inside the body and capable of providing upto 8 litres of blood flow per minute. Only a thin cable for attachment to the power source exits the body. These patients now have an expected longevity approaching 10 years with excellent quality of life. Patients with dilated and ischaemic cardiomyopathy unresponsive to other modalities of therapy including resynchronisation therapy can be considered for cardiac transplantation, especially if their peak oxygen consumption on exercise is less than 12 ml/kg/mt. The other requirement is a calculated pulmonary vascular resistance less than 3-4 wood units. The current results with transplantation are excellent with one year survival in excess of 95 % and 10 year survival in excess of 80 %,essentially due to better understanding of immunosuppression protocols. The functional results are excellent and forms the “gold standard” with normal exercise capacity and no restrictions on physical activity.

GUEST LECTURE 6 ONE SIZE DOES NOT FIT ALL: TIME TO TURN TO PERSONALISED GENOMIC MEDICINE? Prof. Vajira H.W. Dissanayake Professor and Medical Geneticist, Human Genetics Unit, Faculty of Medicine, University of Colombo The reported titled “To Err is Human” published by the Institute of Medicine (IOM) of the United States in 1999 has been widely hailed as a landmark in the efforts to make health care safer. Around the same time, in 1998, another landmark paper from the Food and Drug Administration (FDA) of the USA highlighted that annually 100,000 people die of adverse responses to medications, 2.2 Million people experience serious reactions to medications, and many more fail to respond to medications in the USA. One of the main contributory factors to this was the differences in the genetic make-up of people which made them either respond to treatment without adverse events, respond to treatment with adverse events, neither respond to treatment nor have adverse events, or not respond to treatment but have adverse events. Today the FDA mandates pharmacogenomic biomarker labeling in over 100 drugs to detect indications, dosing, drug interactions, etc. A decade after the IOM report, the era of personalised drug treatment based on the genetic profile of individuals has arrived. In this talk I would illustrate how treatment can be personalized based on ones genetic makeup and then move over to research conducted in Sri Lanka which shows that genetic makeup of the population can inform and the policy on drug that should be available in a country.

ABSTRACTS OF ORAL AND POSTER PRESENTATIONS

The reviewing, selection and arranging of the Abstracts of Oral and Poster presentations were undertaken by the Joint Editors and the Editorial Board of the Ceylon Medical Journal

Guest Editor for the publication of abstracts Dr. Varuni De Silva

LIST OF ORAL PRESENTATIONS

LIST OF ORAL PRESENTATIONS Free Paper Session 1: Infectious Diseases and Genetics OP 1: Genetic polymorphism among rifampicin resistant Mycobacterium tuberculosis CP Adikaram, SMP Senavirathne, WSS Wijesundere, Jennifer Perera Faculty of Medicine, University of Colombo OP 2: Mycobacteria growth indicator tubes (MGIT) for isolation of Mycobacterium species from bone marrow CP Adikaram, HR Jayalatharachchi, Jennifer Perera Faculty of Medicine, University of Colombo OP 3: Effectiveness of single dose intravenous methyl prednisolone in reversing ongoing vascular leakage in dengue R Premaratna, C Abeyrathna, K de Alwis, HA de Silva, HJ de Silva Faculty of Medicine, Ragama OP 4: Natural fluid requirement in dengue haemorrhagic fever and dengue fever SAM Kularatne, KGAD Weerakoon, KR Munasinghe, Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura OP 5: Blood pressure drop in dengue without fluid leakage JKND Miththinda, R Premaratna, R Ragupathy, HJ de Silva Colombo North Teaching Hospital OP 6: Seroprevalance and serotype specific T cell responses in dengue viral infections in healthy individuals in Colombo KC Jeewandara1, GN Malavige1, TN Adikari1, RH Fernando1, BSM Fernando1, D Ariyaratne1, M Salimi2, M Peellawate1, V Jayasuriya1, GS Ogg2 Center for Dengue Research, Faculty of Medical Sciences, University of Sri Jayawardanapura 2 MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford

Free Paper Session 2: Occupational Medicine and Environmental Medicine OP 7: Silicosis among employees of a silica crushing site AD Siribaddana, K Wickramasekara, RD Wijetunga, A Upul Teaching Hospital, Kandy OP 8: Noise levels of vehicles in the city of Colombo NS Nagodawithana1, A Pathmeswaran2, AS Pannila2, RD Gurusinghe2, C Kalansuriya2, N Sathiakumar3, AR Wickramasinghe4 1 Ministry of Health, Sri Lanka 2 Industrial Technology Institute, Colombo, Sri Lanka. 3 Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, USA 4 Department of Public Health, Faculty of Medicine, University of Kelaniya OP 9: Occupational health services provided to Export Processing Zone workers SM Arnold, SJ Senanayake, NC Pallewatta Ministry of Health OP 10: Environmental noise levels in the city of Colombo, Sri Lanka NS Nagodawithana1, A Pathmeswaran2, AS Pannila2, RD Gurusinghe2, C Kalansuriya2, N Sathiyakumar3, AR Wickramasinghe4

Page 76 of 142

LIST OF ORAL PRESENTATIONS

Ministry of Health Industrial Technology Institute, Colombo 3 Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, USA 4 Department of Public Health, Faculty of Medicine, University of Kelaniya 2

OP 11: Prevalence of occupation related musculoskeletal pain among tea pluckers in a selected tea estate in Ratnapura district IA Wanniarachchi, A de Abrew Allied Health Sciences Unit, Faculty of Medicine, University of Colombo. OP 12: The effects of the angle between the sole and the heel of heeled footwear on single and double support time, stride duration and toe off plantar flexion of females SAR Darshika, TDMSB Dassanayake Allied Health Sciences Unit, Faculty of Medicine, University of Colombo

Free Paper Session 4: Miscellaneous OP 19: Review of ancestry of the major ethnic group in Sri Lanka through Craniometric data: a preliminary study UCP Perera, S Cordner, C Briggs, R Wright Department of Forensic Medicine, Faculty of Medicine, University of Ruhuna OP 20: Security, privacy and confidentiality of patient information in Electronic Health Information Systems: a systematic review DBAS Jayawardena Page 77 of 142

LIST OF ORAL PRESENTATIONS

Regional Director of Health Services, Kalutara OP 21: Prevalence of malnutrition and its impact on outcome in patients with cardiac disease NC Lokunarangoda1,2, AK Pathirana1, R Jayawardena1, I Ranathunga1, MMSP Premaratne1, WS Santharaj1 1 Institute of Cardiology, National Hospital of Sri Lanka, Colombo and 2Department of Medicine, Faculty of Medicine and Allied Sciences, University of Rajarata, Mihintale OP 22: Geographical Information Systems (GIS) for monitoring of Millennium Development Goal 5 (MDG): a Study from Badulla district PVDS Dharmagunawardene, HMJR Herath, NSR Hewageegana Post Graduate Institute of Medicine OP 23: Patientsâ&#x20AC;&#x2122; views on health system responsiveness at primary care level NDW Widanapathirana, T Ranasinghe, HSR Perera, R Jayasuriya Office of the Medical Officer of Health, Maharagama OP24: Organizational culture of a hospital and its association with patient safety management system SR Kumar1, S Sridharan2 1 Ministry of Health 2 Quality Secretariat

Free Paper Session 5: Non Communicable Diseases OP 25: National survey on tobacco use among school teachers in Sri Lanka IK Liyanage, AP De Silva, STGR De Silva, JMWJ Bandara National Intensive Care Surveillance, Ministry of Health OP 26: Lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital TM Wijesuriya1, MM Weerasekera1, J Kottahachchi1, SSN Fernando1, U Bulugahapitiya1, MSS Dissanayake1, S Prathapan1, KNP Ranasighe3, TDCP Gunasekera1, A Nagahawatte4, LD Guruge1 1 Faculty of Medical Sciences, University of Sri Jayewardenepura 2 Colombo South Teaching Hospital 3 Base Hospital, Tangalle 4 Faculty of Medicine, University of Ruhuna OP 27: Evaluation of the accuracy of glucometers currently used in Sri Lanka JH Liyanage1, P Katulanda1,HA Dissanayake1, KKK Gamage1, GSP Keerthisena1, PN Weeratunga1, WA Wijesundara1, WMUA Wijetunga1, S Subasinghe1, TAD Tillakaratne1, G Katulanda2 1 Diabetic Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo 2 Colombo North Teaching Hospital OP 28: Influence of age on body mass index (BMI) and body fat percentage of Sri Lankan adults DC Ranasinghe1, P Gamage1, P Katulanda1, N Andraweera1, S Thilakarathne1, ACR Ranasinghe2 1 Diabetes Research Unit, Faculty of Medicine, University of Colombo 2 SCBU, Base hospital Wathupitiwala OP 29: Serum Cystatin C as a marker in the assessment of renal function in diabetic nephropathy in type 2 diabetics in Sri Lanka: a preliminary study NN Wijayatunga1, PPR Perera1, K Wanigasuriya2, H Peiris1 1 Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayawardenepura 2 Department of Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura OP 30: Comparison of system delays during and after working hours affecting primary percutaneous coronary interventions at the National Hospital of Sri Lanka NC Lokunarangoda, AK Pathirana, WS Sanatharaj, KKAO Walawwatta, SP Premaratne, KGV Saranga,KKS Chinthanie Institute of Cardiology, National Hospital of Sri Lanka, Colombo Page 78 of 142

LIST OF ORAL PRESENTATIONS

Free Paper Session 6: Toxicology and Elderly Medicine OP 31: Discovery of a deadly scorpion (Hottentotta tumulus) in the Jaffna peninsula and its clinical importance NP Dinamithra, S Sivansuthan, KB Ranawana, SAM Kularathne, KGAD Weerakoon Faculty of Medicine, University of Rajarata OP 32: Prevalence and factors associated with cataract among the elderly in Mahara Divisional Secretariat Division AAN Nishad1, MS Amaratunga2, J de Silva2, KTAA Kasturiratne2, AR Wickramasinghe2, J Mallawarachchi3 1 Post Graduate Institute of Medicine, University of Colombo. 2 Faculty of Medicine, University of Kelaniya. 3 Wijaya Kumaratunga Hospital, Seeduwa OP 33: Upper urinary tract urothelial carcinoma, 15-year experience and survival data RMPS Ratnayake, SAS Goonewardana National Hospital Sri Lanka, Colombo OP 34: Some characteristics related to falls among the elderly in the district of Colombo AD Ranaweera, P Fonseka, AP Arachchi, SH Siribaddana Ministry of Health OP 35: Community incidence of snakebite in the Anuradhapura district A Kasturiratne1, NK Gunawardena1, BA Wijayawickrama1, SF Jayamanne1, A Pathmeswaran1, G Isbister2, A Dawson2, HJ de Silva1 1 Faculty of Medicine, University of Kelaniya 2 South Asian Clinical Toxicology Research Collaboration OP 36: Improvement of perceived quality of life with a reinforcement programme on lifestyle modification in patients with knee joint osteoarthritis LPK Senaratne, TSP Samaranayake, LS Wijayaratne Post Graduate Institute of Medicine

Free Paper Symposium 7: Psychiatry and Parasitology OP 37: A new people-friendly epidemiological approach to confirm the elimination of lymphatic filariasis in Sri Lanka TC Yahathugoda1, MVWeerasooriya1, F Nagaoka1, H Takagi1, E Kimura1, WA Samarawickrema2, M Itoh1 1 Department of Infection and Immunology, Aichi Medical University School of Medicine, Aichi, Japan 2 Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna OP 38: Rickettsial infections in acute coronary syndromes P Ranjan, KCD Mettananda, DST Danansuriya, NKBKRGW Bandara, HJ de Silva Department of Medicine, Faculty of Medicine, University of Kelaniya OP 39: Intramuscular haloperidol vs. olanzapine for rapid tranquillization: a double blind randomised controlled trial WMH Wijesundara1, R Hanwella2, J Mendis3, VA de Silva2 1 National Hospital of Sri Lanka, Colombo 2 Department of Psychological Medicine, Faculty of Medicine, University of Colombo 3 National Institute of Mental Health, Angoda

Page 79 of 142

LIST OF ORAL PRESENTATIONS

OP 40: Meeting challenges of microscopic diagnosis in malaria surveillance under field conditions in Sri Lanka SD Fernando1, RL Ihalamulla2, J Tillekeratne2, R Wickremasinghe3, P Wijeyaratne2, NL de Silva4, R Premarathna5 1 Department of Parasitology, Faculty of Medicine, University of Colombo 2 Health Associates (PVT) Limited, (TEDHA), Colombo 3 Department of Parasitology, Faculty of Medicine, University of Sri Jayawardenepura 4 Faculty of Medicine Colombo 5 Anti Malaria Campaign, Colombo OP 41: Prolonged internal displacement and common mental disorders in Sri Lanka: the COMRAID study C Siriwardhana1, A Adikari1, S Siribaddana1, A Sumathipala1 1 Institute of Psychiatry, King's College London OP 42: Prevalence of psychological morbidity in an urban population: Is it related to modifiable physical risk factors? SS Williams, MJ Pinidiyapathirage, LT Wijeratne, A Kasturiratne, MUPK Peris, HSA Williams, AR Wickremasinghe Faculty of Medicine, University of Kelaniya

Free Paper Symposium 8: Gastroenterology and Haematology OP 43: Association of genetic variants with non-alcoholic fatty liver disease in an urban Sri Lankan community MA Niriella1, A Kasturiratne1, F Takeuchi1, K Akiyama2, AS Dassanayake1, AP De Silva1, AR Wickremasinghe1, N Kato2, HJ De Silva1 1 Faculty of Medicine, University of Kelaniya, Ragama 2 Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan OP 44: Characterisation of beta globin mutations in Sri Lankan patients with betathalassaemia intermedia P Anuja1, S Perera2, DPSI Silva2, M Hapugoda2, MN Wickramarathne2, I Wijesirwardhena2, DG Efremove3, CA Fisher4, DJ Weatherall4, AP Premawardhena1 1 University of Kelaniya 2 University of Sri Jayawardhenapura 3 Inetrnational Centre for Genetic Engineering, Italy 4 University of Oxford OP 45: Hepatocellular carcinoma in Sri Lanka: Where do we stand? RC Siriwardana1, CAHL Liyanage1, DSP Jayatunge1, A Dassanayaka2,MG Gunetileke1, MA Niriella3, C Sirigampola4,A Upasena4,,HJ de Silva3 Departments of 1Surgery, 2Pharmacology and 3Medicine, Faculty of Medicine, University of Kelaniya 4 North Colombo Teaching Hospital OP 46: Role of red cell distribution width in screening for Hb E trait in population screening for haemoglobin disorders AAN Nishad1&2, IS de Silva2, HL Perera2, A Pathmeswaran2, AP Premawardhena2 1 Post Graduate Institute of Medicine, University of Colombo. 2 Faculty of Medicine,University of Kelaniya. OP 47: The clinical profile of adult Sri Lankans with microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital OP 48: Demographic and clinical profile of adult Sri Lankans with hepatocellular carcinoma admitted to medical units of a tertiary referral center IGI Dissanayake, RL Satarasinghe, NS Jayasinghe, PJ Rathnayake, R Wijesinghe Page 80 of 142

LIST OF ORAL PRESENTATIONS

Sri Jayewardenepura General Hospital

Page 81 of 142

ABSTRACTS OF ORAL PRESENTATIONS

ABSTRACTS OF ORAL PRESENTATIONS Free Paper Session 1: Infectious Diseases and Genetics OP 1: Genetic polymorphism among rifampicin resistant Mycobacterium tuberculosis CP Adikaram, SMP Senavirathne, WSS Wijesundere, Jennifer Perera Faculty of Medicine, University of Colombo Introduction and Objectives: The awareness of genotypes, genetic diversity and transmission patterns identified by molecular epidemiological studies is essential in control of multi drug resistant tuberculosis (MDR-TB). In the present study, genetic diversity and the transmission pattern of rifampicin resistant M. tuberculosis strains were evaluated in the Western Province by IS6110 insertion element fingerprinting using restriction fragment length polymorphisms (RFLP). Methods: Genomic DNA extracted from rifampicin resistant (n=31) and susceptible (n=46) M. tuberculosis strains were digested with PvuII restriction enzyme, electrophoresed and subjected to Southern transfer. The blots were hybridised with IS6110 probe and visualized using a chemiluminescence detection kit. A dendrogram was constructed using PHYLIP (version 3.69). Results: The number of copies of IS6110 per isolate varied from 1 to 14, with sizes ranging from 665bp to 10180bp. All isolates had at least one copy of the IS6110 and majority of the isolates (20.8%) had 11 copies. The dendrogram revealed a total of 68 distinct isolates among 77 M. tuberculosis isolates indicating high genetic polymorphism. The 68 distinct isolates grouped into 9 clusters. All clusters contained both rifampicin resistant and susceptible strains. The bootstrap values confirmed the absence of genetically identical or closest relatedness between any susceptible and resistant isolates. Conclusion: High genetic variation and absence of closest relatedness among rifampicin resistant and susceptible strains indicate that rifampicin resistance occurs due to the acquisition of drug resistant strains (primary drug resistance). Further, number of copies of IS6110 confirmed that most strains belong to the Beijinfamily. OP 2: Mycobacteria growth indicator tubes (MGIT) for isolation of Mycobacterium species from bone marrow CP Adikaram, HR Jayalatharachchi, Jennifer Perera Faculty of Medicine, University of Colombo Introduction and Objectives: The smear negativity rate for acid fast bacilli (AFB) is high in extra pulmonary cases due to low sensitivity of microscopy. The aim of the study was to investigate the usefulness of MGIT for isolation of Mycobacterium from bone marrow specimens. MGIT is a broth based medium which produces positive growth more rapidly (14 days) when compared to solid media (4-6 weeks). Literature discourages the use of MGIT for bone marrow samples. Methods: One hundred and fifty four bone marrow samples received at the Department of Microbiology, Faculty of Medicine, Colombo were used for the study. The growth of Mycobacterium species in MGIT were evaluated against Lowenstein Jensen (LJ) medium. Media were inoculated with decontaminated bone marrow samples and a small portion of the sample was used for the direct smear microscopy. The growth was observed daily and weekly respectively for MGIT and L-J. The presence of growth of Mycobacterium in MGIT and L-J were confirmed by microscopic observation of AFB. Results: Direct smear microcopy was positive for AFB in one specimen (0.64%). The culture positivity rate of bone marrow from suspected patients was 3.2%. When compared to L-J, the sensitivity and specificity of MGIT was 100% and 98% respectively. There was excellent agreement between L-J and MGIT for detection of Mycobacterium species from bone marrow. Conclusions: MGIT is a useful alternative to L-J for the isolation of the Mycobacterium species from bone marrow samples.

Page 82 of 142

ABSTRACTS OF ORAL PRESENTATIONS

OP 3: Effectiveness of single dose intravenous methyl prednisolone in reversing on going vascular leakage in dengue R Premaratna, C Abeyrathna, K de Alwis, HA de Silva, HJ de Silva Faculty of Medicine, Ragama Introduction and Objectives: Non-resolution of vascular leakage within 48 hours in dengue shock syndrome (DSS) can result in complications in the recovery phase due to fluid overload. It can also result in death in 0.5-5%. No medication is known to reverse the ongoing vascular leakage. Methods: Single dose intravenous methyl prednisolone (SDIVMP) was administered to 11 consecutive PCR confirmed adult patients who had ongoing high fever on the 5th day of illness and evidence of plasma leakage; significant rise in Hb, PCV, AST levels and confirmation of fluid leakage by ultrasonography. Informed written consent was obtained from all patients prior to administering SDIVMP. Results: 7/11 were males. Mean age was 24 years (SD 8). At the time of administering SDIVMP; median rise of Hb 9% (5-12), PCV 12%(10-19), absolute rise of AST from 56 iu/L(24-68) to 678iu/L (320-1034) and drop in platelets from 123x109/L (96-165) to 32x109/L (15-56). After administration of SDIVMP in all patients, fever reduced rapidly within one hour and there was no further clinical deterioration, rise in Hb, PCV, AST or worsening of ascites or pleural effusions. However in 5 patients platelet counts continued to drop to < 10x10 9/L over the next 23 days. None of the patients developed sepsis, abnormal sugars or any other complications such as sepsis, or abnormalities in glucose control. Conclusions: SDIVMP was effective in reversing fluid leakage in dengue. These findings support the conduct of a double blind placebo controlled trial. OP 4: Natural fluid requirement in dengue haemorrhagic fever and dengue fever SAM Kularatne, KGAD Weerakoon, KR Munasinghe, Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura Introduction and Objectives: Meticulous fluid management is the mainstay of treatment in dengue fever. This is currently governed by guidelines rather than research evidence. We studied the natural fluid requirement in dengue haemorrhagic fever (DHF) and dengue fever (DF) in a clinical setting. Methods: A cohort of confirmed dengue patients in the Teaching Hospital, Peradeniya from July 2012 to January 2013 where fluid management was guided by the haematocrit and clinical parameters were studied. Results: Of the 302 patient with dengue infection, 209(69%) had confirmation of the diagnosis with NS1and serology. Fifty eight (19%) had DHF. The mean age of DHF group was 29 years (range 12-63 years) and included more males (n=41, 71%, p<0.05). Mean duration of fever on admission was 4 days and total duration of fever was 6 days. There was high incidence of vomiting (n=36, 62%, p=0.03). Mean total daily fluid requirements were day 2=2112 ml, day 3= 3847 ml, day 4=2815ml, day 5=3252 ml, day 6=3145ml and day 7=3126 ml. Mean urine out put was day 2=1056 ml, day 3=2155 ml, day 4=1740 ml, day 5=1982 ml, day 6=2328 ml and day 7= 2449ml. In DF fluid requirement was lowest on the 3rd day (2143 ml). DHF group had significantly lower platelet counts and higher haematocrit values compared to DF. Conclusions: Fluid requirement in DHF was highest on 3rd day of illness, when the fluid requirement in DF was the lowest. This is followed by a drop and plateau after that. OP 5: Blood pressure drop in dengue without fluid leakage JKND Miththinda, R Premaratna, R Ragupathy, HJ de Silva Colombo North Teaching Hospital Introduction and Objectives: Plasma leakage is considered the most important reason for reduction in blood pressures (BP) in Dengue shock syndrome (DSS). However other causes such as dehydration, vascular dilatation due metabolic causes such as lactic acidosis or reduced cardiac output due to myocarditis or cardiomyopathy may lead to reduction in BP. We document observations in 7 patients with dengue who had reduced BP with no evidence of fluid leakage. Methods: We monitored 106 patients with confirmed dengue for fluid leakage with ultrasonography and other clinical, haematological and biochemical parameters. These parameters of the 7 patients (Group A) were compared Page 83 of 142

ABSTRACTS OF ORAL PRESENTATIONS

with an age and sex matched group of patients from the same cohort who did not develop any complications (Group B) in order to investigate the reasons for the BP drop. Results: Comparison between Group A vs Group B; systolic blood pressure drop 21.7mmHg (7.9) vs 5.7mmHg (7.9) p =0.025; diastolic blood pressure drop 17.1mmHg (7.6) vs 7.1mmHg (7.7) p =0.03; percentage rise in Hb 2.8% (3.9) vs 5.3% (4.4) p =0.3; percentage rise of PCV 3.5% (1.5) vs 6.2% (5) p=0.06. Five out of 7 in Group A and none in Group B had T wave inversions in the ECG in more than 3 consecutive leads. ECHO and cardiac enzymes were not done. Conclusions: Except for blood pressure drop and ECG changes, there were no significant differences in clinical, haematological or biochemical parameters between the two groups. Our findings suggest an alternative cause for the drop in blood pressure in dengue patients with no evidence of fluid leakage. OP 6: Seroprevalance and serotype specific T cell responses in dengue viral infections in healthy individuals in Colombo KC Jeewandara1, GN Malavige1, TN Adikari1, RH Fernando1, BSM Fernando1, D Ariyaratne1, M Salimi2, M Peellawate1, V Jayasuriya1, GS Ogg2 Center for Dengue Research, Faculty of Medical Sciences, University of Sri Jayawardanapura 2 MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford Introduction and Objectives: Although dengue viral infection causes dengue hemorrhagic fever and can result in fatality, it causes mild or asymptomatic infection in the majority of infected individuals.Therefore, we set out to determine silent dengue transmission in the community. Methods: Six hundred and thirty six healthy individuals aged 5-80 years were recruited from the community and serum was tested for the presence of anti-dengue virus (DV) antibodies. T cell responses to the DV-NS3 peptides, and non DV proteins were determined by exvivo ELISpot assays in 67 individuals. Cultured ELISpot assays for serotype specific (SS) DV peptides were done using a previously defined panel of SS peptides for all 4 DV serotypes. Results: The seropositivity rates for DV-specific antibodies were 40% by the age of 10 years, 62.5% at 20 years and 95% at 60 years. A significant and positive correlation was observed between age and DV- seropositivity (Spearman r = 0.84, 95% CI 0.55-0.95) (p=0.001). SS T cell responses to at least one DV serotype was detected in 46/47 seropositives but absent in all dengue seronegatives (n=20). Twenty three out of forty six (53%) responded to only 1 DVserotype, 18/46 (39.1%) to 2 serotypes and 3/46 (6.5%) to 3 serotypes. A significant and positive correlation was seen with the number of DV serotypes a person responded to and DV antibody titres (r=0.70, p<0.0001). Conclusions: Rates of seropositivity to DV rose significantly with age and reached almost 100% at 60 years of age. The frequency of DV-NS3 responses appear to rise with the number of DV infections a person has had.

Free Paper Session 2: Occupational Medicine and Environmental Medicine OP 7: Silicosis among employees of a silica crushing site AD Siribaddana, K Wickramasekara, RD Wijetunga, A Upul Teaching Hospital, Kandy Introduction and Objectives: Silicosis is a pneumoconiosis caused by exposure to silica dust. The silica industry is rapidly expanding in Sri Lanka, increasing the risk of occurrence of silicosis. The objective is to assess the patterns of silicosis among workers exposed to silica dust. Methods: A silica crushing site with 250 employees was screened using a questionnaire. All those with cough and shortness of breath were investigated. Details of intensity, duration of silica exposure and use of protective measures were recorded. Chest radiography and spirometry were performed in all symptomatic patients. Diagnosis was made using International Labor Organization criteria for diagnosis of silicosis. Results: Out of 250 employees 25 (10%) had respiratory symptoms. Chest rays of 14 workers (5.6%) showed abnormalities suggestive of silicosis. One worker had X ray changes suggestive of progressive massive fibrosis. Out of 14 patients 6 (42.8%) had duration of exposure less than 5 years and 8 (57.2%) had 5 to 10 years of exposure. Only 7 out of 14 patients (50%) had force vital capacity < 80% of the predicted value at spirometry.

Page 84 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Conclusions: All affected workers had accelerated silicosis as suggested by duration of exposure of less than 10 years. This suggests heavy exposure as a result of poor protective measures. OP 8: Noise levels of vehicles in the city of Colombo NS Nagodawithana1, A Pathmeswaran2, AS Pannila2, RD Gurusinghe2, C Kalansuriya2, N Sathiakumar3, AR Wickramasinghe4 1 Ministry of Health, Sri Lanka 2 Industrial Technology Institute, Colombo, Sri Lanka. 3 Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, USA 4 Department of Public Health, Faculty of Medicine, University of Kelaniya Introduction and Objectives: Though there is concern that vehicular traffic contributes to noise pollution in the city of Colombo there is no reliable data on the noise emitted by different types of vehicles. Objective of this study was to determine the noise emitted by vehicles within the city of Colombo. Methods: Vehicles in the city of Colombo could be classified into sixteen categories based on the type (bus, motorcar, three-wheeler etc), technology (two-stroke, four-stroke, petrol, diesel) and size (light, heavy etc). Nine to 16 vehicles from each category were selected by quota sampling. Sound pressure level (SPL-the magnitude of sound) and maximum sound level (LAmax) of the engine and horn of the selected vehicles were measured according to ISO 5130:2007(E) standards. Results: Diesel three-wheelers recorded the highest SPL (105.2dB) while cars recorded the lowest SPL (80.2dB). SPL of six categories of vehicles were more than 100dB. SPL of four and two stroke petrol three-wheelers and diesel three-wheelers were 97.2, 102.1 and 105.2dB respectively. SPL of large-buses with turbo and normal engines were 95.0dB and 103.6dB respectively. Ranking order of the LAmax level of engines were the same as for SPLs. LAmax of horns ranged from 100.1dB to 113.3dB. Maximum permissible noise level in a municipal council area during day time is 63dB. Conclusions: Diesel three-wheelers, two stroke petrol three-wheelers and large buses with normal engines are the noisiest vehicles in the city of Colombo. OP 9: Occupational health services provided to Export Processing Zone workers SM Arnold, SJ Senanayake, NC Pallewatta Ministry of Health Introduction and Objectives: Much emphasis is placed globally on occupational health and safety. However, in Sri Lanka occupational hazards are common in workplaces and therefore occupational health services should address these problems at the workplace. Objective was to identify the occupational health services available to Export Processing Zone (EPZ) workers. Methods: A descriptive cross sectional study, using an interviewer administered questionnaire and a checklist, was conducted in the EPZ of the Biyagama Medical Officer of Health area. A total of 69 work units in 25 factories were inspected and the interviewer administered questionnaire was administered to 100 workers selected randomly. Results: Of the 25 factories 92.0% were medium scale factories. Employees were trained in safety procedures in 88.0% of the factories while 40.0% had a qualified nurse at the factory premises. Routine pre-employment medical examination had been done in 40.0% of the factories while periodic medical examinations were done in 72.0%. Of the 69 work units inspected, 74.0% had safe individual work stations but 85.5% of the units had protruding objects in the premises increased risk of accidents. Personal Protective Equipment (PPE) were available in adequate quantity only in 26.0% of the units. Of the 100 workers interviewed, 35.0% stressed the need to further minimize occupational hazards. Conclusion: Occupational health services should be improved to protect the health of workers employed in EPZ. OP 10: Environmental noise levels in the city of Colombo, Sri Lanka NS Nagodawithana1, A Pathmeswaran2, AS Pannila2, RD Gurusinghe2, C Kalansuriya2, N Sathiyakumar3, AR Wickramasinghe4 1 Ministry of Health 2 Industrial Technology Institute, Colombo 3 Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, USA 4 Department of Public Health, Faculty of Medicine, University of Kelaniya Page 85 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Introduction and Objectives: Noise is a physical pollutant, which causes adverse health effects. Noise levels in most cities are higher than that recommended by environmental regulatory authorities of the relevant countries. Objective of this study was to determine the level of environmental noise at identified locations in the city of Colombo. Methods: Colombo Municipal Council area is divided into 15 divisions. Sixty places with high traffic density, four from each of the 15 divisions, were purposively selected. At each selected site, equivalent continuous sound pressure level (LAeq) was measured for six hours during day time (three hours each from peak and non-peak traffic hours) using a Class-I Sound Level Meter on week days. LAeq for eight hours (LAeq[8hrs]) was calculated and taken as the average noise level of that place. L10, L50, and L90 measurements were also taken. Results: LAeq (8hrs) within the Colombo city ranged from 76.6dB (at BOC roundabout, Colombo 12) to 84.0dB (at Liptonâ&#x20AC;&#x2122;s roundabout, Colombo 07), well above the maximum permissible noise level (63dB) for municipal council areas. All recorded LAeq values were more than 80dBs in Colombo 5, 9, 10, 13 and 14. Median LAeq value for the entire city was 81.0dB. Median LAeq value for peak traffic hours was 81.1dB and for off-peak traffic hours 80.4dB. Median values for L10, L50 and L90 for the city were 83.1dB, 76.6dB and 71.9dB respectively. Conclusions: Environmental noise levels in Colombo city are well above (13.3dB to 21.0dB) the levels recommended in the National Environmental (Noise pollution) Act of Sri Lanka. OP 11: Prevalence of occupation related musculoskeletal pain among tea pluckers in a selected tea estate in Ratnapura district IA Wanniarachchi, A de Abrew Allied Health Sciences Unit, Faculty of Medicine, University of Colombo. Introduction and Objectives: Tea pluckers are predisposed to health problems including musculoskeletal disorders (MSDs). Objectives were to establish the prevalence of MSDs, to identify the most commonly affected body regions and to determine effects on the wrist and hand. Methods: A descriptive questionnaire survey and targeted physical examination was conducted. Range of motion of the wrist joint was measured by using a universal goniometer and grip strength was measured using a pneumatic hand held dynamometer. Sample size was 94. Results: The prevalence of MSDs among tea pluckers was 85.1%. Knee pain (62.8%) was the most prevalent followed by lower back pain (39.4%) and shoulder pain (39.4%). Lower back pain (p=0.018), shoulder pain (p=0.05), elbow pain (p=0.02), and knee pain (p=0.001) showed significant relationship with age. Lower back pain (p=0.018), shoulder pain (p=0.05), elbow pain (p=0.02), and knee pain (p=0.001) were significantly associated with years of work. Lower back pain (p=0.001), shoulder pain (p=0.034) and knee pain (p<0.001) showed significant relationship with weight of tea leaves plucked per day. Grip strength of dominant (p=0.004) and non dominant sides (p=0.015) showed significant relationship with age and number of working years (p=0.485, p=0.599). Grip strength of dominant (p=0.485) and non dominant sides (p=0.599) were not significantly associated with weight of tea leaves plucked per day. Conclusions: Tea pluckers have high prevalence of MSDs affecting multiple regions. The grip strength was significantly associated with age and working years. OP 12: The effects of the angle between the sole and the heel of heeled footwear on single and double support time, stride duration and toe off plantar flexion of females SAR Darshika, TDMSB Dassanayake Allied Health Sciences Unit, Faculty of Medicine, University of Colombo Introduction and Objectives: This study was conducted to compare the changes in gait parameters between two different footwear sizes with same heel height caused by change of angle between heel and sole of the footwear. Methods: One hundred females participated in the study. Fifty one wore footwear size 36 and 49 wore footwear size 40. Mean ages of the two groups were 23.8 years (SD=2.5) and 24.4 years (SD = 2.4) respectively. Both groups wore footwear with heel height of 3cm. Two cameras (frontal stationary camera and lateral running camera) were used to capture the walking trials. Each individual performed three trials. Captured two dimensional walking trials were analysed with Motion View 8.0 video analysis software. Independent sample t-test was used to analyse the data.

Page 86 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Results: There was 60 greater angle between heel and sole of size 36 footwear than size 40 footwear. There was significantly difference (p<0.05) between the two groups in mean toe off plantar flexion and double support time. Conclusions: The angle between heel and sole of footwear has a significant impact on gait parameters. Therefore shoe length is more important than heel height.

Free Paper Session 3: Paediatrics OP 13: Translation and validation of Patient Practitioner Orientation Scale into the Sinhala language RM Mudiyanse1, RW Pallegama2, T Jayalath2, S Dharmarathna2, E Krupat2 1 Faculty of Medicine University of Peradeniya 2 Center for Evaluation, Harvard Medical School, Boston, USA Introduction and Objectives: Patient centered care focuses on patients’ perspective of illness and their psychosocial needs during the medical encounter. Doctor centered care focuses mainly on the disease. The patient practitioner orientation scale (PPOS), a widely used self-reported instrument, measures the caring and sharing attitudes of patient centeredness. A Sinhala translation of PPOS is useful in research and patient centered practice in Sri Lanka. Methods: Translation and back translation was done following standard procedure. Psychometric properties of the translated version were tested in a sample of 1369 patients and healthy adults including doctors, medical students and allied health staff. Temporal stability was tested in a sub-sample of 140 participants. Results: Age showed significant negative associations with Sharing, Caring and total score of PPOS. A positive association was observed with level of education but not with sex. Average total PPOS values were doctors (4.6), medical students (4.4), allied health staff (4.4) and patients (3.8). Chronbach’s alpha for each sub-group of participants ranged from 0.48 to 0.53 for Sharing and 0.42 to 0.53 for Caring. Intra-class correlation coefficient of agreement was 0.6 for Sharing, 0.4 for Caring and 0.6 for the total score. Conclusions: Sinhala version of the PPOS is a stable, valid and reliable tool which can evaluate patient centeredness among Sinhala speaking professionals and patients. Patient centeredness among subgroups of our sample was lower than that of Western world but higher than other countries in the region. OP 14: Acute poisoning in the paediatric age group in North-Central province of Sri Lanka MBKC Dayasiri, SF Jayamanne, YC Jayasinghe Teaching Hospital Anuradhapura Introduction and Objectives: There is little data on poisoning in the paediatric age group in the North Central Province (NCP) of Sri Lanka. Objective of this study was to identify characteristics, risk factors and outcome of poisoning in the paediatric age group in the NCP. Methods: All children presenting with either accidental or deliberate poisoning, to all paediatric casualty units at the Anuradhapura and Polonnaruwa Teaching Hospitals, over a period of 8 months from March 2012 were studied. Information was obtained from clinical interviews, focus group discussions, clinical observation and clinical records. Results: Of the 167 children, 53% were male and 91% were below six years of age. Parents were agricultural workers in 25% and 51% had been educated up to GCE O’ Level. Poisoning was mainly accidental (97%). Commonest poison was kerosene oil (24.9%). Reasons for delay in seeking medical help included lack of transport (14%), poor knowledge (12%), lack of awareness regarding urgency (12%) and financial constraints (8%). Complications included acute liver injury (4.2%), chemical pneumonitis (3.6%), and convulsions (1.8%). There were no deaths. Inadequate supervision by parents 87.5%, improper storage of household chemicals 52% and medicines 40% were common risk factors. Conclusions: Acute poisoning in children mostly occurred due to inadequate supervision by parents and improper storage of chemicals and medicines. Community education and safe storage of chemicals and medicines will reduce the incidence of poisoning in the paediatric age group. OP 15: Rheumatic fever on the rise: an experience from Teaching Hospital, Jaffna MG Sathiadas, P Kalaventhan

Page 87 of 142

ABSTRACTS OF ORAL PRESENTATIONS

University of Jaffna Introduction and Objectives: Rheumatic fever was the commonest cause of acquired heart disease in the past and the incidence and prevalence of this disease has declined. During the recent years, we noticed a rapid increase in number of new cases of rheumatic fever. Objectives were to evaluate the epidemiological and socio demographic characteristics of patients diagnosed with rheumatic fever at the Teaching Hospital Jaffna. Methods: A survey was conducted among patients with rheumatic fever using an interviewer administered questionnaire. Details regarding the initial presentation, demographic details, housing conditions and diagnosis were recorded. Results: Fifty two patients were followed up at the paediatric clinic Teaching Hospital Jaffna for monthly benzathine penicillin. Forty six patients were diagnosed after the year 2009 and 6 patients before that. Male female ratio was 1.7:1. Majority (60%) were aged 7-9 years. Monthly income was <Rs20,000 in 27 (75.1%), 5.6% developed the disease while they were displaced and living in IDP camps. Housing conditions were poor in 38 (73%). Sore throat was the presenting complaint in 10 (19 %). The commonest presentation was major manifestation of carditis 37 (71%), followed by migrating poly arthritis 31(59%) and Sydenham’s chorea 6 (11.5%). Knee joint was the commonest joint affected by arthralgia and arthritis (72.2%). Mitral valve was the commonest valve affected in those with rheumatic heart disease (80.6%) followed by aortic valve (22.2%). Mitral stenosis was found in 4 (7.7%). Eight patients presented in acute cardiac failure and one patient had cardiac tamponade needing pericardiocentesis. Delayed presentation to the tertiary center was noted among 18 (34.6%). Conclusion: Rheumatic fever with carditis is still a major problem in this part of the country. Overcrowding and poor housing conditions and mass movement are the main risk factors. OP 16: Prevalence and risk factors for childhood wheezing in Ragama Medical Officer of Health area: an ongoing, community based study YC Jayasinghe, KAW Karunasekera, B Kumarendran Department of Paediatrics, Faculty of Medicine, University of Kelaniya Introduction and Objectives:Atopic disease is an important public health problem and local data is essential for formulating treatment guidelines and policy planning . Objectives were to determine the prevalence and severity of wheezing among children less than 13 years of age, and to identify risk factors and triggers for wheezing. Methods: The study commenced in September 2012 and is ongoing. The target study population was 3000 subjects. Data were collected using an interviewer administered questionnaire. Results: There were 2411 participants, of them 388 (16.1%) were categorised as ‘ever had wheezing’, 226 (9.4%) had at least one wheezing episode within the past 12 months and 28 (1.2%) were currently having wheezing. Of those who ‘ever had wheezing’, 103 (27.4%) had activity induced wheeze or cough, 199 (52.8%) had nocturnal cough, 208 (55.2%) had wheezing on exposure to airborne allergens. In 94.7% symptoms improved with treatment, 60 (16%) deteriorated when treatment was stopped. Seasonal variation in wheezing, was seen in 215 (57.2%), 243 (72.5%) had wheezing with upper respiratory tract infection. Prematurity was a risk factor for ‘ever had wheezing’ (OR = 1.85, 95% CI: 1.2 -2.9). Paternal smoking during pregnancy (OR = 0.95, 95% CI: 0.8-1.2) or thereafter, was not a risk factor for wheezing. Wheezing was significantly associated with coexisting atopy, family history of atopy, and antibiotic usage during pregnancy. Conclusions: Prevalence of wheezing in our study is comparable to that in Asia of 16%. The risk factors and triggers of wheezing are similar to that in other studies. However we found no link between antenatal or postnatal exposure to cigarette smoke and childhood wheezing. OP 17: Randomised clinical trial comparing prednisolone and ACTH in reversal of hypsarrhythmia in untreated epileptic spasms J Wanigasinghe1, C Arambepola1, GM Attanapola1, LSD Liyanage1, CB Liyanage3, PSK Silva3, PKSJ Kankanamge3, S Sumanasena1, S S Ranganathan2, B Dissanayake1, M E C Muhandiram1 Department of 1Paediatrics and 2Pharmacology, Faculty of Medicine, University of Colombo 3 Lady Ridgeway Hospital Introduction and Objectives: Although several anticonvulsants improve clinical outcome in infantile spasms, there are no studies showing reversal of hypsarrhythmia. This is the first randomised clinical trial which assessed the role of hormonal therapy on improving hypsarrhythmia in the EEG of infants with infantile spasms. Page 88 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Methods: Eighty two newly diagnosed, untreated infantile spasm patients were randomised to receive oral prednisolone or intramuscular ACTH for 14 days on doses given in the United Kingdom Infantile Spasms Study protocol. Hypsarrhythmia severity was assessed on electroencephalogram on a 16-point-scale score described by Kramer et al., by a single investigator blinded to allocation. Assessment was done, prior to treatment (pre) and on 14th day of treatment (post). Results: EEG evaluations were available in 73 infants. The mean pre-treatment overall severity scores were 10.33 (SD=2.8) for prednisolone and 10.28 (SD=2.5) for ACTH. The mean post-treatment overall severity scores were 2.5 (SD=2.24) for prednisolone and 4.25 (SD=2.5) for ACTH. A significant improvement of hypsarrhythmia was seen with both prednisolone (mean difference of pre and post-treatment severity scores=7.863+2.86) and ACTH (mean difference of pre and post-treatment severity scores=6.02+2.70) (p<0.01). This improvement was significantly higher with prednisolone than with ACTH (p<0.01). All 8 individual components of the severity score significantly improved with both treatment types (p<0.01). Conclusion: Hormonal therapies (prednisolone and ACTH) resulted in significant reversal of hypsarrhythmia in previously untreated infantile spasms. Of the two treatment arms tested, overall reduction of the individual scores was better in those treated with prednisolone. OP 18: Defining obesity in children using a biological end point VP Wickramasinghe, C Arambepola, P Bandara, M Abeysekera, S Kuruppu, P Dilshan, BS Dissanayake Department of Paediatrics, Faculty of Medicine, University of Colombo Introduction and Objectives: Cut-off values for body mass index (BMI) and waist circumference (WC) in children are based on population distribution of the parameters and are not suitable for use in South Asian populations. We attempted to define cut-off values for BMI and WC in Sri Lankan children, based on adverse health outcomes. Methods: A cross-sectional descriptive study of 920 Sri Lankan children aged 5-15 year (boys=547) was carried out. Fat mass (FM) was assessed using Bio-impedance assay (InBody-230 machine; Boispace Co Ltd, South Korea). BMI and WC cut-off values were defined based on %FM associated with adverse health outcomes. A %FM of 28.6% in males and 32.6% in females was associated with metabolic syndrome in this group of children. The corresponding BMI and WC for each age and gender were calculated using a multiple regression model. Results: Sri Lankan children had a low fat free mass index and a high FM index. Individuals with the same BMI had %FM distributed over a wide range. BMI that would detect a FM associated with metabolic syndrome at 18 years was 21.3kg/m-2 for males and 23.1kg/m -2 for females. Corresponding WC cut-off values for males and females were 77.7cm and 82.5cm respectively. Conclusions: This study identified the BMI cutoff values based on a biological endpoint rather than using a population distribution. The newly defined cut-off values appear to be quite low but comparable to that proposed for South Asian populations in recent publications. OP 19: Review of ancestry of the major ethnic group in Sri Lanka through Craniometric data: a preliminary study UCP Perera, S Cordner, C Briggs, R Wright Department of Forensic Medicine, Faculty of Medicine, University of Ruhuna Introduction and Objectives: Craniometric data has been used widely to predict ancestry of various population groups since the advent of the last century. Most of these studies have been carried out by European anthropologists. Sri Lanka is a country of multiple ethnicities and hence it is important to assess ancestral roots of various ethnicities through scientific means such as craniometric analyses which also provide opportunity to establish identification through skeletal data. The objective of the study was to determine ancestral relationship of the Sinhalese ethnic group by analysing craniometric data through the freeware program CRANID. Methods: We examined 114 intact crania of known individuals from coronial autopsy cases referred to the MedicoLegal Unit, Galle, Sri Lanka. A wider distribution of population sample is anticipated during the second phase of the study by incorporating bodies donated to the Anatomy Department of the Ruhuna Medical Faculty. Anthropometric measurements were obtained from provenanced intact crania as initial part of the study by the principal researcher using pre-tested anthropometric equipment under the guidance of overseas supervisors. The analysis of data was done at the University of Melbourne, Australia using the CR5Ind.ZIP programme.

Page 89 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Results and Conclusions: Provisional craniometric assessment of skulls of Sinhalese ethnic group for bio-distance has provided data of wider separation from that of Indian skulls studied previously. Modern people may be identified socially as Sinhalese, but nevertheless there is evidence of recent mixed ancestry. OP 20: Security, privacy and confidentiality of patient information in Electronic Health Information Systems: a systematic review DBAS Jayawardena Regional Director of Health Services, Kalutara Introduction and Objectives: Introduction of electronic health information systems has resulted in concerns about security privacy and confidentiality of patient information. None of these systems are absolutely secure and they can be hacked. Objectives were to review studies on security, privacy and confidentiality of electronic health information systems and computer based health records systems and to describe methods currently available to overcome these issues. Methods: Medline and Pubmed databases from 2000-2010 were searched using key words, security, privacy, confidentiality, electronic health information system and computer based health records. Results: Twenty five articles were selected. All 25 articles identified that security and confidentiality were major problems with electronic health records. None stated that their systems were 100% secure. Two (08%) studies described complying with the Health Insurance Portability and Accountability Act (HIPAA). Conclusions: Safeguarding security, privacy and confidentiality is a major problem of electronic health record systems and pose a major challenge for governments. Social and cultural factors and type of health system need to be taken into account when addressing these issues. OP 21: Prevalence of malnutrition and its impact on outcome in patients with cardiac disease NC Lokunarangoda1,2, AK Pathirana1, R Jayawardena1, I Ranathunga1, MMSP Premaratne1, WS Santharaj1 1 Institute of Cardiology, National Hospital of Sri Lanka, Colombo and 2Department of Medicine, Faculty of Medicine and Allied Sciences, University of Rajarata, Mihintale Introduction and Objectives: It was observed that some cardiac patients admitted to Institute of Cardiology, National Hospital of Sri Lanka (NHSL) have co-morbid malnutrition. Nutritional risk factors are associated with poor outcome in cardiac disease. This study assessed the risk of malnutrition among cardiac patients and its association with clinical outcome. Methods: Data was collected from 526 patients admitted to Institute of Cardiology, NHSL. Nutritional screening was done using the Malnutrition Screening Tool (MST) on admission. Each subject was followed up until discharge and evaluated one month after discharge, to identify the clinical course and outcome. MST score of ≥2 was categorized as ‘at risk of malnutrition’. Results: According to the MST 250 (47.9%) patients were ‘at risk of malnutrition’. Mean hospital stay positively correlated with poor nutritional status (p=0.006). Seven patients who were (2.8%) ‘at risk of malnutrition’, and 3 (1.1%) in the ‘not at risk of malnutrition’ category died during hospital stay. During the one month follow up, 6 (2.7%) more patients in the ‘at risk of malnutrition’ category and 3 (1.2%) more in the ‘not at malnutrition’ category died. Thirty one (13.9%) in the ‘at risk of malnutrition’ category and 22 (8.7%) in the ‘not risk of malnutrition’ category were readmitted during this period. Conclusions: Among cardiac patients, nearly half are at risk of risk of malnutrition according to MST. In these patients the hospital stay is longer and there is higher mortality in hospital and after discharge. OP 22: Geographical Information Systems (GIS) for monitoring of Millennium Development Goal 5 (MDG): a Study from Badulla district PVDS Dharmagunawardene, HMJR Herath, NSR Hewageegana Post Graduate Institute of Medicine Introduction and Objectives: The most demanding challenge in achieving the MDG are the regional disparities and monitoring of sustaining these goals. GIS can be used to monitor MDG through analysis of regional information. Therefore, monitoring of sustainability and regional disparities of MDG using GIS should be explored. Purpose of this study was to analyze the maternal mortality (MDG 5) data, its contributory factors and to forecast the achievement, sustainability and regional disparities in Badulla district using GIS. Page 90 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Methods: This was a descriptive study. It utilized structured formats for secondary data collection from 15 Medical Officer of Health (MOH) Divisions, on MDG 5 and its contributory factors. Data on existing human resources and infrastructure were also collected. Prospective trend analysis to the year 2015 was carried out and Sustainability Index for Maternal Mortality Reduction (SI-MMR) was developed. It used accessibility (access to transfusion facilities, specialist obstetrics services and intensive care) and coverage parameters (rate of institutional deliveries, contraceptive prevalence rate and percentage of pregnant mothers registered before 8 weeks). These were analyzed using GIS to recognize the regional disparities. Results: Ten (66.7%) MOH divisions are expected to achieve maternal mortality targets by 2015. Mean SI-MMR was 0.46 (Standard Deviation ± 0.18) for the Badulla district. Soranathota had the highest SI-MMR (0.80) and UvaParanagma had the lowest (0.22). SI-MMR developed using accessibility and coverage parameters did not correlate with the attainment of MDG 5 or with the maternal mortality ratio in Badulla district. Conclusions: GIS can be effectively used to identify regional disparities. Poor correlation between the parameters demands more attention to quality related aspects of service delivery in maternal mortality reduction. OP 23: Patients’ views on health system responsiveness at primary care level NDW Widanapathirana, T Ranasinghe, HSR Perera, R Jayasuriya Office of the Medical Officer of Health, Maharagama Introduction and Objectives: Health system responsiveness is a measure of how the system responds to nonhealth expectations of people. Patients’ views on the care they receive are essential for improving health services utilization. The objective was to compare the responsiveness of public and private primary care services utilized by adults. Methods: A cross sectional study was conducted using an interviewer- administered questionnaire. Participants (n=411) were recruited by systematic sampling of households in 6 Grama-Niladhari divisions in Moratuwa in 2011. The responsiveness of the last visit to a primary care provider during 6 months preceding data collection was assessed using World Health Survey questionnaire. Results: During the last visit, 101 (24.6%) utilized the public sector and 310 (75.4%) utilized the private sector. The highest responsiveness scores for the public sector were for ‘confidentiality of personal information’, ‘freedom to choose health care provider’, and ‘cleanliness of the health facility’ (n = 88, 87.1%,) while ‘respect for privacy during physical examination’ (n = 301, 97.4%,) scored high in private sector ratings. The lowest responsiveness was reported for ‘waiting time’ (n = 38, 37.6%,) in the public sector and ‘information on alternative treatment’ in the private sector (n = 244, 78.7%,). Responsiveness of the private sector was significantly more than the public sector in 6/7 domains of responsiveness (p<0.05). OP 24: Organizational culture of a hospital and its association with patient safety management system SR Kumar1, S Sridharan2 1 Ministry of Health 2 Quality Secretariat Introduction and Objectives: Errors in patient care is a critical issue facing hospitals today. This study describes how organizational culture and the patient safety management system (PSMS) relate to each other in reducing medical error. Methods: This is a hospital based descriptive, cross-sectional study based on a self administered questionnaire. It included two components, to assess the patient safety management system (PSMS) and the organizational culture of the Castle Street Hospital for Women (CSHW) as perceived by its major clinical staff. The Pearson’s correlation coefficient was used to determine the association between organizational culture and the components of PSMS. Results: Leaders’ commitment to patient safety, team work and, participatory decision making practices were identified as important by the majority of the respondents. In incident reporting procedure, values of employees, encouragement, mutual trust, convenience, confidentiality and feedback were identified as important. Scores for patient safety management system showed a statistically significant, strong positive correlation with group culture (r = 0.553, p<0.001) and developmental culture (r = 0.539, p<0.001). Conclusions: The organizational culture profile of CSHW is dominated by the group culture and hierarchical system. Building and promotion of group culture along with the developmental culture could appropriately address the shortcomings of the patient safety management system. Page 91 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Page 92 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Free Paper Session 4: Miscellaneous OP 25: National survey on tobacco use among school teachers in Sri Lanka IK Liyanage, AP De Silva, STGR De Silva, JMWJ Bandara National Intensive Care Surveillance, Ministry of Health Introduction and Objectives: To describe the prevalence and correlates of smoking among school teachers in Sri Lanka Methods: This cross sectional study used multi-stage, stratified random sampling to select thirty schools from each school cluster, defined by the Ministry of Education (1AB, 1C, and II). All teachers and supervisory staff categories (e.g. principle) were included. A total of 3,652 teachers and principals (78.4%) participated. A pre-tested self administered, anonymous questionnaire was used to collect the data. Results: Prevalence of all time smoking was 15.4% (95%CI 13.0%-18.1%) (teachers: 14.1%, principals:42.7%, males:48.3%, females:3.7%). Smoking during past 30 days was 4.1% (95%CI 3.0%-5.5%). Among principals and teachers 12.3% and 1.7%, respectively smoked within schools premises. Chewed tobacco, was used by 5.3% (95%CI 4.1%-6.9%). Majority (97.1%, 95%CI 96.2%-97.8) believed that smoking should be banned from public places. Tobacco use prevention was actively addressed in school curriculum, in 62.5% (95%CI 59.1%-65.7%) of the schools. A total of 60.1% (95%CI 56.5%-63.6%) of teachers had access to teaching material on prevention of tobacco use, 10.9% (95%CI 9.4%-12.6%) had received training on prevention of youth tobacco use while 53.7% (95%CI 50.0%-57.3%) thought that teachers needed specific training to help students avoid tobacco use. As many as 35.4% (95%CI 31.4%-39.7%) schools used non-classroom programs to teach prevention of youth tobacco use. Majority 94.8%, (95%CI 93.8%-95.7%) believed that tobacco use by teachers influence youth tobacco use. Conclusions: The prevalence of smoking is high among school principals and teachers. The access to teaching material and training to prevent youth tobacco use is inadequate. OP 26: Lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital TM Wijesuriya1, J Kottahachchi1, SSN Fernando1, U Bulugahapitiya1, MSS Dissanayaka2, S Prathapan2, MM Weerasekera1, KNP Ranasighe3, TDCP Gunasekera2, A Nagahawatte4, LD Guruge2 1 Colombo South Teaching Hospital 2 Faculty of Medical Sciences, University of Sri Jayewardenepura 3 Base Hospital, Tangalle 4 Faculty of Medicine, University of Ruhuna Introduction and Objectives: Superficial fungal foot infection (SFFI) in diabetic patients increases the risk of developing diabetic foot syndrome. Sixteen percent of urban population in Sir Lanka has diabetes. Early intervention is advisable as diabetic patients are more prone to fungal foot infections and because of the progressive nature of the infection. There is no data on the prevalence of SFFIs in diabetic patients in Sri Lanka. Objectives were to determine the prevalence and aetiology of SFFI in patients with type 2 diabetes. Methods: Three hundred and eighty five diabetic patients were selected. Nail clippings and swabs were collected from the infected sites using the standard protocol. Laboratory identification was done and pathogens were identified by morpho physiological methods. Results: Clinically 295 patients (77%) showed SFFI, of which 255 (86%) were mycologically confirmed. Out of 236 direct microscopy (KOH) positives, 227 (96%) were culture positive. Two hundred and fifty one patients (98%) with SFFI had diabetes for more than 10 years. Of the patients with SFFIs, 92% had FBS > 100mg/ dl and 81% had PPBS>140mg/ dl. Both elevated FBS and PPBS was seen in 80%. Non-dermatophyte fungal species were the commonest pathogens followed by yeast and dermatophytes. Conclusion: Aspergillus niger was the commonest pathogen followed by Candida albicans. SFFIs was significantly associated with increasing age, gender, duration of diabetes and poor glycaemic control. OP 27: Evaluation of the accuracy of glucometers currently used in Sri Lanka JH Liyanage1, P Katulanda1,HA Dissanayake1, KKK Gamage1, GSP Keerthisena1, PN Weeratunga1, WA

Page 93 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Wijesundara1, WMUA Wijetunga1, S Subasinghe1, TAD Tillakaratne1, G Katulanda2 1 Diabetic Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo 2 Colombo North Teaching Hospital Introduction and Objectives: Self-monitoring of blood glucose using a glucometer is effective in improving glycaemic control in diabetic patients. Studies in other countries have shown variation in the accuracy of glucometers but there is lack of data in Sri Lanka. This study aims to assess the accuracy of commonly available glucometers in Sri Lanka. Methods: Commonly used glucometers were identified (n=8). Healthy volunteers (n=16) and patients admitted to the National Hospital of Sri Lanka (n=14) were selected by convenience sampling (n=30) after obtaining informed consent. A venous sample (VS) from each subject was analysed for glucose using the glucose oxidase method and this was taken as the reference value. Simultaneous finger prick (FP) values were determined using all glucometers ensuring uniformity. Results: The range of glucose levels were 69 - 523 mg/dl. Mean difference (mg/dl) between VS and FP values for glucometers with 95% confidence interval and p values were: A 12.39 (8.04-16.74), p<0.001; B 27.61 (22.2332.99), p<0.001; C 0.87 (5.52-7.26), p =0.78; D 20.81 (15.22-26.39), p<0.001; E 15.63 (6.73-24.53), p =0.001; F 6.08 (4.34-16.47), p=0.243; G 19.53 (9.49-29.57), p<0.001; H 25.48 (18.01-32.92), p<0.001. Highest concordance with American Diabetes Association (ADA) recommendation (less than 5% bias) was seen in ‘C’ and lowest in ‘B’. Conclusions:In a majority of glucometers tested, a statistically significant difference between VS and FP values were noted and the concordance with ADA recommendation seemed unsatisfactory. Patients should be properly advised when buying a glucometer. OP 28: Influence of age on body mass index (BMI) and body fat percentage of Sri Lankan adults DC Ranasinghe1, P Gamage1, P Katulanda1, N Andraweera1, S Thilakarathne1, ACR Ranasinghe2 1 Diabetes Research Unit, Faculty of Medicine, University of Colombo 2 SCBU, Base hospital Wathupitiwala Introduction and Objectives: Sarcopenia, is progressive loss of lean muscle and accumulation of body fat with aging, which increases the risk of non-communicable disease. Sri Lankan population is aging rapidly. We examined the correlation of age with BMI and body fat percentage (BF%) in a group of Sri Lankan adults. Methods: Cross sectional study was conducted on a random sample of adults (18-83 years) attending a medical exhibition. Subjects were grouped as young (Y) (18-39 years) middle-aged (M) (40-59 years) and elderly (E) (>60 years). BMI was calculated with anthropometric measurements and total BF % estimated via 50Hz, 8 electrode bio impedance analysis (Tanita, Japan). Descriptive statistics and Pearsons' correlation coefficients (R) were calculated. General linear analysis tested linearity and polynomial regression examined non-linearity. Results: Sample (n=1114) had 547 males. Females had higher BF% (p<0.001). BF% increased linearly with age (male/female R =0.47/0.64; p<0.001). Differences of mean BF% between males and females also increased with age (male/female: Y= 19.5%/28.0%, M=24.5%/34.7%, E= 25.4%/36.7). Females had higher mean BMI except in young (p<0.05). BMI increased curviliniearly with age, showing decline after age 55-60 years. This effect was more significant in females (R2 change= 0.058, p =<0.001) than males (R2 change=0.009, p<0.05). Conclusions: Compared to males, females had higher BF% throughout life and higher BMI from middle age onwards. In all; BF% (linearly) and BMI (curvilinearly) increased with age. When old age advances, BF% increased and BMI reduced simultaneously indicating possible sarcopenia. This effect was more significant in females. Future research should be carried out to identify the outcomes of these relationships. OP 29: Serum Cystatin C as a marker in the assessment of renal function in diabetic nephropathy in type 2 diabetics in Sri Lanka: a preliminary study NN Wijayatunga1, PPR Perera1, K Wanigasuriya2, H Peiris1 1 Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayawardenepura 2 Department of Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura Introduction and objectives: Serum cystatin C is a new, reliable marker of glomerular filtration rate in diabetics with mild to moderate renal impairment. It has not been studied in the Sri Lankan population before. Our aim was to

Page 94 of 142

ABSTRACTS OF ORAL PRESENTATIONS

study the correlation of serum cystatin C with estimated glomerular filtration rate (eGFRMDRD) and albumin to creatinine ratio (ACR) in type 2 diabetics in Sri Lanka. Method: From Colombo South Teaching Hospital, 63 type 2 diabetic patients (41 females and 22 males) with a past eGFR value of < 60 ml/min/1.732m2 were recruited. Serum cystatin C was measured using Immunoturbidimetric method and creatinine in serum and urine were measured using Creatinine Kinetic method while urine albumin was measured by immunoturbidimetry on Kone 20XT auto analyzer. ACR(mg/g) was calculated and eGFR (ml/min/1.73m2 ) was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation . Results: The mean age was 54.3 years and the duration of diabetes was 9.7 years. In the study group 57.1% were normoalbuminuric (ACR<30) and 34.9% were microalbuminuric (ACR=30-300) while 7.9% were macroalbuminuric (ACR>300). Reduced eGFR (between 30-60) was detected in 30.2% of diabetics, 69.8% had eGFR >60ml/min/1.73m2. Serum cystatin C showed a significant correlation with serum creatinine (r = 0.84, p<0.05), eGFR(MDRD) (r=-0.77, p<0.05) and with ACR (r= 0.56, p<0.05). Conculsions: Serum cystatin C showed a significant correlation with serum creatinine, eGFR (MDRD) and ACR which are routinely used to assess diabetic nephropathy in clinical practice in Sri Lanka. OP 30: Comparison of system delays during and after working hours affecting primary percutaneous coronary interventions at the National Hospital of Sri Lanka NC Lokunarangoda, AK Pathirana, WS Sanatharaj, KKAO Walawwatta, SP Premaratne, KGV Saranga,KKS Chinthanie Institute of Cardiology, National Hospital of Sri Lanka, Colombo Introduction and Objectives: The National Hospital of Sri Lanka (NHSL) is the main centre in the country for cardiac interventional procedures which include primary percutaneous coronary interventions (pPCI) for acute STelevation myocardial infarctions (STEMI). There is a debate whether patients with acute STEMI admitted to hospital outside regular working hours experience more delays than those admitted during regular working hours. The aim of this study was to compare the door to balloon time (DBT) during working hours and after working hours. Methods: This prospectively designed audit included 49 consecutive patients who had undergone pPCI in cardiology unit of NHSL during the 3 months November 2012 - January 2013. Patients were categorized into two groups according to the time they were admitted to NHSL as working hours; and after working hours. Working hours were defined as Monday-Friday 08:00-16:00 hours and Saturday 08:00-12:00 hours. All other times, Sundays and public holidays were defined as after working hours. Time from first medical contact to balloon inflation (DBT) was calculated separately for the two categories. These were compared with the standards recommended in ESC 2008 guidelines: which recommends that DBT should be < 120 minutes. Results: Median DBT during working hours was 150 minutes and DBT <120 minutes was achieved in 27.27%. In contrast median DBT after working hours was 120 minutes and DBT < 120 minutes was achieved in 51.85%. Conclusions: DBT is longer during working hours than after working hours. Deficiencies should be identified and adequate measures should be instituted to minimize the delays especially during working hours. OP 31: Discovery of a deadly scorpion (Hottentotta tumulus) in the Jaffna peninsula and its clinical importance NP Dinamithra, S Sivansuthan, KB Ranawana, SAM Kularathne, KGAD Weerakoon Faculty of Medicine, University of Rajarata Introduction and Objectives:Unprecedented fatalities due to scorpion stings in Jaffna since 1999 indicate a novel and emerging health issue in Sri Lanka. The offending scorpion species is known to the public as â&#x20AC;&#x153;white scorpionâ&#x20AC;? which is believed to be a new entrant. Comparative laboratory and taxonomic work in 2012 identified it as Hottentotta tumulus, the lethal Indian red scorpion which has not been described in Sri Lanka. Objectives of the study were to describe epidemiological and clinical manifestations of H.tumulus stings and features of envenoming. Methods: This prospective study included all patients with a history of scorpion stings admitted to the Teaching Hospital Jaffna from January 2012. Results: Of the 78 patients, 72 were stung by H.tumulus. Of them, 22 (30%) patients brought the offending scorpion (confirmed cases). Mean age of sample was 30 years (range 5-65 years), 6 were less than 12 years. There were 12 (55%) males and 10 (45%) females. Eight (36%) were stung between 6.00 am-9.00 am and six were stung between Page 95 of 142

ABSTRACTS OF ORAL PRESENTATIONS

6.00 pm-9.00 pm. The scorpions were found concealed in dark places and stung 12 (55%) patients inside a compound. All patients had intense local pain and reaction. Systemic manifestations were tachycardia 13 (59%), hypertension 11 (50%), excessive sweating 8 (36%), salivation 4 (18%) and bradycardia in 2. Two patients had severe hypotension. Timely administration of prazosin saved lives. Conclusion: H.tumulus would have enrooted in Jaffna during Indian Peace Keeping Force (IPKF) occupation in the late 1990â&#x20AC;&#x2122;s. In the future, it might spread to other regions. Envenoming causes an autonomic storm which could be fatal unless treated promptly. OP 32: Prevalence and factors associated with cataract among the elderly in Mahara Divisional Secretariat Division AAN Nishad1, MS Amaratunga2, J de Silva2, KTAA Kasturiratne2, AR Wickramasinghe2, J Mallawarachchi3 1 Post Graduate Institute of Medicine, University of Colombo. 2 Faculty of Medicine,University of Kelaniya. 3 Wijaya Kumaratunga Hospital, Seeduwa Introduction and Objectives: To determine the prevalence and factors associated with cataract among the elderly in Mahara Divisional Secretariat Division (DSD). Methods: A population based cross-sectional study was conducted in the 4th quarter of 2012 using multistage random sampling. Detailed clinical eye examination with slit lamp (gold standard method) was carried out to detect and grade cataract using Oxford Lens Opacity Classification system and an interviewer administered questionnaire collected data on associated factors. Results: Sample consisted of 470 persons out of 540 who were invited to participate. Mean age (SD) of the sample was 68.6 (7.3) years females constituted 71%. Prevalence of cataract including the operated eye was 80.6% (95%CI 76.8-84) and 73.6% (95% CI 69.5-77.4) when operated eye was excluded. Nuclear only cataract 44.9% (95% CI 40.5-49.4) was the commonest subtype followed by mixed 27% (95% CI 11.9-37.9) and sub-capsular 1.3% (95% CI 0.6-2.8). Grade 2 cataracts were the commonest 26.8% followed by Grade 1 (25.2%) and Grade 3 (23.8%). Age more than 75 years OR 2.4 (95% CI 1.2-5.4), monthly income less than Rs.10,000 OR 2.0 (95% CI 1.2-3.2) and having chronic medical illness other than diabetes or hypertension OR 7.0 (95%CI=1.7-29) were associated with cataract but gender, diabetes or hypertension were not. Conclusions: Main strength of this study was using the slit lamp for eye examination. We found higher prevalence of cataract among the elderly compared to other Asian populations and past Sri Lankan studies, which emphasizes the importance of strengthening and expanding vision care services. Case control studies to determine risk factors are recommended. OP 33: Upper urinary tract urothelial carcinoma, 15-year experience and survival data RMPS Ratnayake, SAS Goonewardana National Hospital Sri Lanka, Colombo Introduction and Objectives: Upper urinary tract urothelial carcinoma (UTUC) affecting renal pelvis, ureter or both is uncommon and accounts for 5% of all urothelial carcinomas. In the West, pelvicaliceal tumours are twice as common as ureteric tumours. UTUC that invade the muscle wall have very poor prognosis. The 5-year cancerspecific survival is less than 50% for pT2/pT3. Radical nephroureterectomy with bladder cuff excision remains the gold standard treatment. Objective was to identify presentation, tumour characteristics and 5 year survival in UTUC in Sri Lanka. Method: A retrospective study was carried out in Urology Unit 1, National Hospital of Sri Lanka on consecutive patients with histopathologically confirmed UTUC. Demographic, clinical, histopathological and follow-up details of patients treated over a 15 year period (1997-2012) were entered into a data collection form. Survival data was calculated for 5-year periods. Results: Twenty eight patients with UTUC were identified. Mean age was 63 Years Âą 9.5(range 44-83). Majority were male (n=20). Male: female ratio 5:2. Laterality, left sided n=16. Site of tumour was the ureter 15, renal pelvis 8 and both 3. Presenting symptom was haematuria in 21. All patients underwent nephroureterectomy with excision of bladder cuff. Muscle invasion was seen in 14 patients/ High grade-14 patients. Twelve patients were diagnosed between 1997-2012 (survival; 15 years n=1, 14 years n=1, 10 years n=1). Seven patients were diagnosed between 2002-2007 (survival; 8 years n=2, 5 years n=1). Nine patients were diagnosed between 2007-2012.Five year survival rate of 19 patients diagnosed in the first 10 years was 31.5% (6/19). Page 96 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Conclusion: UTUC in Sri Lanka was predominantly ureteric in location. The mean age was 63 years. Haematuria was the commonest presenting symptom. Half the patients had muscle invasion and high grade. Five year survival in this cohort was 31.5% which indicates poor prognosis. OP 34: Some characteristics related to falls among the elderly in the district of Colombo AD Ranaweera, P Fonseka, AP Arachchi, SH Siribaddana Ministry of Health Introduction and Objectives: The elderly population in Sri Lanka is expanding rapidly. Falls are an important cause of morbidity and mortality among the elderly. Each year 28-35% of people aged ≥65 years experience a fall. This study was carried out to assess fall related characteristics among the elderly in the Colombo district. Methods: This is the descriptive component of a large community based study, conducted from August to November 2010. Elderly aged ≥65 years (n=1200), from 40 Grama Niladhari divisions was enrolled by probability proportionate to size method. Data was collected using interviewer administered questionnaires which included a disability assessment questionnaire. Mobility was tested by Timed Up and Go test. Results: Majority of the sample were females (57%, n=684). Proportion of elderly aged more than 75 years was 31.2% (n=375). About one fourth of elderly was categorized as disabled and poor mobility was reported in 13.2%. Out of 1200 elderly, 25.8% (n=310) had falls in the previous year and that proportion was higher among females 29.8% (n= 204) and elderly above 75 years of age 32.8% (n=123). Among the elderly, 43.7% (n=524) had limited their day to day activities due to fear of a fall and 48.6% (n=583) perceived falls as a significant health problem. Conclusions: There was high prevalence of falls among the elderly and this had an impact on day to day activities. Prevalence of known risk factors for falls was high among the study population. OP 35: Community incidence of snakebite in the Anuradhapura district A Kasturiratne1, NK Gunawardena1, BA Wijayawickrama1, SF Jayamanne1, A Pathmeswaran1, G Isbister2, A Dawson2, HJ de Silva1 1 Faculty of Medicine, University of Kelaniya 2 South Asian Clinical Toxicology Research Collaboration Introduction and Objectives: The community incidence of snakebite in Sri Lanka is unknown. To investigate incidence of snakebite, we undertook a community study in the Anuradhapura district as part of an ongoing countrywide survey on snakebite. Methods: The survey was designed to sample at least 1% of the population in each district. Within the district, a Grama Niladhari (GN) division, was defined as a cluster for data collection. The number of clusters required to sample at least 1% of the population was first determined, and clusters were then selected using simple random sampling. In each selected cluster 40 households were sampled consecutively from a random starting point. Population estimates of snakebite were constructed for the district. Results: The Anuradhapura district has a total of 694 GN divisions, and 84 were surveyed. This included 3357 households and a population of 13,428 (1.6% of the district’s population). Eightysix snakebites were reported within the last 12 months. Extrapolating this to the district (mid-year population=855,373), the estimated snakebites in Anuradhapura district was 5478. The crude community incidence of snakebite in the Anuradhapura district was 640.5 per 100, 000 population. Conclusions: The incidence of snakebite in the community is high in the Anuradhapura district, with one in 156 persons bitten annually.

Free Paper Session 5: Non Communicable Diseases OP 36: Improvement of perceived quality of life with a reinforcement programme on lifestyle modification in patients with knee joint osteoarthritis LPK Senaratne, TSP Samaranayake, LS Wijayaratne Post Graduate Institute of Medicine Introduction and Objectives: Ageing of the population has resulted in an increasing number of people living with chronic diseases like osteoarthritis (OA) of the knees, which affects their quality of life. According to NICE guidelines, non-pharmacological options which include patient education, self management and exercise are core Page 97 of 142

ABSTRACTS OF ORAL PRESENTATIONS

treatment which should be offered for every person with OA knees. Objectives of the study were to compare the improvement of quality of life of patients with knee OA following a reinforcement programme on life style modification (RPLM) with a group receiving standard treatment. Methods: A randomised controlled single blind study was carried out on 60 patients in the Rheumatology clinic of the National Hospital of Sri Lanka. Basic demographic data was collected and each participant answered WHOQOL-BREF Sinhalese version. RPLM was implemented in the intervention group. Three months later WHOQOL-BREF was administered to all participants. Domains scores were calculated and paired t test was used to compare the mean scores. Results: Mean scores of all domains except the social domain were above 50 in both intervention and control groups at enrolment. Mean score of the physical and psychological domains and the overall quality of life increased only in the intervention group after the reinforcement programme and all these were statistically significant ( p< 0.05). Conclusions: Reinforcement programmes increased the perceived quality of life related to physical and psychological health and overall quality of life of patients with knee osteoarthritis. OP 37: A new people-friendly epidemiological approach to confirm the elimination of lymphatic filariasis in Sri Lanka TC Yahathugoda1, MVWeerasooriya1, F Nagaoka1, H Takagi1, E Kimura1, WA Samarawickrema2, M Itoh1 1 Department of Infection and Immunology, Aichi Medical University School of Medicine, Aichi, Japan 2 Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna Introduction and Objectives: Currently, the national Programme to Eliminate Lymphatic Filariasis (PELF) seeks cost-effective, people-friendly approaches to confirm the absence of transmission. Objectives were to develop a rapid assessment procedure (RAP) to identify endemicity, to assess usefulness of IgG4 urine ELISA in monitoring mass drug administration (MDA), simplify the urine ELISA and develop a xenodiagnosis method to supplement urine based surveillance tool. Methods: A RAP questionnaire was administrated among 2105 local leaders in Matara district, to ascertained number of elephantiasis and hydrocoele cases. Urine based diagnostic test was carried out among children in 7 schools in Deniyaya, before and after 5 rounds of MDA. A new visual immunodiagnosis method using red-colored latex beads was developed. A new loop-mediated isothermal amplification (LAMP) method was developed to detect filarial DNA. Results: In 2436 subjects tested, hydrocoele prevalence was high by RAP, the positive rates for antigen and antibody were 0.6% and 4.3%, respectively. The pre-treatment IgG4 prevalence of 3.20% in 2002 decreased to 0.91% in 2003 after the first MDA (p< 0.001), and to 0.36% in 2007 after the 5th MDA. The new visual immunodiagnosis showed sensitivity of 87.2% (136/156 ICT positives) and specificity of 97.2%. The LAMP method detected W. bancrofti DNA in 1000Âľl of blood or in a pool of 60 mosquito vectors. Conclusions: As a people-friendly approach, we used urine instead of blood to detect filaria-specific IgG4, We also used LAMP method to detect W. bancrofti DNA in vectors. Both methods vastly improved cost-effectiveness and are therefore recommended for assessment of LF status in Sri Lanka. OP 38: Rickettsial infections in acute coronary syndromes P Ranjan, KCD Mettananda, DST Danansuriya, NKBKRGW Bandara, HJ de Silva Department of Medicine, Faculty of Medicine, University of Kelaniya Introduction and Objectives: Rickettsiae are a group of obligate intracellular pathogens which invade endothelial cells causing vasculopathy. Vasculitis of any cause may result in acute coronary syndromes (ACS). Objectives were to assess the prevalence of Rickettsial infections in patients with ACS from Western province, Sri Lanka. Methods: Prospective patients from Western province with ACS admitted to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama from April-December 2011 were recruited as the study group. A matched control group was selected from in-ward-patients without fever or ACS. Serum samples (2ml) collected at enrolment and after 2 weeks were analysed. Rickettsial-antibody (IgG) titre >128, or a rising or a declining titre were considered positive for acute rickettsioses. A static titre was considered as previous exposure to rickettsioses (sero-prevalence). Results: Of the 46 patients with ACS 11 (23.9%) were male and of the 52 controls 26 (50%) were male. Mean age Page 98 of 142

ABSTRACTS OF ORAL PRESENTATIONS

was, ACS=60.7 years and controls= 55.98 years. None had evidence of acute rickettsiel infection. In ACS group, 3 and 7 were positive for IgG-OT-Orientia tsutsugamushi (prevalence=0.065) and Ig-RC-Rickettsia conori (prevalence=0.152) respectively. In the control group 2 were positive for IgG-OT( prevalence = 0.038) and 6 for IgG-RC (prevalence = 0.115). There was no significant difference in sero-prevalence of rickettsie- antibodies in the study group compared to controls; odds-ratio IgG-OT 1.744 (CI, 0.278-10.928) and IgG-RC 1.376 (CI, 0.4274.438). Conclusion: Sero-prevalence of Orientia tsutsugamushi was 0.038 while that of Rickettsia conori was 0.115 in the selected population. Rickettsia conori was more prevalent than Orientia tsutsugamushi in the Western province of Sri Lanka. There was no significant association between sero-prevalence of rickettsioses and acute-coronarysyndromes. OP 39: Intramuscular haloperidol vs. olanzapine for rapid tranquillization: a double blind randomised controlled trial WMH Wijesundara1, R Hanwella2, J Mendis3, VA de Silva2 1 National Hospital of Sri Lanka, Colombo 2 Department of Psychological Medicine, Faculty of Medicine, University of Colombo 3 National Institute of Mental Health, Angoda Introduction and Objectives: Intramuscular olanzapine and haloperidol are commonly used for rapid tranquilization. Previous four head to head trials comparing these medications have yielded conflicting results. Objectives were to compare efficacy and safety of intramuscular haloperidol and olanzapine in the treatment of acute agitation in patients with schizophrenia or bipolar disorder. Methods: Acutely agitated patients diagnosed with schizophrenia or bipolar disorder, aged 18-65 years with a total score of Positive and Negative Symptoms Scale-Excited Component (PANSS-EC) â&#x2030;Ľ14 or at least one item with a score of â&#x2030;Ľ4 were selected. Ninety two patients were randomized using computer generated random numbers in block size of four. They received intramuscular haloperidol 10 mg or intramuscular olanzapine 10 mg. The primary outcome measure PANSS-EC was measured every 15 minutes for two hours. Patient and assessor were blind to allocation. Results: Mean reduction in PANSS-EC after two hours was haloperidol=18.07 and olanzapine=19.35. Repeated measures ANOVA with a Greenhouse-Geisser correction determined that reduction in agitation (mean PANSS-EC) was significant between time points for haloperidol (F=79.66, p<0.001) and olanzapine (F=102.51, p<0.001). There was no significant difference between haloperidol and olanzapine (F=0.665, p=0.592). The number with extrapyramidal side effects were haloperidol n=6, olanzapine n=11. Restraining was required in haloperidol n=9 olanzapine n=18. These differences were not statistically significant. There was no significant difference in side effects-hypotension, slurring or bradycardia. Conclusions: Haloperidol and olanzapine are both effective in reducing agitation but there is no significant difference in efficacy or safety between the two. OP 40: Meeting challenges of microscopic diagnosis in malaria surveillance under field conditions in Sri Lanka SD Fernando1, RL Ihalamulla2, J Tillekeratne2, R Wickremasinghe3, P Wijeyaratne2, NL de Silva4, R Premarathna5 1 Department of Parasitology, Faculty of Medicine, University of Colombo 2 Health Associates (PVT) Limited, (TEDHA), Colombo 3 Department of Parasitology, Faculty of Medicine, University of Sri Jayawardenepura 4 Faculty of Medicine Colombo 5 Anti Malaria Campaign, Colombo Introduction and Objectives: Individuals with fever are screened for malaria by activated passive case detection in hospitals in the Northern and Eastern Provinces by Tropical and Environmental Diseases and Health Associates Private Limited. Because a large volume of malaria negative blood smears are screened, it is necessary to maintain high diagnostic accuracy. Methods: Changes were made to the protocol of the standard technical procedures required to prepare, stain and examine blood smears for malaria parasites. Quality of the smear according to WHO criteria and time taken for the report to be issued were recorded. After implementing the new protocol, the same parameters were recorded. The diagnostic capability of microscopists was assessed by field visits and test slide packs before and after intervention. Page 99 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Results: Streak formation in thin smears was reduced from 29.4% to 5.1%. The average fixation time of thick smears was reduced from 2.4 hours to 20 minutes. Improper thickness reduced from 18.5% to 5.4% and improperly fixed thick smears from 4% to 3%. Overall quality of thick smears and thin smears increased from 76% to 98% and 81.7% to 87%, respectively. The quality of slides bearing both thick and thin smears increased from 60% to 87%. The competency in diagnosis increased to 100%. Conclusions: New protocol ensured that good quality blood smears were prepared rapidly, reducing the time required to issue reports to patients in resource poor rural hospitals under field conditions. Acknowledgements: Financial Assistance by the Global Fund Grant No. PR2SRL809G11-M is gratefully acknowledged. OP 41: Prolonged internal displacement and common mental disorders in Sri Lanka: the COMRAID study C Siriwardhana1, A Adikari1, S Siribaddana1, A Sumathipala1 1 Institute of Psychiatry, King's College London Introduction and Objectives: There is little evidence about mental health issues of internally displaced persons in Sri Lanka, particularly where displacement is prolonged. The COMRAID study was carried out in 2011. It was a comprehensive evaluation of displaced Muslims in North-Western Sri Lanka, initially displaced in 1991 due to the conflict. The objective was to investigate the prevalence and correlates of common mental disorders in this group. Methods: A cross-sectional survey was carried out among a randomly selected sample of internally displaced person displaced within the last 20 years or were born in displacement. The total sample consisted of 450 adults above 18 years, selected from 141 settlements. Prevalence of common mental disorders and post-traumatic stress disorder were measured using Patient Health Questionnaire and other instruments. Results: The prevalence of any common mental disorder was 18.8%. Prevalence of individual disorders were as follows: somatoform disorder 14.0%, anxiety disorder 1.3%, major depression 5.1%, other depressive syndromes 7.3%. Prevalence of post Traumatic Stress Disorder was 2.4%. The following factors were significantly associated with common mental disorders; unemployment OR 2.8 (95% CI 1.6-4.9), widowed or divorced status OR 4.9 (95% CI 2.3-10.1) and food insecurity OR1.7 (95% CI 1.0-2.9). Conclusions: This is the first study in post-conflict Sri Lanka to investigate the mental health impact of prolonged, forced displacement. The overall prevalence of common mental disorder was 18.8%. There was significant association with unemployment, widowed or divorced marital status and food insecurity. OP 42: Prevalence of psychological morbidity in an urban population: Is it related to modifiable physical risk factors? SS Williams, MJ Pinidiyapathirage, LT Wijeratne, A Kasturiratne, MUPK Peris, HSA Williams, AR Wickremasinghe Faculty of Medicine, University of Kelaniya Introduction and Objectives: To determine the prevalence of psychological morbidity and its relationship to diabetes mellitus, hypertension and alcohol use in an urban population in Sri Lanka. Methods: This study was conducted in the Ragama Health Study cohort that consists of 2986 individuals, between 35-64 years of age, living in the Ragama Medical Officer of Health area in the district of Gampaha. Subjects were selected using age-stratified random sampling, from the electoral lists in 2007, and investigated using clinical, biochemical and anthropometric examinations. Psychological morbidity was estimated using a pre-validated K10 questionnaire which has high sensitivity and specificity for non psychotic psychiatric disorders and a self administered GHQ 30 questionnaire. Baseline age-adjusted prevalence and three year incidence of hypertension and diabetes were estimated. Odds ratios for independent risk factors were calculated. Results: The prevalence of psychological morbidity identified using the K10 questionnaire ranged from 18- 26% in a total population of 2919. Females had a higher prevalence of psychological morbidity than males (28.6% vs 22.4%; p<0.001). Diabetic or hypertensive status and alcohol use did not predict psychological morbidity. A self report of overall low health status was predictive of psychological morbidity OR1.925 (95% CI 1.62 â&#x20AC;&#x201C; 2.28). Discussion: High prevalence of psychological morbidity was identified in this community study. Females are more at risk. In the initial analysis, psychological status was not associated with diabetes mellitus, hypertension or alcohol use.

Page 100 of 142

ABSTRACTS OF ORAL PRESENTATIONS

OP 43: Association of genetic variants with non-alcoholic fatty liver disease in an urban Sri Lankan community MA Niriella1, A Kasturiratne1, F Takeuchi1, K Akiyama2, AS Dassanayake1, AP De Silva1, AR Wickremasinghe1, N Kato2, HJ De Silva1 1 Faculty of Medicine, University of Kelaniya, Ragama 2 Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan Introduction and Objectives: PNPLA3 rs738409 polymorphism is the most reproducible association with susceptibility to NAFLD across diverse populations. Other genetic variants have been identified, but mainly in Western populations. No large community-based genetic studies have been performed in South Asians. Methods: We investigated the association of selected genetic variants with susceptibility to NAFLD and its associated phenotypes as part of an ongoing prospective, large community-based cohort study among urban Sri Lankan adults (n=2986). We selected 10 single nucleotide polymorphisms (SNPs), all previously found to be associated with NAFLD, in a case-control replication study. They included loci derived from Genome-wide association studies [PNPLA3 (rs738409), LYPLAL1 (rs12137855), GCKR (rs780094), PPP1R3B (rs4240624), NCAN (rs2228603)] and candidate gene studies [APOC3 (rs2854117, rs2854116), ADIPOR2 (rs767870) and STAT3 (rs6503695, rs9891119)]. Results: Of the 2986 participants, a sample of 2979 were genotyped. PNPLA3 (rs738409) was associated with susceptibility to NAFLD (OR 1.25, 95% CI 1.08-1.44, P= 0.003) and lower serum triglycerides [Regression coefficient -18.486 (95% CI 28.381 to -8.592); p=0.0002]. None of the other SNPs were associated with NAFLD or related phenotypes. Conclusions: In this Sri Lankan community based cohort only PNPLA3 (rs738409) was associated with susceptibility to NAFLD, the first community based study in a South Asian population to demonstrate this association. Our failure to demonstrate previously reported associations of other genetic polymorphisms highlights the complex genetic heterogeneity of the disease, and reinforces the importance for further genetic research in diverse populations in order to understand its pathophysiology. OP 44: Chracterisation of beta globin mutations in Sri Lankan patients with betathalassaemia intermedia P Anuja1, S Perera2, DPSI Silva2, M Hapugoda2, MN Wickramarathne2, I Wijesirwardhena2, DG Efremove3, CA Fisher4, DJ Weatherall4, AP Premawardhena1 1 University of Kelaniya 2 University of Sri Jayawardhenapura 3 Inetrnational Centre for Genetic Engineering, Italy 4 University of Oxford Introduction and Objectives: Patients with beta thalassaemia intermedia account for a third of patients attending thalassaemia clinics in Sri Lanka. They show immense phenotypic diversity, the genetic basis for which has not been identified so far. Objective were to characterise beta globin gene mutations in Sri Lankan thalassaemia intermedia patients and to determine how it to influences disease severity. Methods: We identified 64 thalassaemia intermedia patients from the five main thalassaemia centers; Anuradhapura (n= 6), Kurunegala (n= 4), Ragama (n= 42), Badulla (n=7) and Chilaw (n=5). Their beta globin DNA sequences were analyzed using ABI PRISM 3131x genetic analyser. Results: Of sixteen patients identified to be homozygous for beta mutations, eleven carried mild beta alleles, IVSI 5 G_C (n= 10) and a rare homozygous promoter mutation - 90 C_T (N=1). Other five were shown to have different types of severe mutations in homozygous state. Nearly half the sample (n=39) was heterozygous for beta mutations. Of them 33 showed mild to severe mutation in one of the alleles IVSI-5 G_C (n=12), IVSI-1 G_A (n= 11) were the commonest. Two patients who were heterozygones for beta mutation had a highly unstable Hb variant haemoglobin Mizuho causing severe haemolytic anaema. Hb variants Hb G-Szuhu and Hb G-Coushatta were identified in two patients. Conclusions: We identified types of beta mutations in some patients with thalassaemia intermedia, which account for the clinical severity. OP 45: Hepatocellular carcinoma in Sri Lanka: Where do we stand? RC Siriwardana1, CAHL Liyanage1, DSP Jayatunge1, A Dassanayaka2,MG Gunetileke1, MA Niriella3, C Sirigampola4,A Upasena4,,HJ de Silva3 Page 101 of 142

ABSTRACTS OF ORAL PRESENTATIONS

Departments of 1Surgery, 2Pharmacology and 3Medicine, Faculty of Medicine, University of Kelaniya 4 North Colombo Teaching Hospital Introduction and Objectives:Hepato-cellular carcinoma (HCC) is the sixth commonest cancer worldwide. We studied 105 consecutive patients with HCC in a single tertiary care centre. Methods: North Colombo Liver Unit maintains a prospective database of HCC since September 2011. There were 105 entries by February 2013. Decision on the best form of treatment was taken at a multidisciplinary meeting. Results: The median age at presentation was 63 years (range 12-79). Patients were predominantly male 93 (87%). Alcohol consumption above the safe limit was reported in 47 (45%). Hepatitis B surface antigen or C antibody was not detected in any of the patients. Background liver cirrhosis was evident in 59 (79%). Forty two (46%) patients had single nodular tumours while in 20 (21%) it was diffusely infiltrating. Portal vein invasion was seen in 22 (20 %). Median alpha-feto protein (AFP) level was 57.25 mg/ml (1.16- 94120 ng/ml; n=72). Twenty four (33%) patients had AFP level > 400u/l. Surgery was performed in 20 (19%), liver transplant in 2 (1.9%), radiofrequency ablation or alcohol ablation in 8 (7.6%), trans arterial chemo embolization (TACE) in 44 (41.9%) and sorafinib was prescribed in four patients. Overall mean survival was 15 months. In the ‘no treatment’ group, mean survival was 4 months. Surgery group had a mean survival of 20 months. Conclusion: Hepatitis B is not a risk factor for HCC in Sri Lankans. Median survival without treatment is 4 months. OP 46: Role of red cell distribution width in screening for Hb E trait in population screening for haemoglobin disorders AAN Nishad1&2, IS de Silva2, HL Perera2, A Pathmeswaran2, AP Premawardhena2 1 Post Graduate Institute of Medicine, University of Colombo. 2 Faculty of Medicine,University of Kelaniya. Introduction and Objectives: The national screening policy for haemoglobinopathies uses the red cell indices MCV <80 and MCH<27 as cut offs, a strategy known to miss some individuals with Hb E trait (EBT), the commonest abnormal haemoglobin in Sri Lanka. We investigated the possibility of increasing the accuracy of red cell indices in detecting Hb E trait. Objective was to determine if red cell distribution width (RDW) cut off values would help increase sensitivity of screening for Hb E trait. Methods: Mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and red cell distribution width (RDW) of all samples referred for thalassaemia screening were measured using the Coulter counter. High Performance Liquid Chromatography (HPLC) was carried out as the gold standard to detect haemoglobinopathies. Receiver Operating Characteristic (ROC) curve was drawn to determine the cut-off value for EBT against Beta trait (BTT) and other anaemias. Results: There were 246 BTT, 110 EBT and 151 other anaemias. Mean (SD) MCV of BTT 62.7 (5.9), EBT 73.4 (7.4) and other anaemias 71.3 (8.3) femtolitres (p<0.001). Mean (SD) MCH of BTT 19.6 (2.1), EBT 24 (2.7) and other anaemias 22.8 (3.6) (p<0.001). Mean (SD) RDW among BTT were 16 (2.8), EBT 14.5 (2.9) and other anaemias 15.8 (4.2) (p<0.001). Using 14.45 as cut off for RDW in addition to accepted cut off values for MCV<80 and MCH<27, gave a predictive sensitivity of 98.2% for EBT. Discussion: By using RDW cutoff at 14.45 in addition to the accepted screening indices, sensitivity of Hb E trait detection went up from 86.6% to 98.2%. This study highlights the importance of taking RDW into consideration for screening. OP 47: The clinical profile of adult Sri Lankans with microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital Introduction and Objectives: Objective was to study the clinical profile of adult Sri Lankans with microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital. Methods: Case notes of 83 consecutive patients admitted to medical units of Sri Jayawardenepura General Hospital, Kotte, histologically diagnosed with microscopic colitis from January 2008 to January 2012 were retrospectively analyzed. Results: Age range was 21-84 years, mean age 51.1 ±17.4 years. Sex distribution male: female (1.3:1). Presentations were watery diarrhea (55.4%), abdominal pain (42.2%), weight loss (40.9%), asthenia (38.1%) and Page 102 of 142

ABSTRACTS OF ORAL PRESENTATIONS

bleeding per rectum (2.4%). There were no major associated background problems in 71.1%. Hypertension, diabetes mellitus or bronchial asthma was present in 21.7%, 8.0% and 7.2% respectively. The salient histological feature was infiltration of plasmacytes and lymphocytes beyond lamina propria without other specific features of colitides. Rectum, sigmoid, transverse colon, ascending colon, descending colon and ceacum were histologically involved in 89.2%, 86.7%, 68.7%, 65.1%, 60.2%, 38.1% respectively. Pancolitis was seen in 25.3%. Inflammatory markers (ESR and/or CRP) were elevated in 20.8% who were investigated. Neutrophilia was present in 13.3%. Non steroidal anti inflammatory drugs and proton pump inhibitors were prescribed in 6.0% and 4.8% of those where treatment information was available. Conclusions: Microscopic colitis not specified otherwise is an ill defined colitis which could represent low grade immunological reaction to an unidentified intra-luminal antigen, which causes therapeutic dilemmas. Further studies are needed for better categorization and to define the outcome. OP 48: Demographic and clinical profile of adult Sri Lankans with hepatocellular carcinoma admitted to medical units of a tertiary referral center IGI Dissanayake, RL Satarasinghe, NS Jayasinghe, PJ Rathnayake, R Wijesinghe Sri Jayewardenepura General Hospital Introduction and Objectives: Objectives were to study the demographic and clinical profile of adult Sri Lankans with hepatocellular carcinoma over the last 4 years. Methods: Clinical notes of 42 patients with hepatoma admitted to medical units at Sri Jayawardenepura General Hospital, Kotte from January 2008 to January 2012 were retrospectively analysed. Results: The age range was 43-91 years with a mean age of 65.5 Âą11.1. Sex distribution was male: female (9:1). Of the sample 90.5% were dependent on alcohol. Established liver disease at the time of diagnosis was seen in 57.1%. Radiological evidence of cirrhosis was present in 27.7% of patients with undiagnosed liver disease at presentation. On presentation ascites, abdominal pain, hepatic encephalopathy, anorexia and weight loss were found in 38.1%, 19%, 19%, 16.7% and 14.7% respectively. Uni-focal tumours were found in 61.9%. Secondaries were seen in 11.9%. The detectable sites were lymph nodes, bones, lungs, and the inferior vena cava extending into the right atrium. Hepatitis B and C infection were not identified. The available curative therapeutic modalities were minimal. Conclusions: A marked male dominance was seen. Alcohol dependence was the commonest cause. Hepatoma can be the first presentation of undiagnosed liver disease. In all patients the diagnosis was made at an advanced stage of the tumour resulting in poor prognosis. We recommend that ultrasound scanning of the abdomen and alpha-feto protein estimation is done every six months in patients with chronic liver disease.

Page 103 of 142

LISTOF POSTER PRESENTATIONS

LIST OF POSTER PRESENTATIONS PP 01: Audit on use of palivizumab RMS Perera, S Ali General Hospital, Nuwara Eliya PP 02: An analysis of hospital admissions and notification rates of food poisoning in Sri Lanka MAA Shahmy, UIP Gallage, Jennifer Perera Department of Microbiology, Faculty of Medicine, University of Colombo PP 03: Knowledge and self reported practices regarding infection control methods among selected â&#x20AC;&#x153;Minor Health Care Workersâ&#x20AC;? S Goonewardena, C Porutota, CSE Goonewardena, WAA Wijayasiri University of Sri Jayewardenepura PP 04: Knowledge regarding rabies among grade ten students in the Nugegoda education division DMS Jayawardene, NS Gunawardene Department of Community Medicine, Faculty of Medicine, University of Colombo PP 05: Survey of newspapers on reporting of food-borne infection outbreaks: a retrospective survey DVW Walatara, Jennifer Perera Department of Microbiology, Faculty of Medicine, University of Colombo PP 06: A case of Kikuchi disease: a rare condition in Sri Lanka NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital PP 07: A rare occurrence of sarcoidosis with both dilated and restrictive cardiomyopathy NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital PP 08: A case of symptomatic severe myositis in dengue fever NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital PP 09: Fever detection and management practices in children with dengue fever PKB Mahesh, SM Arnold Ministry of Health PP 10: A recurring, chronic case of atypical cutaneous leishmaniasis prevailing for 8 years KKGDUL Kariyawasam, I Kahawita, HVYD Siriwardana, ND Karunaweera Department of Parasitology, Faculty of Medicine, University of Colombo PP 11:L.donovani in Sri Lanka: clinico-epidemiological patterns and antibody response AMBWMRNN Ekneligoda1, HVYD Siriwardana1, PH Chandrawansa1, G Sirimanna1, V Warnasooriya1, S Ranasinghe2, ND Karunaweera1 1 Faculty of Medicine, University of Colombo 2 General Hospital, Panadura PP 12: Comparison of clinical features of dengue illness in Colombo: a prospective hospital based study GJ Kottegoda1, DE Kannangara1, HMRH Denuwara1, H Tissera1, P Palihawadana1, A Amarasinghe1, S Gunasena2, A de Silva3, A Wilder-Smith4, DJ Gubler5 1 Epidemiology Unit, Ministry of Health Page 104 of 142

LISTOF POSTER PRESENTATIONS

Medical Research Institute, Colombo University of North Carolina 4 Centre for Global Health Research at University of Umea, Sweden 5 Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawai 3

PP 13: Knowledge, attitude and practice of primary wound care in prevention of rabies: a descriptive cross sectional study in Colombo SA Mendis, S Mathotaarcchchi, H Meegahapola Faculty of Medicine, University of Colombo PP 14: Secondary Bacteraemia in Dengue patients with Prolonged Fever GND Dissanayake, FHDS Silva, M Dassanayake, R Premaratne University Medicine Unit, Teaching hospital, Ragama PP 15: Cutaneous leishmaniasis amongst military personnel in the Northern Province of Sri Lanka: findings from a preliminary study S Semege 1 , S Ranasinghe2, N Pathirana2, R Wickremasinghe2 1 Sri Lanka Army Medical Services 2 Department of Parasitology, Faculty of Medicine, University of Colombo PP 16: Viral characteristics and genomics of early onset, single organ specific presentations in dengue R Premaratna1, HKK Perera2, KH Chan2, MF Yeung2, C Meththananda2, JSM Peiris2, HJ de Silva1 1 Department of Medicine, Faculty of Medicine, University of Kelaniya 2 School of Public Health University of Hong Kong, Hong Kong PP 17: Comparison of clinical and laboratory parameters between Rickettsiosis positive and negative children R Premaratna, KAW Karunasekara, MAM Fernando, L de Silva, TGAN Chandrasena, HJ de Silva, JKND Miththinda, MNF Mufeena, KSK Madeena, NKBKRGW Bandara Department of Medicine, Faculty of Medicine, University of Kelaniya PP 18: Clinical characteristics of paediatric rickettsioses R Premaratne, KAW Karunasekera, MAM Fernando, L de Silva, TGN Chandrasena, HJ de Silva Faculty of Medicine, University of Kelaniya PP 19: Detection of a porcine rotavirus in a child with acute diarrhoea in Sri Lanka N Chandrasena1, M Takaki2, TGN Chandrasena2, S Rajindrajith2, NK Gunawardena2, A Nishizono2, K Ahmed3 1 Department of Parasitology, Faculty of Medicine, University of Kelaniya 2 Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Oita, Japan 3 Research Promotion Institute, Oita University, Yufu, Oita, Japan PP 20: Factors affecting urine culture contamination among in-ward patients in National Hospital of Sri Lanka JK Liyanagamage, LM Kasthuriarachchi, GSP Keerthisena Faculty of Medicine, University of Colombo PP 21: Species identification of nontuberculous Mycobacteria (NTM) by conventional biochemical methods and DNA sequencing of 16s rDNA and DNA gyrase B genes PJ Kumarasiri, Jennifer Perera, GMM Perera, S Gamage Department of Microbiology, Faculty of Medicine, University of Colombo PP 22: A study on completeness of entries and utilization of Child Health Development Record by mothers and health care workers YDRM Gunaratne, KKK Gamage, RS Gamage Faculty of Medicine, University of Colombo Page 105 of 142

LISTOF POSTER PRESENTATIONS

PP 23: Prevalence and factors associated with anaemia among children aged 12-59 months in Jaffna district K Kandeepan, S Balakumar, V Arasaratnam Faculty of Medicine, University of Jaffna PP 24: Selected birth-related risk factors of acute lower respiratory tract infections in infants at a selected hospital SMD Mendis, MM Mohamed, MEC Muhandiram Faculty of Medicine, University of Colombo PP 25: Identification of aero-allergens in children seeking treatment for bronchial asthma at the Lady Ridgeway Childrenâ&#x20AC;&#x2122;s Hospital Colombo JASSK Jayasinghe1, MP Senanayaka1, R de Silva2, MDCJP Jayamanna2, V Jayasuriya2, GN Malavige3 1 Department of Paediatrics, Faculty of Medicine, University of Colombo Departments of 2Community Medicine and 3Microbiology, Faculty of Medical Sciences, University of Sri Jayawardenepura PP 26: Meconium stained liquor and the outcome of neonates: a retrospective study TRN Fernando, NAPJ Senewirathna, AGPM Padeniya University of Rajarata PP 27:Pre hospital care received by injured children aged less than five years admitted to Lady Ridgeway Hospital S Goonewardena, CSE Goonewardena, WAA Wijayasiri University of Sri Jayewardenepura PP 28: Cancer in a general paediatric ward: the morbidity pattern over one year DS Gunasekera, MP Senanayaka Lady Ridgeway Hospital, Colombo PP 29: Walking the wire: prevalence and factors associated with occupational injuries among Ceylon Electricity Board labourers in Western Province North RU Mambulage, V Jayasuriya Anti Leprosy Campaign PP 32: Balance confidence among soldiers with unilateral below-knee amputations attending a rehabilitation institute in Ragama TKC Peiris, NR Perera Allied Health Sciences Unit, Faculty of Medicine, University of Colombo PP 33: Injury pattern of terrorist suicide bombers in Sri Lanka: a review of two decades UCP Perera, HTK Wijayaweera, SPA Hewage, S Cordner University of Ruhuna, Sri Lanka PP 34: Association of estimated glomerular filtration rate and albumin to creatinine ratio in type 2 diabetic patients with diabetic retinopathy: a preliminary study NN Wijayatunga, H Peiris, PPR Perera, K Wanigasuriya Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayawardenepura PP35: The risk factors for Chronic Kidney Disease in the Polpitigama Divisional Secretariat Division PVDS Dharmagunawardena1, RMSK Rathnayake2, R Vipula Shantha2, NR Abeynayake2, WADV Weerathilake2 1 Post Graduate Institute of Medicine 2 Wayamba University of Sri Lanka, Makandura

Page 106 of 142

LISTOF POSTER PRESENTATIONS

PP 36: Differences in estimation of glomerular filtration rate using three standard formulae in selected type 2 Diabetic patients NN Wijayatunga, PPR Perera, K Wanigasuriya, H Peiris Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayawardenepura PP 37: Predictors of post-operative serum creatinine in kidney transplant receipients VH Gamage, A Abayadeera, RJMKA Jayasundara, YHH Guathilaka, DP Jayasekara Department Of Surgery, Faculty Of Medicine, University Of Colombo PP 38: Frequency, pattern and outcome of renal dysfunction in patients with cirrhosis: a prospective study using the proposed ADQI-IAC criteria ST De Silva, KRP Perera, MA Niriella, A Pathmeswaran, HJ de Silva Faculty of Medicine, University of Kelaniya PP 39: Can we salvage failing arteriovenous fistulae by minimal invasive method?: a first Sri Lankan experience CW Weerasinghe, N Seneviratne, BI Bulathsinghala, DM Liyanage Teaching Hospital Anuradhapura PP 40: Early and late complications of patients who died after kidney transplantation: experience from a single ward YHHGunathilaka, RJMKA Jayasundara, DP Jayasekara, SM Wijeyaratne, MRN Cassim Faculty of Medicine, University of Colombo PP 41: Need of inotropes for optimal renal graft perfusion in renal transplant recipients VHA Gamage, A Abayadeera Department Of Surgery, Faculty of Medicine, University of Colombo PP 42: Patient characteristics and treatment modalities in adults with immune thrombocytopenia: experience from a single centre BCM Wimalachandra, EH Wijesinghe, LV Gooneratne Department of Pathology, Faculty of Medicine, University of Colombo

Free Paper Session 6: Toxicology and Elderly Medicine PP 43: Barriers to cataract surgery among elderly in Mahara Divisional Secretariat Division AAN Nishad1, MS Amaratunga2, KTAA Kasturiratne2, J de Silva2, J Mallawarachchi2, AR Wickramasinghe3 1 Post Graduate Institute of Medicine, University of Colombo 2 Wijaya Kumaratunga Hospital, Seeduwa 3 Faculty of Medicine, University of Kelaniya PP 44: Hypoglycaemia among patients with type II diabetes mellitus: A retrospective study UDCA Perera, FHDS Silva, ST De Silva Faculty of Medicine, University of Kelaniya PP 45: Knowledge, attitudes and practices regarding type 2 diabetes mellitus, nutrition and lifestyle in urban Sri Lankan women I Waidyatilaka1, PHIU Waidyatilaka1, A de Silva1, S Atukorala1, N Somasundaram1, P Lanerolle1, R Wickremasinghe2 1 Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo 2 Department of Public Health, Faculty of Medicine, University of Kelaniya PP 46: Cut-off values for percentage body fat, in Sri Lankan adolescent girls M de Lanerolle-Dias, P Lanerolle, S Atukorala, A de Silva Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo Page 107 of 142

LISTOF POSTER PRESENTATIONS

PP 47: Obesity and hypertension in patients with newly diagnosed type 2 diabetes mellitus: a clinic based prospective study UAD Wijesinghe, A Medagama, NSB Dissanayake National Hospital of Sri Lanka, Colombo PP 48: Prolactin and male infertility T Weerasooriya, I Illeperuma, R Hasan, WS Weerasinghe, AKG Withana Faculty of Medicine, University of Kelaniya PP 49: Hypoglycaemia: What do we know of the cause? HA Dissanayake, KKK Gamage, JH Liyanage, GSP Keerthisena , WA Wijesundara, WMUA Wijetunga ,S Subasinghe, TAD Tilakaratne, P Katulanda Diabetic Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 50: Obesity in children: an experience from Jaffna MG Sathiadas, P Tharshigan, S Balakumar University of Jaffna PP 51: Life style during menstrual periods among adolescent school girls RJMKA Jayasundara, SD Jayawickrema, AU Gamage, TAAOT Jayaweera, Faculty of Medicine, University of Colombo PP 52: Use of mid upper arm circumference and skinfold thickness as alternatives for Body Mass Index (BMI) to assess underweight among cardiac patients in Sri Lanka NC Lokunarangoda1, AK Pathirana1, N Thalagala1, KKS Chinthanie1, R Jayawardena1, WS Santharaj1 1 Institute of Cardiology, National Hospital of Sri Lanka, Colombo PP 53: Physical activity and weight gain during the period from first trimester of pregnancy to six months post partum M G S N S Perera, C Abeysena Ministry of Health-MOH Office, Mahara PP 54: Survival of patients treated with Percutaneous Transluminal Coronary Angioplasty following ST segment elevation myocardial infarction V Abeysuriya1, A Kasturiratne1, LG Chandrasena2, VS Hettiarachchi2, AR Wickremasinghe1 1 Department of Public Health, Faculty of Medicine, University of Kelaniya 2 Nawaloka hospitals PLC, Cardiology unit PP 55: Electrocardiographic and echocardiographic manifestations of cardiac involvement in leptospirosis T Fernando1, C Rodrigo1, L Samarakoon1, R Navinan1, C Dandeniya1, G Constantine2, S Rajapakse2 1 University Medical Unit, National Hospital of Sri Lanka 2 Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 56: Biochemical and clinical indicators of peripheral neuropathy in patients on long term statin treatment HMST Bandara, DWN Dissanayake, PM Atapattu, MAN Manchanayake, HPC Tissera, SS Batagoda Department of Physiology, Faculty of Medicine, University of Colombo PP 57: Cardiovascular endurance of physiotherapy undergraduates and associated metabolic risks DC Ranasinghe, GLRS Perera, A Rathnayake, A Weththesinghe Allied Health Sciences Unit, Faculty of Medicine, University of Colombo PP 58: Cardiovascular risk among patients attending the Family Practice Centre, University of Sri Jayawardenepura HL de Silva, H de Silva, TSP Samaranayaka, MSA Perera, A Jayawardane, K Dassanayake, T Thilakaratne, MAYR Manchanayaka, MGAI Chulika, PVG Chaturika, KC Jeewandara Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura Page 108 of 142

LISTOF POSTER PRESENTATIONS

PP 59: Effect of sitagliptin on diabetic patients poorly controlled with other oral hypoglycaemic agents GSP Keerthisena, P Katulanda, HA Dissanayake, JH Liyanage, WA Wijesundara, TAD Tilakaratne, WMUA Wijethunga, KKK Gamage, SS Subasinghe, Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 60: Audit on timelines for administration of acute reperfusion therapy in acute ST elevation myocardial infraction at the National Hospital of Sri Lanka AK Pathirana1, WS Santharaj2, RAI Ekanayake2, JB Jayawardena2, V Senaratne2, MP Seneviratne2, KKAO Walawwatta1, KGV Saranga1 1 Institute of Cardiology, National Hospital of Sri Lanka 2 Emergency Treatment Unit, National Hospital of Sri Lanka PP 61: Comparison of electronic and paper based indoor morbidity and mortality reporting systems NC Kariyawasam, MKDRB Dayaratne, SC Wickramasinghe, KKP Sylva University of Tasmania PP 62: Survey of tobacco use among third year medical students in Sri Lanka AP de Silva, P de Silva, IK Liyanage, STGR de Silva, JMWJ Bandara National Intensive Care Surveillance, Ministry of Health PP 63: Current practices and perceived needs of general public on drug information in Sri Lanka AB Padeniya1, H Benaragama2, SK Ananda2, L Jinadasa2, N De Soysa2 , DSilva3, , AP De Silva4 1 Lady Ridgway Hospital 2 General Hospital Kalutara 3 Clinical Pharmacist Australia 4 National Intensive Care Surveillance, Ministry of Health) PP64: Survey of psychoactive substance use among mentally ill patients in unit six, National Institute of Mental Health ADMA Herath, N Fernando, HMAB Herath National Institute of Mental Health, Angoda PP 65: Validation of PHQ-9 questionnaire for use in cardiology clinics in Sri Lanka IH Rajapakse, AS Dissanayake, PA Jayasinghe, CL Fonseka Faculty of Medicine, University of Ruhuna PP 66: Water, sanitation and hygiene (WASH) among school children in a conflict affected area MSK Wickrematilake, SM Arnold, K Pethiyagoda, AM Faizal Department of Community Medicine, Faculty of Medicine, University of Peradeniya PP 67: The Sri Lankan Twin Registry (SLTR) A Sumathipala, S Siribaddana, C Siriwardana, K Jayaweera, A Adikari Institute for Research & Development PP 68: Knowledge, attitude and skills of leadership among final year medical students MUD Yapa, DWN Dissanayake, UP Nanayakkara Department of Physiology, Faculty of Medicine, University of Colombo PP 69: Lapses on pre disaster education: a study in a suburban community in Sri Lanka frequently affected by floods MAC Lakmal, PCI Wijesinghe, I Karunathilake Faculty of Medicine, University of Colombo PP 70: Sri Lankan research output in the global context: where do we stand? AMNL de Silva, P Wijetunga, S Rajapakse Department of Clinical Medicine, Faculty of Medicine, University of Colombo Page 109 of 142

LISTOF POSTER PRESENTATIONS

PP 71: Association between academic performance and emotional intelligence among medical students Jennifer Perera, PHU Cooray, AN Hettiarachchi Faculty of Medicine, University of Colombo PP 72: A study on knowledge and attitudes towards end-of-life decisions of medical and non medical professionals and clergymen V Pinto, MVG Pinto, PVR Kumarasiri, WMABW Eriyawa, SDK Weerasinghe, TMRP Senasinghe Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya PP 73: Evaluation of drug related problems in patients admitted to a medical unit of a tertiary care institute in Sri Lanka. LGT Shanika, TS Guruge, S Jayamanne, N Wijekoon, A De Silva, D Perera, , J Coombes, I Coombes, F Mohamed, A Dawson South Asian Clinical Toxicology Research Collaboration PP74: Factors affecting patient safety culture in a tertiary care hospital MT Amarapathy, S. Sritharan, MALR Perera Sri Jayawardenapura General Hospital PP 75: Students views on learning anatomy: using cadaveric dissections and computer assisted learning EAST Edirisinghe, SG Yasawardene Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenapura PP 76: Emotional reactions of medical students to cadaver dissections EAST Edirisinghe, SG Yasawardene Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenapura PP 77: The use of inappropriate abbreviations in prescriptions NR Samaranayake, PRL Dabare, CA Wanigatunge, BMY Heung University of Sri Jayewardenepura PP 78: Elder abuse in a selected Medical Officer of Health area in the district of Colombo: prevalence of physical, emotional and financial abuse and neglect PC Samaraweera1, S Kathriarachchi2, S Sivayogan3, A Wijayasiri3 1 National Dengue Control Unit, Department of 2Psychiatry and 3Community Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura PP 79: Validation of Sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) and evaluation of health related quality of life among patients with cirrhosis in Sri Lanka JKND Miththinda, CK Ranawaka, A Pathmeswaran, AS Dassanayake, WRS de Alwis, MNF Mufeena, SM Senanayake, MA Niriella, AP de Silva, HJ de Silva Departments of Medicine, Faculty of Medicine, University of Kelaniya PP 80: Liver functions; alpha fetoprotein levels and clinical features in patients with hepatoma NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital PP 81: Autoimmune hepatitis in Sri Lanka: How common are conventional serological markers? KRP Perera1, CK Ranawaka1, FHDS Silva1, JKND Miththinda1, AS Dassanayake1, MA Niriella2, AP de Silva2, HJ de Silva2 1 Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama 2 University Medical Unit, Colombo North Teaching Hospital, Ragama PP 82: Crohnâ&#x20AC;&#x2122;s disease with henoch schonlein purpura: first documented case in Sri Lanka NS Jayasinghe, RL Satarasinghe, R Wijesinghe, PJ Rathnayake, N Rasendran, Sri Jayewardenepura General Hospital Page 110 of 142

ABSTRACTS OF POSTER PRESENTATIONS

ABSTRACTS OF POSTER PRESENTATIONS PP 01: Audit on use of palivizumab RMS Perera, S Ali General Hospital, Nuwara Eliya Introduction and Objective: To compare the current use of palivizumab at Northampton General Hospital against recommendations made by the Joint Committee on Vaccination and Immunization (JCVI) in UK. Method: In this retrospective observational cohort study, data of 18 children followed up from 01.10.2010 to 31.03.2011 for monthly prophylaxis treatment with palivizumab were analysed. Results: Thirteen patients (72%) had been in the special care baby unit. Only two (11%) babies were on home oxygen at the beginning of the study period. Chronic lung disease (CLD) was the main indication to use palivizumab in 12 children (67%). The average stay in special care baby unit for children with CLD was 120 days. Among them, 10 children (83%) did not have any other risk factors associated with CLD. Only 2 children (17%) had associated co morbidities which were pulmonary hypertension and congenital heart disease. In the sub group with congenital heart disease (CHD), majority (83%) had cyanotic heart disease. A total of 31,224 £ was spent on palivizumab with an average cost of 1735 £ per child. Five children were admitted for lower respiratory tract infections during this period and four of them had RSV infection. But they had less severe disease and no deaths were reported. Conclusions: Some of the findings of this study are similar to those of other studies. Two major sub groups who were on palivizumab prophylaxis were CLD and CHD. It is necessary to expand the inclusion criteria in accordance with recommendations made by JCVI. PP 02: An analysis of hospital admissions and notification rates of food poisoning in Sri Lanka MAA Shahmy, UIP Gallage, Jennifer Perera Department of Microbiology, Faculty of Medicine, University of Colombo Introduction and Objectives: Sri Lanka has a good public health system which helps prevent many health hazards. Food poisoning is a notifiable disease and each reported case is investigated. Incidence of food poisoning differs seasonally and regionally but studies are limited. The objectives were to analyze the available data to identify gaps, if any, in notification rates and to identify seasonal and regional variation in notification. Methods: Data from Inward Morbidity and Mortality Register (IMMR) which indicates government hospital admissions for years 2007-2009 and published data from Epidemiological Unit (EU) for years 2007 - 2011 were analysed. Results: For years 2007, 2008 and 2009 island wide incidence of food poisoning, according to IMMR statistics were, 23.65, 22.01 and 20.32 per 100,000 persons. Notification rates as per EU were 5.21, 8.28, and 8.05 per 100,000, indicating a gap of 18.45, 13.73, and 12.26 respectively. Notified data in the years 2009-2011 showed two identifiable peaks in April-May and October-November. Nuwara Eliya (224.7) and Mannar (117.1) districts had the highest cumulative incidence per 100,000 persons during 2007-2011. Conclusions: The gaps in notification of food poisoning are substantial. This has an impact on control strategies. Seasonal variations show fall in rate immediately before the monsoons, when there is water shortage and poor sanitation. The possible reasons for the regional variations may be poor sanitary facilities in the estate sector and the war situation. Regular education and interventions are important to improve notification and thereby achieve better disease control. PP 03: Knowledge and self reported practices regarding infection control methods among selected “Minor Health Care Workers” S Goonewardena, C Porutota, CSE Goonewardena, WAA Wijayasiri University of Sri Jayewardenepura Introduction and Objectives: Basic infection control measures in any healthcare setup can reduce the rates of health care-associated infections. Objective was to study the knowledge and self reported practices regarding infection control methods among “Minor Health Care Workers” (MHCW) in District General Hospital Kalutara. Methods: A hospital based descriptive cross sectional study was carried out. Knowledge and self reported practices of the MHCWs (n=429) were studied using an interviewer administered questionnaire. Page 111 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Results: Majority of the MHCWs 258 (60.1 %) were females and 243 (56.7 %) had more than 10 years of working experience. Of them 46% had participated in at least one training on infection control. Nineteen (4.4%) MHCWs had experienced accidental cut or prick injuries within the last six months. Majority MHCWs 384 (89.5%) had adequate knowledge on infection control. Knowledge of MHCWs on infection control was significantly associated with age, employment category, duration of employment, training experience related to infection control and type of training on selected areas of infection control such as hand washing, handling patients with communicable diseases, house- keeping and instrument cleaning (p <0.05). Practices were significantly associated with age, civil status, education, employment category and training experience in relation to infection control such as hand washing, handling patients with communicable diseases and handling waste (p<0.05). Although MHCW had a good knowledge of infection control, it was not significantly associated with the self reported practices. Conclusion: Many inadequacies in knowledge and practices were identified and regular in-service programmes are needed to improve the knowledge and good practices in relation to infection control. PP 04: Knowledge regarding rabies among grade ten students in the Nugegoda education division DMS Jayawardene, NS Gunawardene Department of Community Medicine, Faculty of Medicine, University of Colombo Introduction and Objectives: Rabies continues to contribute to the mortality, morbidity and economic burden of Sri Lanka, despite the very conducive environment prevalent in our island for its elimination. Lack of knowledge has been attributed as the main cause, and awareness specially targeting children has been advocated to eliminate rabies from Sri Lanka. This study aims to describe the knowledge regarding rabies, among grade ten students in the Nugegoda education division. Methods: A descriptive cross-sectional study design with multistage cluster sampling using probability proportionate to the size (694), of grade 10 student population was carried out. A pretested, structured, selfadministered questionnaire was used to collect data from grade ten students studying in state Type 1AB and Type 1C schools. Results: The majority of students (68.2%) had poor knowledge about rabies. A majority of students (73.7%, n= 509) were not aware that a lick by an infected animal on mucous membranes results in transmission of the disease. Only 22 (4.7%) students who had heard of rabies correctly identified sterilisation of dogs as a rabies preventive strategy, while only 33% of the students knew that rabies was fatal. The majority of students (85.1%, n=588) had never heard of the term â&#x20AC;&#x2DC;responsible dog ownershipâ&#x20AC;&#x2122;. Conclusions: A majority of students had poor knowledge regarding rabies. PP 05: Survey of newspapers on reporting of food-borne infection outbreaks: a retrospective survey DVW Walatara, Jennifer Perera Department of Microbiology, Faculty of Medicine, University of Colombo Introduction and Objectives: Food-borne infections are prevalent in all parts of world. Globally, one in three people suffer from food-borne diseases. The aim of the study was to review the food-borne infection outbreaks reported in popular newspapers. Methods: A retrospective survey of Daily News, The Island, Daily Mirror, The Sunday Observer, The Sunday Times, and Lankadeepa newspapers from 2010 to 2012 was carried out. The data were gathered on the district of the outbreak, number of victims, symptoms and type of food consumed. Results: There were 34 incidents reported from 15 districts. Of them 17.6% were reported from Gampaha district. The reporting was high in July (20.6%), February and March (14.7%). The affected population ranged from 2-3000 per outbreak, with a mean of 199.15, median of 57.5. Total number of cases was 6771. There were 4 deaths. Presenting complaints were abdominal pain (38.2%), vomiting (55.9%), fever (5.9%), diarrhoea (29.4%), dizziness (20.6%) and headache (17.6%). The suspected sources were food and beverages in 64.7% cases. In 17.6% of incidents suspected sources were tested and 14.7% were tested at Medical Research Institute. Investigations were conducted by public health inspectors, doctors and government analysts in 11.8%, 2.9% and 2.9% incidents respectively. Conclusions: No seasonal pattern was observed for the reported food poisoning outbreaks. The information on length of time taken to develop symptoms and investigations were lacking. Food poisoning continues to be a public health issue. Page 112 of 142

ABSTRACTS OF POSTER PRESENTATIONS

PP 06: A case of Kikuchi disease: a rare condition in Sri Lanka NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital Introduction: Kikuchi disease or hystiocytic necrotizing lymphadenitis is an uncommon, benign self limiting condition. The commonest clinical manifestation is cervical lymphadenopathy, with or without systemic signs and symptoms. Rarely, it could be associated with hepatospenomegaly. Clinically and histologically, the disease can be mistaken for lymphoma or systemic lupus erythematosus (SLE). Kikuchi disease almost always runs a benign course and resolves in several weeks or months. Treatment of Kikuchi disease is generally supportive. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to alleviate lymph node tenderness and fever. The use of corticosteroids, such as prednisone, has been recommended in severe extranodal or generalized Kikuchi disease. Case report: A 34-year old lady presented with high fever with chills and rigors and a painful swelling in the left upper neck of three weeks duration. Connective tissue disorders, lymphoma and granulomatous infections were considered as major differential diagnoses. There was localized left upper cervical tender lymphadenopathy. There was 3cm non tender hepatomegaly and 4 cm soft splenomegaly. Full blood count was normal. Blood picture was reactive and there was no evidence of haematological malignancies. ESR was 09mm with a CRP of 01mg/dl. ANA was negative. Serum LDH level was 495 U/L(230-460U/l). Ultra sound abdomen and the CT abdomen showed hepatosplenomegaly. FNAC of left cervical lymph node was suggestive of a reactive node without signs of malignancy. Excision biopsy of the lymph node showed hystiocytic necrotizing lymphadenitis suggesting Kikuchi disease. Intravenous methyl prednisolone 1g daily was started. After 3 days of treatment, there was rapid improvement in the clinical condition. Two weeks later, she made a complete recovery and there was no lymphadenopathy. PP 07: A rare occurrence of sarcoidosis with both dilated and restrictive cardiomyopathy NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital Case report: A 50-year old diagnosed patient with sarcoidosis presented with a history of recent worsening of shortness of breath, productive cough, paroxysmal nocturnal dyspnoea and ankle oedema of 4weeks duration. On examination she was dyspnoeic with bilateral ankle oedema. Blood pressure was 90/60mmhg with elevated JVP. Auscultation found murmurs of mitral regurgitation and tricuspid regurgitation with bilateral basal end inspiratory crepitations. No acute ischemic changes or arrhythmias were noted in the ECG. Chest X-ray showed evidence of pulmonary oedema. Ultrasound abdomen and chest showed evidence of ascitis and right sided mild pleural effusion. 2D-Echo findings were-Grade 3-4 MR, Grade 2 TR, grade 3-4 diastolic dysfunction of left ventricle, dilated right atrium and ventricle, Dilated cardiomyopathy with poor systolic function with ejection fraction 20-25% and restrictive type of grade 3 diastolic dysfunction. There was M-mode evidence of mild pulmonary hypertension. Patientâ&#x20AC;&#x2122;s clinical condition deteriorated in spite of standard treatment for acute heart failure and intravenous antibiotics and intravenous methyl prednisolone. She passed away after two days treatment in the ICU. Discussion: Sarcoidosis is a systemic disease resulting in the formation of noncaseating granulomas that can infiltrate the myocardium. It is associated with restrictive cardiomyopathy in 5% of patients, and may later progress to dilated cardiomyopathy. In rare instances it may have features of restrictive and dilated cardiomyopathy at different times in the course of the disease. It is associated with ventricular tachycardia and conduction abnormalities that can cause syncope and sudden cardiac death. PP 08: A case of symptomatic severe myositis in dengue fever NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital Introductions: Dengue fever with myositis is a common, but rarely documented clinical entity. Severe myositis can cause rhabdomyolysis and acute renal failure. The cause of myositis in dengue is due to the production of myotoxic cytokines, particularly tumour necrosis factor (TNF) released in response to viral infection. Dengue virus infection had been shown to increase production of TNF in humans. Case report: A 24-year old patient presented with fever, headache, postural dizziness, arthralgia and severe myalgia of 3 days duration. On examination, haemodynamics were stable. Severe muscle tenderness could be elicited over calf, thigh and upper limb muscles. Initial CPK level was 26,307 IU/L, serum creatinine 105 Âľmol/l, AST 502 U/L Page 113 of 142

ABSTRACTS OF POSTER PRESENTATIONS

and ALT 187 U/L. Platelet count was 133,000. Gradually the CPK levels came down although he remained symptomatic (repeat values 18,046 IU/L, 11,111 IU/L, 5,460 IU/L, 3,470 IU/L, 1,306 IU/L). There was no evidence of rhabdomyolysis or myoglobinuria. Serial full blood counts were compatible with dengue fever with evidence of haemoconcentration. Day 10 dengue IgM antibody was positive. Other causes for high CPK were excluded. The patient was managed as dengue fever according to National Guidelines. Myalgia disappeared with the normalization of CPK levels. He recovered fully by the 9th day of illness and was discharged from the ward. Conclusions: Elevated CPK levels are the most sensitive indicator of myositis. It is suggested that diagnosis of dengue fever can be made even before serological confirmation in patients with fever, myalgia and increased CPK. PP 09: Fever detection and management practices in children with dengue fever PKB Mahesh, SM Arnold Ministry of Health Introduction and Objectives: Presence of four subtypes and favourable breeding conditions of the vectors, have made dengue, a continuing public health burden in Sri Lanka. Timely interventions reduce the morbidity and mortality of dengue in which fever is the main symptom. Literature is scarce on home-based secondary prevention and its influence on the outcome of dengue. This study was done to evaluate selected practices of the parents of children treated as dengue fever/dengue heamorrhagic fever, and their associations with disease outcome. Methods: A descriptive cross sectional study was carried out at the Lady Ridgeway Hospital for Children. Sample of 425 was selected using systematic sampling. Knowledge of parents was assessed using an interviewer administered questionnaire. Associations between practices and selected outcomes were evaluated. Results: Only one third of the parents used a thermometer to detect fever. Self-medication was practiced by more than 85% prior to seeking professional medical care. Less than 50% administered the correct dose of paracetamol. Giving an overdose of paracetamol was significantly associated with elevated liver enzymes (p<0.001). Conclusions: Majority did not use a thermometer to measure fever. Overdosing of paracetamol and not using thermometer was associated with unfavorable outcomes. More health education programmes targeting general public on correct fever management should be implemented. More research must be encouraged as this could help reduce mortality from dengue. PP 10: A recurring, chronic case of atypical cutaneous leishmaniasis prevailing for 8 years KKGDUL Kariyawasam, I Kahawita, HVYD Siriwardana, ND Karunaweera Department of Parasitology, Faculty of Medicine, University of Colombo Introduction: Cutaneous leishmaniasis (CL) is an established disease in Sri Lanka. A genetically distinct variant of the usually visceralizing L.donovani is the causative agent. Case report: A 35-year old male presented from Polonnaruwa with a non-healing ankle lesion of 8 years duration. Lesion started as a small papule and he sought medical advice in 2006 due to rapid enlargement and ulceration. Excision of the lesion was done thrice due to the recurrence. After the last recurrence in 2009, he was investigated and diagnosed with CL, and treated with intra-lesional injection of sodium stibo gluconate (SSG). Lesions healed and recurred 3years later, and was again positive for Leishmania parasites. The lesion was hypo-pigmented, non tender, non itchy, nodulo-ulcerative type. Satellite lesions were also found. Patient didnâ&#x20AC;&#x2122;t have fever, hepatosplenomegaly, lymphademopathy or anemia. Patient was treated with IM-SSG and the lesions healed. Conclusions: A chronic case of CL is described. Atypical presentations of CL have been previously reported in Sri Lanka. Surgical excisions without complementary anti-leishmanials are not recommended in management of CL. Raising awareness regarding case management important. This may provide early evidence for possible SSG resistance. PP 11: L.donovani in Sri Lanka: clinico-epidemiological patterns and antibody response AMBWMRNN Ekneligoda1, HVYD Siriwardana1, PH Chandrawansa1, G Sirimanna1, V Warnasooriya1, S Ranasinghe2, ND Karunaweera1 1 Faculty of Medicine, University of Colombo 2 General Hospital, Panadura Introduction and Objectives: An epidemic of autochthonous cutaneous leishmaniasis (CL) due to L.donovani, a usually visceralizing parasite, started in Sri Lanka in year 2001. Over 2000 cases have been passively detected up to Page 114 of 142

ABSTRACTS OF POSTER PRESENTATIONS

date. Objectives were to study the trends in clinico-epidemiological characteristics and antibody response in CL patients in Sri Lanka. Methods: A total of 1444 clinically-suspected, referred cases were clinically evaluated and investigated using microscopy, culture/ PCR, and rK39 serological assay. Laboratory confirmed 110 cases of CL were also tested for the presence of anti-leishmania antibodies. Results: Majority confirmed by laboratory tests had CL (CL 1006 /1422, 4/20VL, 2/2 MCL). During the early part of the outbreak (2001-2003) majority of CL cases were males (92/110, 81%) in 21-40 year group (76/110, 69%), and were soldiers (69/110, 62.9%). In recent years, more children, elderly individuals, females and more civilians were involved (55% males, 38% young adults and 0.7% soldiers in 411 confirmed cases reported after 2008). More single, early lesions (<3 months) were observed in patients presenting after 2008 as compared to period between 2001- 2003. Bi-annual peaks of case presentation was seen throughout. North and South remained the 2 main areas of disease foci. A humoral immune response was evident in a subset of CL patients. Majority of sero-positives were from the Southern province (53%). Conclusions: There appears to be a change in the demography. A detailed study covering the entire epidemic will be of importance. The ability of L.donovani, to induce a serological response in some patients might indicate its potential to visceralize. PP 12: Comparison of clinical features of dengue illness in Colombo: a prospective hospital based study GJ Kottegoda1, DE Kannangara1, HMRH Denuwara1, H Tissera1, P Palihawadana1, A Amarasinghe1, S Gunasena2, A de Silva3, A Wilder-Smith4, DJ Gubler5 1 Epidemiology Unit, Ministry of Health 2 Medical Research Institute, Colombo 3 University of North Carolina 4 Centre for Global Health Research at University of Umea, Sweden 5 Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawai Introduction and Objectives: Dengue is one of the commonest febrile illnesses among patients treated in hospital. Clinical features help in diagnosis as well as differenciating between clinical entities of the disease. We compared common symptoms and signs of dengue fever (DF) and dengue haemorrhagic fever (DHF). Methods: Patients with fever less than seven days, admitted to selected medical institutions in Colombo were assessed using a pre-tested questionnaire. A total of 812 diagnosed cases of dengue (DF=635, DHF=177) were studied. Results: Common clinical features of both DF and DHF were, fatigue and weakness 726 (89.4%) (DF: 87.8%, DHF:94.9%), loss of appetite 716 (98.6%) (DF:86.4%, DHF:94.4%), headache 655 (80.7%) (DF:80.7%, DHF:80.2%), arthralgia and myalgia 591(72.8%) (DF:71.8, DHF:19.8%), nausea and vomiting 491 (60.5%) (DF: 57.9%, DHF:69.5%). Commonest haemorrhagic manifestations were vaginal bleeding 80 (9.8%) (DF: 8.8%, DHF: 13.5%) and gum bleeding 59 (7.2%) (DF:6.1%, DHF:11.3%). Rash was not a common finding in both groups (DF: 6.3%, DHF:8.4%). Features such as abdominal pain and tenderness, hepatomegaly and hepatic tenderness were significantly higher among DHF than DF (p< 0.01). Conclusions: Similar clinical features were observed in both DF and DHF. However, frequencies of some features were significantly higher in DHF which would help in the early identification of DHF. PP 13: Knowledge, attitude and practice of primary wound care in prevention of rabies: a descriptive cross sectional study in Colombo SA Mendis, S Mathotaarcchchi, H Meegahapola Faculty of Medicine, University of Colombo Introduction and Objectives: Rabies is a fatal disease. Most of these deaths can be prevented through post exposure prophylaxis, including primary wound washing with soap and water or antiseptics. The objectives of the study were to assess the knowledge, attitude and practice among victims of mammal exposure in Sri Lanka. Methods: A descriptive cross sectional study was carried out among 111 victims of mammal exposure who presented to the Rabies Treatment Unit of the National Hospital, Sri Lanka. Their knowledge, attitude and practices

Page 115 of 142

ABSTRACTS OF POSTER PRESENTATIONS

were assessed using an interviewer administered questionnaire. Frequencies, percentages and associations between variables were analysed. Results: Majority of the participants was males (64.9%) while 43.2% of the populations were aged 21-40 years. Majority had dog bites (63.06%) and rest were due to rats (14.4%) and cats (11.7%). On knowledge assessment 88.3% scored >50%. Only 36.9% knew about the fatality of the disease. Among the victims, 95.5% had washed the wound with soap and water or antiseptics and 16.2% had used home remedies. Knowledge regarding rabies did not correlate with the correct practice (p>0.05). Participants with good education had significantly higher knowledge scores (p<0.05). Conclusions: Most of the sample followed the correct practice of primary wound care but their knowledge on fatality of the disease was poor. PP 14: Secondary Bacteraemia in Dengue patients with Prolonged Fever GND Dissanayake, FHDS Silva, M Dassanayake, R Premaratne University Medicine Unit, Teaching hospital, Ragama Introduction and Objectives: In dengue infection, fever usually lasts 5- 7 days. Less than 5% develop Dengue Shock Syndrome due to fluid leakage. Some of the patients with third space fluid accumulation (TSFA) continue to have prolonged high fever. Few studies have shown growth of bacterial species in blood cultures which suggest secondary bacteraemia. This is probably caused by translocation of gut bacteria by disruption of intestinal mucosal and vascular integrity. Clear understanding of secondary bacterial infections is necessary to treat the severe dengue infections effectively. Our objective was to assess the prevalence and risk of bacteraemia in patients with dengue who had prolonged fever. Methods: A prospective, descriptive study was conducted at the Professorial Medical Unit of Colombo North Teaching Hospital, Ragama. Forty six patients with seropositive, acute dengue infection and prolonged fever (>5 days) were recruited. Two sets of blood cultures were obtained Haematological and biochemical tests were carried out. Clinical diagnosis of TSFA (ascites/ pleural effusions) were recorded. None of the patients were treated with antibiotics prior to obtaining blood cultures. Results: Thirty (65.2%) patients had no evidence of fluid leakage and none of them had positive blood culture isolate. Of the 16 (34.8%) patients who had third space leakage, 10 (62.5%) patients had positive blood culture growths; Coliforms (3), Staphalococcus aureus (2), Pseudomonas sp.(1), mixed growths (4). Conclusions: Patients with prolonged fever and fluid leakage are at risk of developing secondary bacteraemia compared to those without fluid leakage. PP 15: Cutaneous leishmaniasis amongst military personnel in the Northern Province of Sri Lanka: findings from a preliminary study S Semege 1 , S Ranasinghe2, N Pathirana2, R Wickremasinghe2 1 Sri Lanka Army Medical Services 2 Department of Parasitology, Faculty of Medicine, University of Colombo Introduction and Aims: Military personnel mobilised in the Northern Province participate in military operations, reconstruction and rebuilding efforts. Because of the increase in the number of cutaneous leishmanaisis (CL) cases since 2002, it was made a notifiable disease in 2008. Because the military is a high risk groups, a preliminary active case detection survey was carried out to determine the true burden of the disease amongst the military personnel. Methods: A prospective study carried out on 4321 military personnel of one military division in the Northern Province. Screening was carried out by army nurses trained for the purpose. All individuals with skin lesions suggestive of CL were referred for further investigations to the army medical centre, where they were examined by the investigators. Slit skin smears were prepared from the lesions, stained with Giemsa and examined for the presence of amastigotes. Results: Of the 4321 Military personnel screened for the presence of CL, 41 individuals were referred for confirmation of diagnosis. Clinical diagnosis of CL was made in 26 individuals and specimens were collected for confirmation. Amastigotes were detected by light microscopy in 25 slit skin smears. Conclusions: The prevalence of CL in the military division under study was 0.58%. Since the vector Phlebotomus argentipes has been isolated from the Vavuniya and Anuradhapura districts, identification of infected individuals Page 116 of 142

ABSTRACTS OF POSTER PRESENTATIONS

and at risk populations are of vital importance. Efforts are underway to extend the surveillance to the entire Northern Province and carry out awareness programmes regarding leishmaniasis amongst military personnel. PP 16: Viral characteristics and genomics of early onset, single organ specific presentations in dengue R Premaratna1, HKK Perera2, KH Chan2, MF Yeung2, C Meththananda2, JSM Peiris2, HJ de Silva1 1 Department of Medicine, Faculty of Medicine, University of Kelaniya 2 School of Public Health University of Hong Kong, Hong Kong Introduction and Objectives: Early onset neurological, hepatic and cardiac complications of dengue are increasingly recognized. However, doubts exist as to whether such complications of dengue are consequences of dengue shock syndrome rather than direct organ involvement. We studied virus characteristics and their genomics in patients who presented with early onset single organ involvement due to dengue, without features of DSS. Methods: Blood samples were collected at admission of seven patients, who presented to the Professorial Medical Unit, Colombo North Teaching Hospital Ragama during 2011-2012, confirmed as having acute dengue by PCR. Samples were analysed with single-tube, nested RT-PCR using type-specific primers. Viral RNA was extracted and sequencing was performed. The dengue virus sequences were aligned with other sequences that are available in the GenBank and maximum-likelihood (ML) tree was made. Results: Early onset organ specific manifestations included; self-limiting fits and clouding of consciousness on the 2nd day, rise in AST (1337iu/L) and ALT (749iu/L) on the 4th day and T wave inversions in the ECG on the 3rd day. Seven Dengue 1 viruses were isolated, which were in close homology in all 7 patients, based on the maximum likelihood tree with 1000 boot-straps. Conclusions: All the strains detected were clustered within the Genotype I clade of dengue-1 and in close homology with the dengue-1 viruses detected in the country in the recent past. The significance of viral characteristics and genomics related to organ specific manifestations need further study. PP 17: Comparison of clinical and laboratory parameters between Rickettsiosis positive and negative children R Premaratna, KAW Karunasekara, MAM Fernando, L de Silva, TGAN Chandrasena, HJ de Silva, JKND Miththinda, MNF Mufeena, KSK Madeena, NKBKRGW Bandara Department of Medicine, Faculty of Medicine, University of Kelaniya Introduction and Objectives: Identification of clinical or biochemical parameters that differentiate rickettsioses from other fevers would help in clinical practice to reduce morbidity and mortality associated with childhood rickettsioses. Methods: Clinical and laboratory parameters of 22 confirmed paediatric rickettsioses (SFG-16/22, ST-5/22, Mixed1) were compared with those of 24 with fever who were negative for rickettsioses, based on data received by the Rickettsial Disease Diagnostic and Research Laboratory (RDDRL), Faculty of Medicine, University of Kelaniya. Results: Comparisons of clinical and laboratory parameters between rickettsioses vs non-rickettsioses were mean(SD); age in months 56.59 (43.9) vs 78.13 (42.08) (p=0.1); fever duration 9.81 days (4.5) vs10.68 days (8.79) (p=0.68); fever intensity 102.80F (1.03) vs 102.440F (1.23) (p=0.4); fever spikes per day 2.33 (0.67) vs 2.68 (0.75) (p=0.186); headache 12/22 vs11/24 (p=0.64); body-aches 9/22 vs 9/24 (p=0.52); pain in arms and legs 6/9 vs 7/9 (p=0.5); joint pains 6/22 vs 7/24 (p=0.89); cough 14/22 vs 9/24 (p=0.07); shortness of breath 5/22 vs 2/24 (p=0.19); eschar (all ST) 4/22 vs 0/24 (p=0.02); rash 14/22 vs 14/24 (p=0.69); maculo-papular rash13/14 vs 12/14 (p=0.91); diarrhoea 4/22 vs 4/24 (p=0.89); lymphadenopathy 7/22 vs 8/24 (p=0.913); spleen1/22 vs 5/24 (p=0.18); total WBC 11.1x109/L (4.8) vs 9.8x109/L (4.8) (p=0.36); N-84.8% (13.8) vs 5.4(2) (p=0.29); ESR 1stHr 46.3mm (26.7) vs 81.8mm (10.2) (p=0.37); CRP 42.1mg/dl vs 56.7mg/dl (6.7) (p=0.46); SGOT 51.2iu/L (32.1) vs 248.7iu/L (678) (p=0.43); SGPT 50.2iu/L (51.4) vs 170.7iu/L (404) (p=0.44). Conclusions: In paediatric patients, no clinical or biochemical parameter could differentiate rickettsioses from other aetiologies. Presence of eschars would help to diagnose scrub typhus. However laboratory confirmation is needed to differentiate SFG from other fevers. PP 18: Clinical characteristics of paediatric rickettsioses R Premaratne, KAW Karunasekera, MAM Fernando, L de Silva, TGN Chandrasena, HJ de Silva Faculty of Medicine, University of Kelaniya

Page 117 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Introduction and Objectives: Rickettsioses are re-emerging in Sri Lanka. Both children and adults are vulnerable to these infections. Data on paediatric rickettsioses in the country are sparse. Objectives were to study the clinical characteristics of paediatric rickettsioses based on data received by the Rickettsial Disease Diagnostic and Research Laboratory (RDDRL), Faculty of Medicine, University of Kelaniya, over the last two years. Methods: All clinical and laboratory data of confirmed rickettsioses were analysed. Results: Out of 46 requests received by the RDDRL, 22 were positive for acute rickettsioses in diagnostic titres IFA-IgG>1:128 (all>256). Of the 22 positives, 16 were positive for spotted fever group rickettsioses (SFG), 5 for scrub typhus (ST) and 1 for both. 4/5 ST had eschars. The mean age was 56.59 months (43.9); the youngest affected was aged 5 months. Of the sample 12 (54.5%) were male. Fever was present in all; mean duration was 9.81 (4.5) days; fever intensity was 102.80F (1.03); frequency of spikes per day was 2.33 (0.67). Clinical features were headache 12 (54.5%), body aches 9 (40.9%), joint pains 6 (27.3%), cough 14 (63.6%), shortness of breath 5 (22.7%), rash 14 (63.6%);macular papular rash 13, diarrhoea 4 (18.2%), lymphadenopathy 7 (31.8%), palpable liver 4, palpable spleen 1. Total WBC 11.1x109/L (SD-4.8); neutrophils-84.8% (SD-13.8) lymphocytes 40.5% (17.2). ESR 1st Hr 46.3mm (SD-26.7) CRP 42.1mg/dl (40.6) SGOT 51.2iu/L (32.1) SGPT 50.2iu/L (51.4). ECG was normal in all, Chest x-ray showed patchy shadows in 4. Conclusions: SFG rickettsioses were commoner than ST, among children living in the Gampaha and Kurunegale districts. Clinical features were similar to adults. Diagnostic investigations were requested late in the febrile illness. PP 19: Detection of a porcine rotavirus in a child with acute diarrhoea in Sri Lanka N Chandrasena1, M Takaki2, TGN Chandrasena2, S Rajindrajith2, NK Gunawardena2, A Nishizono2, K Ahmed3 1 Department of Parasitology, Faculty of Medicine, University of Kelaniya 2 Department of Microbiology, Faculty of Medicine, Oita University, Yufu, Oita, Japan 3 Research Promotion Institute, Oita University, Yufu, Oita, Japan Introduction and Objectives: Globally, rotaviruses are an important cause of acute childhood diarrhea. These pathogens are found in various animal species. Interspecies transmission is a major source of generation of new reassortants and genetic variants. During a hospital-based rotavirus surveillance program at Colombo North Teaching Hospital (CNTH), we identified a case of acute gastroenteritis caused by a rotavirus strain of porcine origin. Case report: A 12 month old boy was hospitalized at the CNTH in June 2009 with fever and acute diarrhoea of 4 days duration. Stools were watery with a frequency of 8 motions a day. There was no associated vomiting. He was moderately dehydrated on admission. He was discharged after 4 days of oral rehydration solutions and probiotics. The childâ&#x20AC;&#x2122;s family and their neighbours practiced pig farming as a source of additional income. Rotavirus was detected in stools using the commercially available ELISA kit. Genotypes determined by reverse transcription (RT) PCR, identified the strain as G4P. Nucleotide sequencing of VP7, VP8 and NSP4 genes identified the strain to be of porcine origin. Conclusion: This is the first report from Sri Lanka of interspecies transmission of rotaviruses implicating a zoonotic strain of causing symptomatic infection. Surveillance should be continued in Sri Lanka to detect the spread of zoonotic strains. Zoonotic strains are a challenge to the currently available rotavirus vaccines since they can generate reassortant and genetic variants of rotaviruses. PP 20: Factors affecting urine culture contamination among in-ward patients in National Hospital of Sri Lanka JK Liyanagamage, LM Kasthuriarachchi, GSP Keerthisena Faculty of Medicine, University of Colombo Introduction and Objectives: Urine culture contamination is a recognized problem in clinical practice. A clean catch mid-stream urine sample is necessary for accurate results. Our aim was to assess how patient factors affect contamination of urine culture samples and the extent to which guidelines are practiced in the collection of samples. Methods: Subjects (n=111) were evaluated using cross sectional study design. Eight wards were selected randomly and subjects were recruited by convenience sampling. Urine collection procedure and socio-demographic data were collected using a pretested questionnaire. A patient score was generated by allocating one mark for each step of urine collection procedure (total of 06 steps). Associations between patient score and socio- demographic data with contamination rates were evaluated. Results: A total of 27 (24%) cultures were contaminated. Contamination rates increased significantly with increasing age (p=0.002), lower educational status (p=0.0063) and lower family income (p=0.002). Only 6 subjects (5.4%) had a perfect score. Perineum cleansing was done by 53 (47.75%), 87 (78.38%) had not wiped genitalia and Page 118 of 142

ABSTRACTS OF POSTER PRESENTATIONS

88 (79.28%) had taken a mid-stream sample. None of the women had separated labia before taking the sample, 42 men had retracted foreskin. Unintentional sample contamination was reported in 33 (29.73%), 17 (15.32%) washed the bottle before closing the lid. A positive association was observed between adherence to guidelines and noncontamination (p=0.086). Conclusions: Age, family income and educational status were significantly associated with contamination rates. A majority of patients did not follow protocol. Adherence to guidelines was associated with non-contamination. PP 21: Species identification of nontuberculous Mycobacteria (NTM) by conventional biochemical methods and DNA sequencing of 16s rDNA and DNA gyrase B genes PJ Kumarasiri, Jennifer Perera, GMM Perera, S Gamage Department of Microbiology, Faculty of Medicine, University of Colombo Introduction and Objectives: Incidence and species distribution of nonturberculous Mycobacteria (NTM) is not adequately studied in Sri Lanka and patients are treated empirically, although both British and American Thoracic Society guidelines prescribe species specific treatment. Currently patients are treated without resorting to speciation. The study aims to determine clinically significant NTM species and compare accuracy of conventional methods with gene sequencing methods in identification. Methods: Thirty one clinically significant NTM isolates were recovered from patients with pulmonary disease in 2011, at the tuberculosis diagnostic laboratory, Faculty of Medicine, Colombo. Speciation was done using biochemical tests and 16s rDNA and DNA gyrase B gene sequencing. Results: The species identified were M. fortuitum (12), M. intracellulare (9), M. abscessus (4), M. gordonae (2), M. smegmatis (2), M. massiliense (1), M. porcinum (1). M. intracellulare was accurately identified by DNA gyrase B gene sequencing but 16s rDNA sequencing showed similarities with M. simiae. Final identification was based on chromogenicity as M. simiae is a non-chromogen. Among the 4 M. abscessus isolates, two showed conflicting results with semi-quantitative catalase test. M. gordonae and M. smegmatis showed consistent results with both biochemical and genomic methods. Commonly identified inaccuracies were noted with semi-quantitative catalase, sodium chloride tolerance and iron uptake tests. Conclusions: NTM speciation using conventional biochemical tests is not optimal, when compared to more accurate gene sequencing. DNA gyrase B gene is more species specific than 16s rDNA gene. Utilizing more than one method minimizes errors in NTM speciation. PP 22: A study on completeness of entries and utilization of Child Health Development Record by mothers and health care workers YDRM Gunaratne, KKK Gamage, RS Gamage Faculty of Medicine, University of Colombo Introduction and Objectives: Child Health Development Record (CHDR) is the key tool used to monitor and record vital aspects related to child health in Sri Lanka. Objective of the study is to assess completeness of entries and utilization of CHDR by mothers and health care workers. Methods: A descriptive cross sectional survey was carried out using a structured, pre tested, interviewer administered questionnaire plus a checklist among 108 mothers of children under 2 years of age, attending Child Welfare Clinics of Dehiwala MOH area. Participants were selected using consecutive sampling. Results: All participants scored above 50% about awareness of birth details, breast-feeding, complementary feeding and caring for newborn. Awareness regarding immunization, developmental milestones and growth monitoring showed a significant difference (p<0.05) when compared with the section on school health programme. Accuracy of growth curve interpretation was 79.6% with a significant difference between mothers educated up to O/L and beyond O/L (p<0.05). Only 51.85% were educated about CHDR at any point. Among the participants 57.4% preferred this to be provided by the clinic. PP 23: Prevalence and factors associated with anaemia among children aged 12-59 months in Jaffna district K Kandeepan, S Balakumar, V Arasaratnam Faculty of Medicine, University of Jaffna Introduction and objective: Anaemia still persists among children and women of childbearing age in Sri Lanka. This study assessed the prevalence of anaemia and associated factors among children aged 12-59 months in Jaffna district.

Page 119 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Methods: Multistage cluster sampling was used and a total of 846 children (414 males and 432 females) were recruited. Height and weight were used to compute age and sex specific Z scores to derive wasting, underweight and stunting based on WHO standards. Information regarding socio-demographic and economical factors and feeding practices were collected. Biochemical variable such as haemoglobin (<11g/dL), serum ferritin (<12μg/L), albumin (<3.5g/dL) were determined. Results: Mean haemoglobin concentration was 11.7g/dL (95% CI 11.6-11.8), in males (11.7 g/dL) and in females (11.8 g/dL). The prevalence of anaemia was 36.4 % (mild and moderate anaemia was 20.5% and 16.0% respectively). Among anaemic children, 31.7 % were affected by iron deficiency anaemia (IDA) and mean ferritin concentration was 8.01 (1.4) μg/L. Prevalence of anaemia was significantly higher in urban children (23.9%) than in rural children (15.9%) (p=0.007) and the prevalence of IDA was significantly higher in urban children (37.6%) than in rural children (29.8%). Educational level of the parents, number of children in a household, birth weight (r=0.17), albumin concentration (r=0.21) and duration of exclusive breastfeeding (r=1.36) were correlated with haemoglobin concentration (p<0.05). Risk of anemia was high in children with wasting [OR 3.37 (95% CI 2.404.73, p<0.0001)], underweight [OR 2.78 (95% CI 2.06-3.74, p<0.0001)] and stunting [OR 1.50 (95% CI 1.10-2.05, p=0.01)]. Conclusions: The prevalence of anaemia is high and commonly due to iron deficiency. The risk factors associated with anaemia in Jaffna were identified. PP 24: Selected birth-related risk factors of acute lower respiratory tract infections in infants at a selected hospital SMD Mendis, MM Mohamed, MEC Muhandiram Faculty of Medicine, University of Colombo Introduction and Objectives: Acute lower respiratory tract infections (ALRTI) are a leading cause of morbidity and mortality among children. Many studies have identified socio-demographic and environmental risk factors but few have focused on birth-related factors, which are modifiable. The objective of this study was to assess birthrelated risk factors of ALRTI in infants admitted to the Lady Ridgeway Hospital for Children (LRH). Methods: Hospital-based case control study was conducted with 100 cases from general medical wards of the LRH, and 124 age and gender matched controls from Child Welfare Clinics of the Kolonnawa MOH area. Controls had no previous hospitalization for respiratory symptoms. Participants were selected from residents of the Western Province using convenient sampling. World Health Organization criteria were applied to identify cases. Those with congenital heart disease and chronic lung conditions were excluded. Data was collected using an interviewer-administered questionnaire and Child Health and Development Record. Odds ratios and 95% confidence intervals were calculated. Results: Odds ratios and 95% confidence intervals for associated risk factory were as follows: low birth weight (< 2500g/≥ 2500g) OR 1.119 (0.572-2.513), prematurity (<37 weeks/ ≥ 37 weeks) OR 0.742 (0.295-1.869), caesarean section (LSCS) vs. vaginal delivery OR 1.324 (0.711-2.466), emergency vs. elective LSCS OR 1.696 (0.525-5.481). Conclusions: Although birth related factors show no statistically significant association, low birth weight and delivery with LSCS are associated with development of ALRTI during infancy. PP 25: Identification of aero-allergens in children seeking treatment for bronchial asthma at the Lady Ridgeway Children’s Hospital Colombo JASSK Jayasinghe1, MP Senanayaka1, R de Silva2, MDCJP Jayamanna2, V Jayasuriya2, GN Malavige3 1 Department of Paediatrics, Faculty of Medicine, University of Colombo Departments of 2Community Medicine and 3Microbiology, Faculty of Medical Sciences, University of Sri Jayawardenepura Introduction and Objectives: Despite a significant rise in asthma globally and in Sri Lanka, data regarding allergen sensitization patterns and other risk factors for asthma are not available. Therefore, we set out to determine the allergen sensitization patterns in children with asthma in Sri Lanka. Methods: Skin prick testing for common indoor aeroallergens (cockroach, cat, dog, house dust mite, moulds) were carried out in 143 children with bronchial asthma treated at Lady Ridgeway Hospital for Children. Results: Of the patients 52.1% were sensitised to at least one allergen whereas 6.99% were sensitized to 3 or more allergens. We found that 35.7% tested positive to house dust mite, 25.9% to cockroach and 5.6% to the indoor moulds, 12.6% to cats and 9.1% to dogs. Those with daily symptoms had a higher rate of sensitisation to an allergen than those with weekly or seasonal symptoms OR 3.8, p =0.001. Allergen sensitization was significantly lower in children aged ≤ 4 years (p <0.0001) than in older children, 46% of children also had allergic rhinitis (AR). Allergen sensitization was significantly higher in those who also had AR OR 2.4, p =0.01. There was no statistically Page 120 of 142

ABSTRACTS OF POSTER PRESENTATIONS

significant association with asthma severity and sensitization to moulds OR 2.4, p=0.19) and the use of firewood OR1.8, p=0.09). Conclusions: Sensitization to aero-allergens was seen in majority of children with asthma. Sensitization was significantly more in children above 4 years of age. Patients with more frequent symptoms and with AR were more likely to be sensitized to allergens.

PP 26: Meconium stained liquor and the outcome of neonates: a retrospective study TRN Fernando, NAPJ Senewirathna, AGPM Padeniya University of Rajarata Introduction and Objectives: Meconium-stained liquor (MSL) 15% is seen in 20% of term pregnancies. Meconium aspiration syndrome (MAS) accounts for 2% of perinatal deaths in United Kingdom. MAS is associated with an increased risk of neonatal encephalopathy. Objectives were to find out the association between MSL and neonatal outcome. Methods: Hospital based retrospective study was carried out. All MSL documented in the birth registry of ward 7 labour room De Soysa Hospital for Women, during January 2012 to March 2013 were included. Data was collected from bed head tickets. Results: There were total of 73 MSL during the study period. Mean age of the mother was 27.4 years (SD= 5.8). There were 35 (47%) primi mothers and 39 (53%) multi parous women. The mean birth weight was 2.85 kg (SD= 0.46). The average period of gestation at delivery was 38 weeks (SD= 1.5). The grade of meconium: thin= 35 (48%), moderate= 22 (30%), thick= 15 (20%). The APGAR scores at 5 minutes and 10 minutes were 10 in all neonates except in two. Majority (n= 31, 42%) had post partum hospital stay >24 hrs due to neonatal problems, out of which 15 (20.5%) neonates were given intravenous antibiotics. Six neonates (8.2%) had neonatal sepsis. LSCS rate was higher in moderate and thick MSL compared to thin MSL (p= 0.001). There was no significant difference in PBU admission in moderate and thick MSL neonates compared to thin MSL neonates (p= 0.103). Conclusions: Although the caesarian section rate was higher in thick MSL, the out come of neonates were similar to the thin MSL group. PP 27: Pre hospital care received by injured children aged less than five years admitted to Lady Ridgeway Hospital S Goonewardena, CSE Goonewardena, WAA Wijayasiri University of Sri Jayewardenepura Introduction and Objectives: Childhood injuries are a growing problem. The opportunity to prevent death and disability during the post injury period differs depending on the severity of the injury. Pre-hospital care plays a major role in preventing death and disabilities due to injuries. Objective was to describe the pre-hospital care received by injured children, less than five years old, admitted to the Lady Ridgeway Hospital. Methods: A hospital based descriptive cross sectional study was carried out at the Lady Ridgeway Hospital accident ward. A sample of 400 pairs consisting of a pre-hospital care giver and child were recruited using consecutive sampling method. Data was collected using a pre tested, interviewer administered questionnaire. Results: Majority of care givers were unemployed mothers aged 30-39 years. Only 15.7% of the care givers had first aid training. A first aid box with basic equipment was available for 56.8% of injured children. Majority (59.3%) of children were transported within the golden hour and three-wheelers were used in 57%. Although a majority (87.5%) of care givers had access to communication methods, only 21.5% knew the emergency telephone number. Majority (60.5%) of care givers had good knowledge on first aid. A care giver education level of above or equal to GCE Oâ&#x20AC;&#x2122; Level and having first aid training was significantly associated with the good knowledge on first aid. Having first aid training for the care giver (15.7%) was significantly associated with the correct practice of pre hospital care for bleeding wound, contusion and fractures. Availability of first aid box with basic equipment and use of suitable vehicle to transport the child was significantly associated with care giver education level. Only 21.5% knew the emergency number. Conclusions: Correct practice of first aid was significantly associated with first aid training of the care giver, which was low (15.7%). Majority used three-wheelers to transport injured children. PP 28: Cancer in a general paediatric ward: the morbidity pattern over one year DS Gunasekera, MP Senanayaka Page 121 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Lady Ridgeway Hospital, Colombo Introduction and Aims: To describe the pattern of patients presenting to a general paediatric ward with neoplasms and related disorders. Methods: This cross-sectional descriptive study included all patients admitted to a general paediatric ward of Lady Ridgeway Hospital, Colombo from 1st March 2012 to 28th February 2013 with confirmed diagnosis of a haematological malignancy, benign or malignant solid tumour and related disorders. Related disorders were entities not strictly defined as neoplasms but treated by oncologists (eg: Histiocytic diseases, Kikuchi-Fujimoto disease, Post Transplant Lympho-proliferative Disorder). Results: Total number of patients admitted to this tertiary referral general paediatric unit during this period was 8393. Out of this, 51 patients fulfilled criteria for inclusion in this study and they represented 16 different disease entities. Acute Lymphocytic Leukaemia was the most prevalent (37%) and the commonest solid tumours were brain tumours (12%). Out of all patients 31 (60%) were newly diagnosed while 10 (20%) were admitted for treatment of oncological therapy related complication and 10 (20%) for special investigations or therapeutic procedures (eg: MRI, vascular access). Twenty six (51%) had haematological malignancies while 20 (39%) had solid tumours and 5 (20%) related disorders. Conclusions: Patients with neoplasms and related disorders had a wide variety of malignancies. Although there is no data available regarding the cancer incidence in a general paediatric ward, our rates appear to be high. Specialised endocrine and neurological services offered by this ward may have contributed, but with the increasing incidence of malignancies, we recommend more audits to assess this morbidity pattern. PP 29: Walking the wire: prevalence and factors associated with occupational injuries among Ceylon Electricity Board labourers in Western Province North RU Mambulage, V Jayasuriya Anti Leprosy Campaign Introduction and Objectives: The Ceylon Electricity Board (CEB) labourers are a high risk occupational group due to inherent dangers of electricity and their work at heights. This cross sectional study describes the prevalence and factors associated with occupational injuries among Western Province CEB labourers. Methods: Three hundred and one randomly selected labourers were interviewed using a structured questionnaire and a sub-sample was observed to validate self- reported safety practices. Results: The annual estimated prevalence of occupational injuries was high, 15.2/100 workers (95% CI = 11.1-19.2) and included mechanical accidents 52.2%, electrical shock 17.4%, road traffic accident 17.4% and explosions 8.7%. Injured were more likely to be young (aged 39.9 years or less) [OR= 2.54 (1.04-6.19], and inexperienced <10 years [OR= 2.66(1.09-6.48)]. Although self-reported safety practices were high (81.4%), the actual observed use was lower especially for use of gloves (37.5%). Conclusions: Every one in six workers, especially the young and inexperienced were at risk of injury. The current training and practices of the workers requires urgent attention to prevent and protect this vulnerable occupational group. PP 32: Balance confidence among soldiers with unilateral below-knee amputations attending a rehabilitation institute in Ragama TKC Peiris, NR Perera Allied Health Sciences Unit, Faculty of Medicine, University of Colombo Introduction and Objectives: Thousands of soldiers have undergone below knee amputations as a result of the injuries during the four-decade-long civil war in Sri Lanka. This study aims to describe the balance confidence of soldiers with unilateral below knee amputations. Methods: Balance confidence is defined as self-confidence in oneâ&#x20AC;&#x2122;s ability to not fall. This study is a descriptive cross-sectional study. One hundred and twenty eligible soldiers with unilateral below-knee amputations attending a rehabilitation institute in Ragama, were selected using convenient sampling. A self-administrated questionnaire was used to gather relevant information. The participant data sheet collected socio-demographic, amputation-related and health-related information. The Activities-specific Balance Confidence (ABC) scale was used to measure the balance confidence. Independent samples t-test and Analysis of Variance (one way ANOVA) for uni-variable data analysis and multiple linear regressions for multi-variable data analysis were performed.

Page 122 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Results: The mean age of the sample was 34.89 years (SD= 7.9). The mean ABC scale score for the total sample was 67.05 (SD= 16.02). Variables associated with balance confidence were engagement in sports activities, high monthly family income level, increased number of hours of using the prosthesis, and low or absent alcohol intake. Conclusions: The balance confidence should be considered an important clinical concern in this population. The mean ABC scores in this sample were lower compared to other studies. PP 33: Injury pattern of terrorist suicide bombers in Sri Lanka: a review of two decades C Perera, UCP Perera, HTK Wijayaweera, SPA Hewage, S Cordner University of Ruhuna, Sri Lanka Introduction: The impact of terrorist suicide bombing is devastating. Suicide terrorism or more specifically suicide or homicide bombings are an extreme manifestation of terrorism in the modern era. The LTTE, which was defeated militarily in 2009, was a global leader in suicide terrorism, carrying out two-thirds of the world's suicide attacks during their operational period. Between July 1987 and February 2000, the LTTE carried out approximately 168 suicide attacks in Sri Lanka and India killing two world leaders and wounding thousands of civilians. Objectives: Our objective was to document and analyse the injury pattern of suicide bombers involved in causing bomb explosions from 1987 to 2009 in Sri Lanka as suicide bombing is not reported from all countries/regions. Methods: The crime scene documentation and autopsy details of major suicide bombings which occurred in various parts of Sri Lanka from 1987 to 2009 were reviewed. The injury pattern of the each suicide bomber was described according to body regions. Results: The terrorist suicide bombers involved in all incidents could be categorised into two main groups. These groups are suicide bombers who have the explosives attached to the body via a special suicide kit (strapped human bomb; person-borne bomb) and suicide bombers who drive a vehicle packed with high explosive material (vehicular human bomb; vehicle-borne bomb). Conclusion: Accordingly we have identified a specific pattern of injuries in terrorist suicide bombers involved in attacks over the last three decades. PP 34: Association of estimated glomerular filtration rate and albumin to creatinine ratio in type 2 diabetic patients with diabetic retinopathy: a preliminary study NN Wijayatunga, H Peiris, PPR Perera, K Wanigasuriya Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayawardenepura Introduction and Objectives: Retinopathy and nephropathy are microvascular complications of diabetes mellitus. Retinopathy is present in 21.2% of type 2 diabetic (T2DM) patients in Sri Lanka. Our objective was to study the association between estimated glomerular filtration rate (eGFR) and albumin to creatinine ratio (ACR) with diabetic retinopathy (DR) in a group T2DM patients. Method: From Colombo South Teaching Hospital, 58 T2DM patients (37 females and 21 males) with a past eGFR value of less than 60 ml/min/1.732m2 were recruited. Serum and urine creatinine was measured using Creatinine Kinetic method and urine albumin was measured by Immunoturbidimetry on Kone 20XT auto-analyzer. Retinopathy status was recorded from eye-clinic records. The eGFR was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation. Results: The mean age was 54.3 Âą5 years and duration of diabetes 10.04 Âą6.74 years. Of the sample 36.2% had DR and 53.4% had normoalbuminuria (ACR 300mg/g). eGFR was between 30-60ml/min/1.73m2 in 36.2% of diabetics, while 63.8% had eGFR more than 60ml/ min/ 1.73m2. Patients with DR had significantly higher levels of ACR and eGFR levels. Conclusion: ACR was higher in Type 2 diabetics with diabetic retinopathy. PP35: The risk factors for Chronic Kidney Disease in the Polpitigama Divisional Secretariat Division PVDS Dharmagunawardena1, RMSK Rathnayake2, R Vipula Shantha2, NR Abeynayake2, WADV Weerathilake2 1 Post Graduate Institute of Medicine 2 Wayamba University of Sri Lanka, Makandura Introduction and Objectives: CKD is an emerging health problem in Kurunegala District and Polpithigama Divisional Secretariat Division (DSD) has the highest number of patients. Objective of the study was to identify the epidemiological patterns and the risk factors for CKD in the Polpithigama DSD. Methods: This case control study design utilized a pre-tested interviewer administered questionnaire for data collection. Cases were selected through community screening which identified proteinuria using dipstick method. Page 123 of 142

ABSTRACTS OF POSTER PRESENTATIONS

CKD was confirmed in these patients by assessing kidney size using ultrasound scanning. Only those who were permanent residents in Polpithigama for longer than 10 years were selected as cases or controls. Age and sex matched controls were randomly selected from non-affected individuals. Urine was tested for micro-albumin in controls to confirm the absence of any overt kidney disease. Results: Study included 122 CKD patients and 122 controls. Prevalence of CKD was 16.24 per 10,000 population. There were 101 males and 21 females each in case and control groups. CKD was predominately seen among males (82.8%). Mean age was 59.385 years (SD 13.71). Most controls 83 (68%) and cases 92 (75.3%) were engaged in agriculture. Cause could be identified only in 45 (36.9%) patients. Significant associated risk factors were history of a Viper bite OR 4.06, (95% CI 1.95-8.45), betel chewing OR 2.19 (95% CI 1.11-4.32) and smoking OR 1.86 (95% CI 1.07-3.24). However, this study could not identify any risk factors specific for CKD of unknown aetiology. Conclusions: A cause for CKD could not be identified in a majority of patients and therefore, measures should be developed to prevent the identified and modifiable risk factors. PP 36: Differences in estimation of glomerular filtration rate using three standard formulae in selected type 2 Diabetic patients NN Wijayatunga, PPR Perera, K Wanigasuriya, H Peiris Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayawardenepura Introduction and Objectives: Modification of diet in Renal Disease Study equation (MDRD) is commonly used in Sri Lanka to calculate estimated glomerular filtration rate (eGFR) and the latest 2012 KDIGO guideline recommends CKD-EPI equations to estimate eGFR (ml/min/1.732m2) . Our objective was to compare the differences in diagnosing renal impairment by MDRD and CKD-EPI Creatinine and CKD-EPI Cystatin C equations in Sri Lankan type 2 diabetics. Methods: From Colombo South Teaching Hospital 66 type 2 diabetics (43 females and 23 males) with a past eGFR value of less than 60 were recruited. Serum cystatin C was measured using Immunoturbidimetry and serum creatinine was measured using Creatinine Kinetic method traceable to IDMS on Kone 20XT auto-analyzer. The eGFR was calculated using MDRD, 2009 CKD-EPI Creatinine and 2012 CKD-EPI Cystatin C equations. Results: The mean eGFR obtained with MDRD study equation, 2009 CKD-EPI Creatinine and 2012 CKD-EPI Cystatin C equations were 67 , 73 and 82 respectively. The MDRD study equation indicated that 33.3% had eGFR between 30-60 and 66.7% had eGFR 60 whilst the 2009 CKD-EPI Creatinine equation indicated that 22.7% had GFR between 30-60 and 77.3% had eGFR 60. The 2012 CKD-EPI Cystatin C equation showed that 27.3% and 72.7% had GFR between 30-60 and eGFR 60 respectively. Conclusions: Differences were observed when MDRD equation, 2009 CKD-EPI Creatinine and 2012 CKD-EPI Cystatin C equations were used for detection of renal impairment. Thus clinicians need to be aware that diagnosis of renal impairment could differ depending on the equation used to estimate GFR. PP 37: Predictors of post-operative serum creatinine in kidney transplant receipients VH Gamage, A Abayadeera, RJMKA Jayasundara, YHH Guathilaka, DP Jayasekara Department Of Surgery, Faculty Of Medicine, University Of Colombo Introduction and objectives: The success of renal graft survival after transplantation is closely associated with early graft function, based on intraoperative perfusion, characteristics of the allograft and good urine output. The objective of our study is to assess the relationship between urine output and serum creatinine, post operatively, in renal transplant recipients. Methods: Our study obtained data from a database of renal transplant recipients. One hundred and fifty one were followed up three days post operatively with the input, output and serum creatinine. Results: Mean age was 44.2 years and 115 (76.2%) were males. Ninety two (60.9%) were hypertensive, 45 (29.8%) had type 2 diabetes and 10 (6.0%) had IHD. There is a statistically significant negative correlation between day one urine output and day two serum creatinine (r=-0.613, p=0.000) and an even higher correlation with day three serum creatinine (r= -0.677, p=0.000). There is no correlation between the pre-operative creatinine and day one urine output. But there is significant positive correlation with pre-operative potassium (r=-0.228, p=0.007) and sodium (r=-0.276, p=0.001) values with the day one urine output. Conclusion: There is significant negative correlation between the serum creatinine level and the previous day urine output. Urine output is a good predictor of renal function post operatively in kidney transplant recipients. Preoperative sodium and potassium levels predict the post-operative urine output in kidney transplant recipients.

Page 124 of 142

ABSTRACTS OF POSTER PRESENTATIONS

PP 38: Frequency, pattern and outcome of renal dysfunction in patients with cirrhosis: a prospective study using the proposed ADQI-IAC criteria ST De Silva, KRP Perera, MA Niriella, A Pathmeswaran, HJ de Silva Faculty of Medicine, University of Kelaniya Introduction and Objectives: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1 and 2) in patients who have structural kidney disease. Definitions addressing these issues have been proposed by a working party from the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). Methods: We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. Consecutive patients attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectively recruited and followed up. Results: Of 277 patients with cirrhosis and stable serum creatinine, 27 (9.7%) had serum creatinine >1.5mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR<60ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfill criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; p<0.0001), more likely to be female (50.8% vs 19.3%; p<0.0001), had cryptogenic cirrhosis (67.7% vs 41%; p<0.0001), and were Child-Pugh class B or C (95.4% vs 74%; p<0.001). As expected, they had higher MELD scores (16.6 vs 13.5; p<0.0001). 48/277 (17.3%) died during follow-up [mean 6.5 months (SD 2.2)]; an eGFR<60ml/min independently increased risk of death (HR 2.7; Nagelkerke R Square test). Conclusions: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhotic patients with CKD. As CKD is associated with increased mortality, further study is needed to determine whether prognosis can be improved by treating acute deterioration of CKD with available treatments for HRS1. PP 39: Can we salvage failing arteriovenous fistulae by minimal invasive method?: a first Sri Lankan experience CW Weerasinghe, N Seneviratne, BI Bulathsinghala, DM Liyanage Teaching Hospital Anuradhapura Introduction and Objectives: The stenosis and subsequent thrombosis of arteriovenous fistulae (AVF) may lead to loss of vascular access sites for haemodialysis. Percutaneous angioplasty is commonly used in correcting such lesions. However, usage of this procedure is not reported in Sri Lanka. Objective was to analyse feasibility and the technical success of Fistuloplasty, done using minimal resources. Method: All patients who underwent fistulogram under local anesthesia with sedation, for AVF stenosis or thrombosis during the period of August 2012 to March 2013 at the Teaching Hospital Anuradhapura were included. Demographic information and access- specific data were collected. The technical success of the angioplasty, defined as less than 30% residual stenosis, was evaluated. Procedure was done using a C- Arm and angioplasty balloon catheters. Results: We reviewed total of 6 patients. Two patients presented with acute thrombosis of the AVF within 48 hours, 1 with long-standing occlusion and 3 with stenotic lesions. Two patients with acute thrombosis were treated with emergency thrombectomy and proceeded to Fistulogram. There were 2 patients with Central vein stenosis, 4 with venous stem stenosis and 1 with anastomotic stenosis. The median follow up was 4.5 months and average radiation time was 4.7 min. We achieved 66% success rate (2/3) of salvaging occluded fistula and 100% success rate of treating stenotic lesions. All successful fistuloplasties achieved normal venous pressures following dialysis to date and was clinically significant. Conclusion: Minimal invasive methods can be successfully used to salvage troubled AVF effectively under limited facilities with minimal radiation. PP 40: Early and late complications of patients who died after kidney transplantation: experience from a single ward YHHGunathilaka, RJMKA Jayasundara, DP Jayasekara, SM Wijeyaratne, MRN Cassim Faculty of Medicine, University of Colombo Introduction and Objectives: In spite of the sophisticated medical care available, worldwide the mortality and morbidity of patients after kidney transplant remains high. Objective was to describe the early and late complications of patients who died following kidney transplantation.

Page 125 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Methods: A retrospective descriptive study was carried out on 65 patients who died within one year of kidney transplantation. Data was collected from the data base of kidney transplant patients. Early and late complications were assessed using descriptive statistics. Results: Out of 497 kidney transplants 65 patients (13.08%) died during one year follow up period. Out of the 65 who died, 42 (64.61%) patients developed early complications during the immediate post-operative period while in hospital. The commonest early complication was acute rejection, which occurred in 14 patients (21%). The second commonest early complication was lower urinary tract infection which occurred in 9 (13.86%) patients. Out of 65 deaths 47 (72.30%) had developed late complications. The commonest late complication was pneumonia in 11(16.92%) patients. Conclusions: Among the early and late complications of post kidney transplant patients, infection has a significant impact on morbidity and mortality. This could be prevented by proper aseptic precautions. PP 41: Need of inotropes for optimal renal graft perfusion in renal transplant recipients VHA Gamage, A Abayadeera Department Of Surgery, Faculty of Medicine, University of Colombo Introduction and Objectives: The need to use inotropes prior to release of the renal artery vascular clamp, for optimal renal graft perfusion, varies from patient to patient. This study aims to identify factors which would significantly predict the need for use of inotropes. Methods: Patients who underwent renal transplantation since October 2007 were studied prospectively. Results: Study population is 490 recipients with a mean age of 43.87 years. Of them 359 (74.5%) were males. Inotropes were required in 125 (25.5 %). Dobutamine was used in 124 (25.3 %), dopamine, noradrenalin and adrenalin were used in <1%. Dobutamine and dopamine or noradrenaline combination was used in 3 (0.06 %). Inotropes were used in 99.2% who were on at least one antihypertensive. This association is significant (p=0.000). There is a positive, significant correlation with antihypertensive use and need for inotropes. (r=0.134, p=0.003). Inotropes were needed in 16 (12.8%) who were on ACEI or ARB s, 49 (42.6%) on beta blockers, 82 (82%) on calcium channel blockers, 81 (82.7%) on diuretics and 71 (73.2%) on alpha blockers. But the association between individual antihypertensive type and need of inotropes were not significant. There was no significant association between the use of inotropes and poor cardiovascular states, presence of LVH, pre anaesthetic mean arterial pressure, central venous pressure, and duration of renal failure or dialysis. Conclusions: Poor cardiovascular status, duration of dialysis and duration of renal failure does not significantly predict the need for inotropes. Antihypertensive therapy significantly predicts the need for inotropes. PP 42: Patient characteristics and treatment modalities in adults with immune thrombocytopenia: experience from a single centre BCM Wimalachandra, EH Wijesinghe, LV Gooneratne Department of Pathology, Faculty of Medicine, University of Colombo Introduction and Aims: Immune thrombocytopenia (ITP) is an autoimmune disorder characterised by isolated thrombocytopenia due to peripheral destruction. Severity of bleeding varies widely. First line treatment options are standard. Second line options vary considerably according to the treating physician, patient characteristics and available resources. Variations are probably due to paucity of high level evidence. We add to the literature, our experience from a cohort of ITP patients in a tertiary care setting. Methods: Study was a retrospective evaluation of patient characteristics and treatment modalities in adult ITP patients followed up at the University Research Clinic, National Hospital of Sri Lanka in 2011 and 2012. Data was obtained from clinic records. Results: Of 31 patients 77% were females. Four had a secondary cause. Severe ITP (clinical features of bleeding at presentation) was seen in 80%. Serious bleed was seen in 33%, which included gastrointestinal (n=5) and pulmonary (n=2). Cutaneous bleeds (n=14) were commonest followed by menorrhagia (n=12). First line therapy was steroids in 27 and IV Immunoglobulin in 3 patients. One patients did not warrant treatment. Azathioprine was used in all 20 patients (65%) requiring second line therapy. Those who failed azathioprine had rituximab (n=4), splenectomy (n=4), dapsone (n=2), cyclosporine (n=2), and/or danazol (n=1). Steroids were discontinued in a patient positive for HIV and the platelet count normalized following anti retroviral therapy. Conclusions: As suggested by recent epidemiologic data, the incidence in adults is approximately equal males and females, except in the mid-adult years (30-60 years), when the disease is more prevalent in women. 67% presented Page 126 of 142

ABSTRACTS OF POSTER PRESENTATIONS

with non serious bleeds. One third maintained a safe platelet count with first line therapy alone. In 40% azathioprine failed as second line therapy. PP 43: Barriers to cataract surgery among elderly in Mahara Divisional Secretariat Division AAN Nishad1, MS Amaratunga2, KTAA Kasturiratne2, J de Silva2, J Mallawarachchi2, AR Wickramasinghe3 1 Post Graduate Institute of Medicine, University of Colombo 2 Wijaya Kumaratunga Hospital, Seeduwa 3 Faculty of Medicine, University of Kelaniya Introduction and Objectives: Even though treatment services are available, barriers in accessing services may account for higher prevalence of cataract in the community. Objective was to describe the barriers to cataract surgery among elderly and its associations. Methods: Random sample of 540 elderly were screened for cataract in Mahara Divisional Secretariat division from August to October 2012 and we identified 349 cataract patients who had not sought treatment. Data were collected to identify reasons for not seeking treatment (barriers). Barriers were categorized as lack of awareness, financial issues, quality-perception, attitudes and beliefs. Results: Seventy four percent didnâ&#x20AC;&#x2122;t know that they had cataract. Fifty percent were not aware about available treatment modalities. Forty percent did not know that cataract can be cured. Sixty seven percent were not able to bear the surgical cost. Transport facilities were available to 89%. Ninety four percent believed that surgery can cure cataract and 99% had faith on the quality of surgery. Eighteen percent were postponing surgery due to family commitment and busy schedules. Fear of surgery was reported by 35% and this was more among females. (p=0.03) Seventy five percent worried about the cost. Lower educational status (p=0.01) and lower income level had a significant association with worry about cost (p=0.01). False beliefs and negative attitudes towards surgery were more among low educational and lower income groups. Discussions: Limited awareness and knowledge about cataract and treatment services, financial constraints and socio-cultural misconceptions were identified as main barriers. Efforts to dispel misconceptions and addressing financial constrains are needed to reduce blindness. PP 44: Hypoglycaemia among patients with type II diabetes mellitus: A retrospective study UDCA Perera, FHDS Silva, ST De Silva Faculty of Medicine, University of Kelaniya Introduction and Objectives: Although there is emphasis on strict glucose control in type II diabetes mellitus (T2DM), information about problems that occur due to hypoglycaemia, especially in resource-poor settings, is lacking. We aimed to determine the prevalence of symptomatic hypoglycaemia, awareness of hypoglycaemia and knowledge about avoiding, detecting and treating hypoglycaemia, in a cohort of patients with T2DM. Methods: A descriptive, retrospective study of patients with T2DM attending general medical clinics of the University Medical Unit, Teaching Hospital, Ragama was carried out for 7 months from May 2012 using an interviewer administered questionnaire. Results: Three hundred patients were recruited. One hundred and two (34%) had experienced at least one hypoglycaemic episode, and more than 2 episodes were experienced by 88 (86.3%). Commonest symptoms were sweating (65.7%) and palpitations (54%). Neuroglycopaenic symptoms were experienced by 54 (52.9%) and 18 (17.6%) had become unconscious. Thirty (29.4%) had required hospital admission. Sixty nine (67.6%) were on sulphonylurea alone or in combination with metformin. Sixty nine (67.6%) were unaware of hypoglycaemia. Main reasons for hypoglycaemia were missed meals 49 (48%) and associated illness 49 (23.5%). Two hundred and thirty eight (79.3%) knew how to treat hypoglycaemia and 151 (50.3%) had received information on hypoglycaemia from medical officers. Two hundred and sixty one (87%) were not using a glucometer and 223 (74%) were unaware of such a device, although 249 (83%) said they could afford one. Conclusions: Hypoglycaemia is a common but under-recognised symptom among T2DM patients. Severe or recurrent hypoglycaemia is associated with a high cost to the individual and to the health service. Raising awareness by health education, with emphasis on self-monitoring where possible, should receive priority. PP 45: Knowledge, attitudes and practices regarding type 2 diabetes mellitus, nutrition and lifestyle in urban Sri Lankan women I Waidyatilaka1, PHIU Waidyatilaka1, A de Silva1, S Atukorala1, N Somasundaram1, P Lanerolle1, R Wickremasinghe2 Page 127 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo Department of Public Health, Faculty of Medicine, University of Kelaniya

Introduction and Aims: Data on population specific patterns of knowledge, attitudes and practices (KAP) is essential for the design of effective intervention strategies. The aim of this study was to assess KAP regarding type 2 diabetes mellitus (T2DM), nutrition and lifestyle in Sri Lankan urban women who were unaware of their glycaemic status. Methods: 2800 apparently healthy urban women (30 - 45 years) were screened for dysglycaemia and 345 normoglcaemics and 272 dysglycaemics were selected from Colombo Municipal Council area by random cluster sampling for a cross sectional study. An interviewer administered questionnaire was used to obtain KAP, demographic information and family history. Chi square test and Studentâ&#x20AC;&#x2122;s t- tests were used for categorical variables and for group comparison respectively. Results: KAP on T2DM, nutrition and healthy lifestyle were poor. Knowledge on pre-diabetes and prevention of T2DM was also poor. However majority wanted to improve their knowledge. Women with a family history had better knowledge (p< 0.001) and attitudes (p< 0.05), but lower practice scores (p< 0.05) compared to women without a family history of T2DM. A significant (p< 0.001) proportion of women with a family history of T2DM found it difficult to resist eating foods high in fat and sugar. Conclusions: Overall KAP was poor, especially about pre-diabetes and prevention. Willingness to learn can be used positively to direct future interventions. Poor practices despite better knowledge and attitudes among women with a family history of T2DM indicate a need for targeted intervention. PP 46: Cut-off values for percentage body fat, in Sri Lankan adolescent girls M de Lanerolle-Dias, P Lanerolle, S Atukorala, A de Silva Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo Introduction and objectives: Cut-off points for excess body-fat (BF) in adolescent populations have been defined as values ranging from 20.7% to >35%. There is no established cut-off value for Sri Lankan adolescent girls. This study aims to identify a %BF cut-off value for Sri Lankan adolescent girls. Methods: Weight and height were measured and BMI calculated in 160 Sri Lankan adolescent girls age 15-19 years. The girls were categorized as overweight and non-overweight (underweight and normal-weight) according to age specific WHO classification. Body-fat was assessed by a deuterium dilution technique. Receiver Operating Curve (ROC) analysis was performed to obtain an absolute cut-off point, where overweight status by BMI was considered as the state variable. The relative cut-off point was calculated as the 85th percentile value for %BF. Results: A cut-off of 34.8% was derived as the absolute cut-off (specificity = 0.88; sensitivity = 0.67, area under the ROC curve = 0.903). The relative %BF cut-off was 34.9%. While the derived cut-off of 34.8% identified 16.3% of girls as having excess BF, WHO defined age specific BMI cut-offs identified only 7.5% of girls as being overweight. Conclusion: The %BF cut-off for Sri Lankan adolescent girls may be considered to be 34.8%. This cut-off identifies girls with excess BF who were not identified by BMI. PP 47: Obesity and hypertension in patients with newly diagnosed type 2 diabetes mellitus: a clinic based prospective study UAD Wijesinghe, A Medagama, NSB Dissanayake National Hospital of Sri Lanka, Colombo Introduction and Objectives: The objective of this study was to study the prevalence of obesity and hypertension in newly diagnosed patients with type 2 diabetes mellitus. Methods: Three hundred and seventy consecutive, newly diagnosed patients with type 2 diabetes mellitus, above 18 years, referred to diabetes clinic at Teaching Hospital, Peradeniya from 1st of October 2009 to 30th September 2010 were enrolled. Blood pressure was calculated based on the mean of 3 readings during consecutive clinic visits. Weight, height and waist circumference (WC) were measured and body mass index (BMI) calculated. Overweight and obesity were defined as BMI >23 kg/m2 and BMI >27 kg/m2 respectively. Waist circumference >80 cm in females and >90 cm in males were considered as central obesity. Results: There were 234 (63.2%) females and 136 (36.8%) males. The mean age of the sample was 50.2Âą11.7 years. The mean systolic blood pressure was 128mmHg and diastolic blood pressure was 78.9mmHg. Prevalence of hypertension was 31.4%. Age and WC but not BMI were strongly correlated with systolic and diastolic blood Page 128 of 142

ABSTRACTS OF POSTER PRESENTATIONS

pressure. The mean BMI and in males was 23.9kg/m2 ±4.5 and females 25.2kg/m2 ±5.5. Mean WC in males was 90.6cm ±8.1 and females 94.2cm±10.7. The prevalence of overweight, obesity and central obesity were 38.9%, 30% and 77.3%. Female gender and urban residence were independently and significantly associated with overweight, obesity and central obesity while age was strongly correlated only with central obesity. Conclusions: The significantly higher prevalence of hypertension and obesity at the time of diagnosis of diabetes indicate the need to identify and manage these conditions, from the onset. PP 48: Prolactin and male infertility T Weerasooriya, I Illeperuma, R Hasan, WS Weerasinghe, AKG Withana Faculty of Medicine, University of Kelaniya Introduction and Objectives: Male infertility due to endocrine disturbances is seen among 1% of couples seeking medical help for childlessness. Effects of prolactin on the male reproductive system are not fully understood. Objective was to determine prolactin level in healthy males with infertility. Methods: A case control study recruited 297 males attending infertility clinics in a government or private institution over a period of 54 months. A detailed clinical assessment of reproductive health was carried out. All underwent a basic seminal fluid analysis (BSA) and an endocrine profile consisting of FSH, LH, testosterone and prolactin (PRL) hormones carried out using the immulite random access chemiluminescent immunoassay method (normal range 2.517ng/ml). Age, weight and height matched volunteers comprised the control group. Results: None of the cases had any anatomical, medical or surgical disorder which could account for the infertility. Among the controls, mean age was 33.2yrs ±5.2, BMI 21.04 kgm-2 ±1.39, BSA 34x106± 7.87x106, number of children fathered 2 ±1, PRL 6.78ng/ml ±2.92. Twenty nine (9.76%) had abnormal PRL levels irrespective of serum testosterone level with a BSA sperm count < 20x106 and there were structural and functional abnormalities. Hyperprolactinaemic was seen in 28 and 26 had marked hypotestosteronaemia. FSH and LH were normal. Conclusions: Prolactin abnormalities affect the male reproductive system and semen parameters. Further studies should be carried out on PRL and male infertility PP 49: Hypoglycaemia: What do we know of the cause? HA Dissanayake, KKK Gamage, JH Liyanage, GSP Keerthisena , WA Wijesundara, WMUA Wijetunga ,S Subasinghe, TAD Tilakaratne, P Katulanda Diabetic Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction:Hypoglycaemia, is a feared experience for diabetic patients due to the disturbing symptoms. It reduces treatment compliance and also contributes to morbidity and mortality in diabetes. Identifying the cause of hypoglycaemia is important for optimal glycaemic control. Methods: The study was conducted using a structured, interviewer administered questionnaire among 717 diabetic patients attending a private sector clinic, using consecutive sampling. Hypoglycaemic episodes during the preceding month were analysed and severity was graded based on clinical features and capillary blood glucose levels. Results: In 717 patients 55.2% were male. Mean age was 54.9 (±12.5) years. Mean duration of diabetes was 10.5 years (±7.9). Mean fasting blood glucose was 135.4 mg/dL (±51.45) and HbA1c was 7.83% (±1.73) respectively. Prevalence of hypoglycaemia was 25.5% (mild 75.69%, moderate 17.68%, severe 6.63%). Common causes of hypoglycaemia were, sudden change in the diet (quantity, composition or timing) 48.60%, increased medicine dosage 16.57% and unaccustomed exercise 14.92%. A cause was not identified in 14.36%. Non-prescribed native food items were the cause in 19.89% (Thebu 6.08%, Karawila 9.39%, Kothalahimbutu 1.10%, Madatiya kola 0.55%, others 2.76%). Conclusions: Hypoglycaemia is common among diabetic patients. Patients should be advised to maintain a regular routine of diet and exercise. Consumption of non-prescribed native food should be investigated as a cause for hypoglycaemia. PP 50: Obesity in children: an experience from Jaffna MG Sathiadas, P Tharshigan, S Balakumar University of Jaffna

Page 129 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Introduction and objectives: The rise in childhood obesity over the past decade has been dramatic. During the post war period in Jaffna district, we have seen more school children becoming obese. The study objectives were to identify the prevalence of obesity among school children and to identify the complications of obesity. Methods: Four schools were selected randomly in the Jaffna education zone. A total of 2000 children between the ages of 12 and 18 were randomly screened. The height and weight was measured and BMI was calculated. Those who were overweight and obese according to the WHO standards were investigated further. The blood pressure after 30 minutes of rest, fasting blood sugar, lipid profile, and insulin levels were done. Data was recorded using a data entry sheet. Results: A total of 105 (5.3%) children were identified in the overweight and obesity groups. Mean age was 13.9 years (±2.8). The male female ratio was 1:1. Six boys and 14 girls were between 85th -95th centile and 16 boys and 9 girls were >95th centile for age. A total of 45 (43%) children attended the paediatric clinic for further evaluation. Impaired fasting (>100g/dl) was seen in 2 (4.4%), triglyceride level of >150mg/dl in 6 (13.3%), total cholesterol >200mg/dl in 11 (24%), LDL >190mg/dl in 3 (6.6%) and HDL 15 micromol/l in 19 (42%). Acanthosis nigricans was seen in 33 (73%). Conclusions: In the target population of 12-18 year age group, prevalence of overweight in girls and obesity in boys was high. Fasting cholesterol and fasting insulin were high in a significant number. There was a clear association with the fasting insulin level and presence of acanthosis nigricans. PP 51: Life style during menstrual periods among adolescent school girls RJMKA Jayasundara, SD Jayawickrema, AU Gamage, TAAOT Jayaweera, Faculty of Medicine, University of Colombo Introduction: Menstrual health is an important issue but there is insufficient knowledge regarding this. Aims: To assess the life style in relation to physical, mental and social health during menstrual periods, of grade 10 students of government girls’ schools in Borella educational division. Methods: Through multi-staged stratified random sampling, a sample size of 113 students was selected. Permission was obtained from relevant authorities. A self-administered questionnaire gathered data. Chi-squared test was used to identify associations. Results: During the menstrual period, more than 90% washed the perineal region at least twice a day. Majority (85%) used soap and water for the purpose of cleaning genitalia, while the rest used only water for this purpose. Eighteen percent did not bathe and out of those who bathe, 19.1% avoided bathing on day one of the menstrual period. Only 12% trimmed perineal hair during this period. Most (50.4%) refrained consuming certain food items during this period, 44% did not participate in sports, 18% refrained from attending tuition classes, 4.4% refrained from attending school, 64.6% avoided religious places, 47.8% avoided funerals and 1.8% avoided weddings. Parents did not allow 15% to engage in social activities, 4% were kept away from male family members and 1 student reported that she was kept isolated. Poor knowledge on menstruation was significantly associated with avoiding socio-cultural activities (p<0.05). Higher level of hygiene was observed among girls whose mothers were housewives (p=0.001). Conclusions: Unhealthy practices were observed during menstruation in the study group. PP 52: Use of mid upper arm circumference and skinfold thickness as alternatives for Body Mass Index (BMI) to assess underweight among cardiac patients in Sri Lanka NC Lokunarangoda1, AK Pathirana1, N Thalagala1, KKS Chinthanie1, R Jayawardena1, WS Santharaj1 1 Institute of Cardiology, National Hospital of Sri Lanka, Colombo Introduction and Objectives: Management of underweight is important in treating primary disease conditions. There are practical difficulties in using Body Mass Index (BMI) for detecting underweight among cardiac patients in the wards, because patients are critically ill and bed bound. Current study evaluated the validity of mid upper arm circumference (MAUC) and triceps skinfold thickness (TSFT) instead of BMI to assess underweight in cardiac patients. Methods: A cross sectional study was carried out among 526 patients admitted to the Institute of Cardiology, National Hospital of Sri Lanka. Height, weight, MUAC and TSFT was measured using standard techniques and BMI was calculated. Those with BMI ≤18.5kg/m-2 were considered as underweight. Receiver operating characteristic (ROC) curves analysis assessed the validity of MUAC and TSFT in detecting underweight. Page 130 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Results: Mean MUAC and TSFT were 29.1cm and 1.5cm respectively. MUAC had ROC curve area of 0.9384 which is higher than that of TSFT (0.8123). The difference of ROC curve areas is statistically significant (p<0.0001) which indicates that MUAC is a better alternative for BMI than TSFT. MUAC of 26cm showed highest sensitivity (96.2%) and specificity (81.9%). Conclusions: Measurement of MUAC can be used as an alternative for BMI in screening underweight cardiac patients. MUAC of ≤26 cm can be used as the cut off value. PP 53: Physical activity and weight gain during the period from first trimester of pregnancy to six months post partum M G S N S Perera, C Abeysena Ministry of Health-MOH Office, Mahara Introduction and Objectives: Weight gain from first trimester of pregnancy to six months post partum, places a woman at risk of developing obesity in later life. Objectives were to determine the association between physical activity and weight gain during the period first trimester of pregnancy to six months post partum, in mothers attending child welfare clinics in Biyagama and Kelaniya Medical Officer of Health areas. Methods: This was a clinic based descriptive cross sectional study, conducted from August to October 2012. International Physical Activity was used in data collection. Low physical activity was defined as no activity or < total 600 MET-min/week (Metabolic Equivalents of Task) for 5 or more days. Results were expressed as percentages, Odds ratios (OR) and 95% confidence intervals (CI). Multivariate logistic regression was performed to control for confounders. Results: Median total Physical Activity was 1,087 MET-minutes per week (inter quartile range IQR 240 - 1836). Low level of physical activity was observed in 38.8% (95% CI 34 -44%) of mothers. Percentage of mothers who gained weight from first trimester of pregnancy to six month post partum was 67.8% (95% CI 63% -72%). Multivariate logistic regression showed low level of physical activity was significantly associated with weight gain from first trimester to six months post partum OR12.0 (95% CI 6.1-23.8, p=0.001). Conclusion: Low level of physical activity was associated with weight gain from first trimester of pregnancy to six months postpartum. PP 54: Survival of patients treated with Percutaneous Transluminal Coronary Angioplasty following ST segment elevation myocardial infarction V Abeysuriya1, A Kasturiratne1, LG Chandrasena2, VS Hettiarachchi2, AR Wickremasinghe1 1 Department of Public Health, Faculty of Medicine, University of Kelaniya 2 Nawaloka hospitals PLC, Cardiology unit 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 patients (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, hFABP 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 1.096110.205] was significantly associated with survival of patients after controlling for other risk factors. Conclusion: The three year survival of patients with STEMI who underwent PTCA was 83%. Patients with proximal LAD occlusion were 11 times more likely to die within 3 years of PTCA as compared to those who had a distal LAD occlusion. PP 55: Electrocardiographic and echocardiographic manifestations of cardiac involvement in leptospirosis Page 131 of 142

ABSTRACTS OF POSTER PRESENTATIONS

T Fernando1, C Rodrigo1, L Samarakoon1, R Navinan1, C Dandeniya1, G Constantine2, S Rajapakse2 1 University Medical Unit, National Hospital of Sri Lanka 2 Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction and Objectives: Cardiac involvement in leptospirosis ranges from non-specific ECG changes and arrhythmias to myocarditis, pericarditis, endocarditis and cardiogenic shock. There is limited data on the echocardiographic findings in leptospirosis. Methods: We carried out a descriptive study to identify the electrocardiographic and echocardiographic changes in serologically confirmed leptospirosis patients in Sri Lanka. Twelve lead ECGs were obtained at admission in all patients and an echocardiogram was also done. Results: Fifty five patients with suspected clinical leptospirosis were screened; 22 patients had serologically confirmed leptospirosis (males 68%, mean age: 38.8 years). Ten (45.4%) patients complained of cardiac symptoms [ischaemic type of chest pain n=10 (100%), palpitations 6 (60%) and new onset shortness of breath n=2 (20%)]. Thirteen (59.09%) patients had abnormal findings on ECG. Of them 10 (77%) patients had sinus tachycardia and 1(7.7%) had tachycardia with atrial fibrillation, which was transient. Three patients (23%) had dynamic T-wave inversions in precordial leads during hospital stay. Nine (41%) patients had abnormal findings on the echocardiogram [mild mitral regurgitation n=5 (55.5%), aortic regurgitation n=2 (22.2%), apical hypokinesia and wall motion abnormalities n=3 (33.3%)]. Overall definite clinical and echocardiographic evidence of myocarditis was seen only in two patients. Conclusions: Our preliminary data suggest that echocardiography may be useful in identifying myocarditis, despite previous studies. Larger studies are needed to identify the clinical, biochemical and electrocardiographic predictors of myocarditis, and also to determine the significance of myocarditis in terms of morbidity and outcome. PP 56: Biochemical and clinical indicators of peripheral neuropathy in patients on long term statin treatment HMST Bandara, DWN Dissanayake, PM Atapattu, MAN Manchanayake, HPC Tissera, SS Batagoda Department of Physiology, Faculty of Medicine, University of Colombo Introduction and objective: Atorvastatin is increasingly used as first line treatment in primary prevention of cardiovascular disease in Sri Lanka. Peripheral neuropathy is an adverse effect, which is reversible if statins are stopped early. It is hypothesized to be due to lowering of serum cholesterol and inflammatory degeneration of nerve and liver cells. Objective of the study was to describe the association between treatment parameters and clinical and biochemical findings in patients on long term statin treatment. Methods: Patients on atorvastatin for >2years, attending medical clinics at National Hospital, Sri Lanka were studied using an interviewer-administered questionnaire, modified neuropathy symptom (mNS ≥1 indicative of neuropathy) and examination (mNE>3 indicative of neuropathy) scoring. Total serum cholesterol (TC), low density lipoprotein (LDL), triglyceride (TGs) and alanine transaminase(ALT) levels were measured. Results: In the sample of 30, there were 13 males and 17 females. Mean age was 60.8 years ±8.44, mean atorvastatin dose was 14 ±4.98 mg and mean duration of treatment was 5.07 years ±2.65. Ten (33.3%) had mNS≥1 and six (20%) had mNS>3. There was no significant relationship (p>0.05) between levels of TC (mean 159.1 mg/dL ±31.5), LDL (mean 89.9 mg/dL ±28.3), TGs (mean 117 mg/dL ±50.1) and ALT (mean 23.6 U/L ±7.2) with mNS or mNE. No correlation was found between TC, LDL, TGs and ALT levels with drug dose and treatment duration. There were significant negative correlations between treatment duration and mNS (r= -0.495, p=0.005) and mNE (r= -0.362, p=0.049). Conclusions: Biochemical and treatment parameter are not reliable indicators for early detection of peripheral neuropathy in patients on long-term treatment with statins. Further studies are required to delineate prevalence, indicators and causes of peripheral neuropathy in patients on long-term statin treatment. PP 57: Cardiovascular endurance of physiotherapy undergraduates and associated metabolic risks DC Ranasinghe, GLRS Perera, A Rathnayake, A Weththesinghe Allied Health Sciences Unit, Faculty of Medicine, University of Colombo Introduction and Objectives: Cardiovascular endurance (CE) of young adults is inversely associated with increased metabolic risk in the middle-age. Physical inactivity leads to low CE and altered body composition. Physiotherapists are educated on physical exercise to promote physical activity of the public. Our objectives were to measure the CE, body composition and physical activity of physiotherapy undergraduates of the University of Colombo. Page 132 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Methods: A cross sectional study was conducted. A 20m multistage shuttle run test (20mMST) was performed under medical supervision to estimate CE; and predict maximal oxygen uptake (VO2 max: mlkg-1min-1). Height and weight were measured and Body Mass Index (BMI) calculated and compared with Asian cut-offs. Physical activity levels were estimated using Physical Activity Index. Results: Sample (n=51) consisted 33 females (mean age 23.4 ± 1 years). Overall mean VO2 max was 31.3±7.5 mlkg-1min-1. Males (39.2±5.8 mlkg-1min-1) had better VO2 max than females (27.02±3.9 mlkg-1min-1) of the sample. 43.1% were overweight and obese. Obesity was associated with less VO2 max compared to normal weight (p<0.05). Conclusions: Majority of students did not reach minimum required cardiovascular endurance. Female gender and obesity were associated with lower CE. Prevalence of overweight, obesity and physical inactivity was high. Future research should identify causative factors and interventions to improve CE, body composition and physical activity of physiotherapy undergraduates. PP 58: Cardiovascular risk among patients attending the Family Practice Centre, University of Sri Jayawardenepura HL de Silva, H de Silva, TSP Samaranayaka, MSA Perera, A Jayawardane, K Dassanayake, T Thilakaratne, MAYR Manchanayaka, MGAI Chulika, PVG Chaturika, KC Jeewandara Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura Introduction and Objectives: Diseases related to the cardiovascular system are among the commonest causes of death in Sri Lanka. The incidence and prevalence of cardiovascular diseases (CVD) is increasing. Evidence suggests that the modification of risk factors such as diabetes, hypertension, smoking and central obesity will reduce the clinical events and premature deaths due to CVD. This study was designed to assess the CVD risk by using the WHO/ ISH risk assessment chart and Framingham risk score. Methods: A prospective study was carried out among patients over 40 years of age, with no past history of cardiovascular events, attending the FPC. Data was collected using an interviewer administered, semi-structured questionnaire. Informed written consent was obtained from patients. Results: Mean age was 56.8 years and the majority were females (77%). The CV risk factor distribution was as follows; diabetes mellitus 35%, hypertension 36%, hypercholesterolemia 33%, smoking 5%, alcohol 12.8%. BMI >23kgm-2 was seen in 72.7%, BMI >27.5kgm- 2 was seen in 28.6%. In 44% of males WC >90cms and in 76.6% of females WC >80cm. According to WHO/ISH Score 89.6% had a 30% risk. According to Framingham score 84.4% had 10% CVD risk at 10 years, 12% had intermediate risk (10-20%) and 3.6% high risk (20% or more). Conclusions: Collective cardiovascular risk is relatively low though the prevalence of individual risk factors is high. PP 59: Effect of sitagliptin on diabetic patients poorly controlled with other oral hypoglycaemic agents GSP Keerthisena, P Katulanda, HA Dissanayake, JH Liyanage, WA Wijesundara, TAD Tilakaratne, WMUA Wijethunga, KKK Gamage, SS Subasinghe, Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction and Objectives: Sitagliptin (DPP-4 inhibitor) is a newer oral hypoglycaemic agent (OHA) effective in achieving good metabolic control in diabetic patients. It is effective in lowering blood glucose levels without causing significant hypoglycaemia or weight gain. Our aim was to assess the effectiveness of sitagliptin in patients with poor glycaemic control with other oral hypoglycaemic agents. Method: Patients (n=43) who had unsatisfactory glycaemic control with at least two conventional oral hypoglycaemic agents were recruited from private sector consultation and commenced on sitagliptin as a part of clinical management. Anthropometric and biochemical parameters were monitored at baseline and regular intervals and results were analysed using student t test. Results: In 43 patients mean age was 56.84 ±11.90 years, and 60.5% were males. Mean duration of diabetes was 12.90 ±6.87 years, mean pre-treatment HbA1c 8.54% (±1.21), fasting blood glucose (FBG) 156.46 mg/dL (±35.22) and body weight (BW) 63.93Kg (±13.73). Mean HbA1c at 3 and 6 months were 7.37% (±1.34, p<0.001) and 7.45% (± 1.00, p=0.002). Mean FBG at 3 and 6 months were 128.02 mg/dL (±27.64, p<0.001) and 119.77 mg/dL (±39.94, p=0.021). Mean BW at 3 and 6 months were 64.23Kg (±13.91, p=0.2) and 68.03Kg (±16.26, p=0.92) respectively. Conclusions: Addition of sitagliptin to OHAs improved HbA1c and FBG. Improvement at 3 months was more marked than 6 months. Effect on body weight was insignificant. Page 133 of 142

ABSTRACTS OF POSTER PRESENTATIONS

PP 60: Audit on timelines for administration of acute reperfusion therapy in acute ST elevation myocardial infraction at the National Hospital of Sri Lanka AK Pathirana1, WS Santharaj2, RAI Ekanayake2, JB Jayawardena2, V Senaratne2, MP Seneviratne2, KKAO Walawwatta1, KGV Saranga1 1 Institute of Cardiology, National Hospital of Sri Lanka 2 Emergency Treatment Unit, National Hospital of Sri Lanka Introduction and Objectives: Timely administration of acute reperfusion therapy is proven to decrease mortality in acute ST segment elevation myocardial infarction (STEMI). The aim of this study was to identify deficiencies in local practice compared to the standards recommended in European Society of Cardiology (ESC) guidelines, enabling future changes which are directed at improving the quality of patient care. Methods: This was the first cycle of a prospectively designed audit. The data was collected from 180 consecutive admissions to National Hospital of Sri Lanka (NHSL) with acute STEMI during 3 months November 2012 - January 2013. Time from first medical contact to balloon inflation (Door to Balloon Time-DBT) in case of primary percutaneous coronary interventions (pPCI) and time from first medical contact to needle time (Door to Needle Time-DNT) in case of thrombolytic therapy were calculated and compared with the standards recommended in ESC 2008 guidelines: DBT should be < 120 minutes; DNT should be < 30 minutes. Results: Out of 180 patients, 142 (78.9%) received acute reperfusion therapy, 92 (51.1%) received thrombolysis and 50 patients (27.8%) received pPCI. Of those receiving thrombolysis at NHSL, median DNT was 80 minutes and DNT<30 minutes was achieved only in 18.0%, while those receiving pPCI, median DBT was 150 minutes and DBT<120 minutes was achieved in 40.82%. Conclusions: Treatment times in the local practice are longer than the standards recommended in the ESC guidelines. Measures should be taken to minimise the delays and the performance needs to be reviewed periodically by audits. PP 61: Comparison of electronic and paper based indoor morbidity and mortality reporting systems NC Kariyawasam, MKDRB Dayaratne, SC Wickramasinghe, KKP Sylva University of Tasmania Introduction and Objectives: In Sri Lanka, discharge data is presently collected using the paper based Indoor Morbidity and Mortality Record (PBIMMR). To overcome problems associated with this system, an electronic Indoor Morbidity Mortality Report (eIMMR) was developed. This new system was piloted in seven major hospitals in Sri Lanka for more than a year. Objective is to evaluate PBIMMR and electronic eIMMR system regarding accuracy, customer satisfaction, timeliness and implementation cost. Methods: The accuracy of PBIMMR and eIMMR was studied in Base Hospitals Horana and Panadura. A randomly selected sample of 470 BHTs from each hospital was studied. Data was collected using a check list. Focus group discussions were conducted (FGD) with Medical Records Officers who implemented eIMMR, to determine customer satisfaction. Initial implementation cost of eIMMR and PBIMMR as well as recurrent costs of each system for one year was calculated. Results: eIMMR was significantly more accurate in entering of ICD codes, age, sex and correct quarter. FGD showed eIMMR to be more user friendly and it was able to produce more timely reports. Users suggested more features that support analysis to be included in the new system. eIMMR had a significant initial capital cost but the recurrent cost was almost identical. Conclusions: We recommended the use of eIMMR to improve the accuracy and timeliness of the IMMR returns. Possibility of using the eIMMR as a platform to introduce other surveillance systems such as NCD surveillance, cancer surveillance and accident surveillance should be explored. PP 62: Survey of tobacco use among third year medical students in Sri Lanka AP de Silva, P de Silva, IK Liyanage, STGR de Silva, JMWJ Bandara National Intensive Care Surveillance, Ministry of Health Introduction and Objectives: Objective was to describe the prevalence and correlates of tobacco use among 3rd year medical students in Sri Lanka.

Page 134 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Methods: This cross sectional study was conducted among 3rd year medical students in all medical schools in Sri Lanka during 2011. A pre-tested, confidential, self-administered questionnaire was used for data collection. The final sample was weighted to adjust for non-response. Results: A total of 1,118 (92.9%) participated in the survey. There were 484 males (43.8%) and 619 females (56.2%). The prevalence of all time smoking was 15.9% (95% CI 15.4-16.5) (males: 31.8%, females: 3.2%). Smoking during past 30 days was seen in 3.2% (95% CI 3.0-3.5). A total of 29.4% (95% CI 28.7-30.1) were exposed to passive smoking. Majority 97.7% (95% CI 97.4-97.9) believed that smoking should be banned from public places. Intention to quit smoking was reported by 44.7% (95% CI 39.6-49.9) of the current smokers 74.2% (95% CI 70.2-77.9) have tried to quit during the past year. Only 18.6% (95% CI 18.0-19.2) have learned cessation approaches that can be used with patients. Further 48.7% (95% CI 47.9-49.4) were not taught reasons why people smoke. However 90.2% (95% CI 89.7-90.6) were taught about the importance of recording tobacco use as part of patientâ&#x20AC;&#x2122;s general medical history. Majority 52.8% (95% CI 52.0-53.6) informed that health professionals who smoke are less likely to advice patients to stop smoking. Conclusions: The prevalence of smoking and exposure to passive smoking was high among medical students. Although some aspects of tobacco consumption were taught in medical schools, training in cessation was inadequate. PP 63: Current practices and perceived needs of general public on drug information in Sri Lanka AB Padeniya1, H Benaragama2, SK Ananda2, L Jinadasa2, N De Soysa2 , DSilva3, , AP De Silva4 1 Lady Ridgway Hospital 2 General Hospital Kalutara 3 Clinical Pharmacist Australia 4 National Intensive Care Surveillance, Ministry of Health) Introduction and Objectives: Objectives were to describe the current practices and perceived needs of general public on drug information in Sri Lanka. Methods: A descriptive cross sectional study was conducted in three randomly selected districts. Individuals from households were selected using multi stage cluster sampling method probability proportionate to size. The primary sampling unit was the Gramasevaka division. A cluster size was limited to 25. Data was collected using a pre-tested interviewer administered questionnaire. Results: For most people 220 (56%) medicine information means information about medicine safety. One hundred and seventy seven (45%) recalled that they had questions about medicine and 193 (49.1%) have sought information from the doctors. Questions regarding medicines were; how to take a medicine 130 (33.1%), what happens when multiple drugs are prescribed 119 (30.3%), safety in pregnancy or breastfeeding 109 (27.7%), how medicines work 108 (27.5%), medicine availability and price 108 (27.5%) and the generic name of brands 101 (25.7%). Almost all participants 384 (97.37%) think Sri Lanka needs a National Medicine Information Centre (NMIC) while 242 (61.5%) informed that the service should be available 24 hours. A significant proportion 341 (86.8%) stated that they would utilize NMIC if available in Sri Lanka. Most participants thought that the best way to advertise the availability of such a service is through television 291 (74.1%) and newspapers 134 (34.1%). Conclusions: Most identified the need for a NMIC and said they would utilize such a service. Majority wanted to know about safety of medications. Many had sought information from doctors. PP64: Survey of psychoactive substance use among mentally ill patients in unit six, National Institute of Mental Health ADMA Herath, N Fernando, HMAB Herath National Institute of Mental Health, Angoda Introduction and Objectives: Prevalence of substance use among mentally ill is about 60%. Co-morbid substance use increases morbidity and mortality. The objective of the study was to determine the patterns of substance use and interventions in those who use psychoactive substances. Methods: Out of 63 in-ward patients, 32 (50.7%) used psychoactive substances. These were alcohol n=11 (34.3%), cannabis n=6 (18.7%) nicotine n=5 ( 15.6%) and poly substance use n=10 (31.2%). Of the users, 29 (90.6%) were males, 18 (56.2%) were unemployed. Five (15.6%) were diagnosed with schizophrenia. Of the 32, 9 had a diagnosis of substance use disorders while 16 (50%) had a comorbid psychiatric illness. Of these, 9 had schizophrenia. Sixteen clinical records (50%) documented types of substance but not patterns of use. Seven (21.8%) recorded patterns of Page 135 of 142

ABSTRACTS OF POSTER PRESENTATIONS

use according to ICD-10. Sixteen (50%) were treated pharmacologically. Psychological interventions were carried out in 19 (59.3%). Thirteen (40.6%) were not treated. Follow-up appointments were given to 22 (68.7%) patients, while 10 (31.2%) were not followed up. Conclusions: Nearly half the in-patients used psychoactive substances, most abusing alcohol or using multiple substances. Co-morbidity was high. In 40.6% no psychological interventions were carried out implying that in many patients, staff did not consider active preventive measures. PP 65: Validation of PHQ-9 questionnaire for use in cardiology clinics in Sri Lanka IH Rajapakse, AS Dissanayake, PA Jayasinghe, CL Fonseka Faculty of Medicine, University of Ruhuna Introduction and Aims: America Heart Association (AHA) recommends the routine screening of all patients with coronary heart disease (CHD) for depression. AHA recommends the use of Public Health Questionnaire PHQ-9 as the screening tool. Out of a total score of 30, those scoring 0-9, 10-19 and 20-30 are determined to have minimal, moderate and severe depressive symptoms. Depression screening instruments should be validated in the specific cultural setting prior to general use. The aim was to validate the PHQ to screen for depression in patients with CHD in cardiology and medical clinics in Sri Lanka. Methods: A sample of 286 patients with CHD underwent PHQ screening. Mental state examination (MSE) was considered as the gold standard for diagnosis of depression. The sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) and likelihood ratios were calculated. Results: Sensitivity and specificity of PHQ were 91% and 52%. The PPV and NPV were 35% and 93%. Likelihood ratio positive and negative were 1.9 and 0.17 Conclusions: The PHQ is very sensitive in diagnosing depression but is not good at ruling out depression. Only a third of those identified as positive actually had depression. PHQ was good at identifying those were not depressed. Due to high sensitivity, the PHQ is a valid instrument to screen for depression in the busy cardiology/medical clinic. If the test is negative, the physician could rule out depression with a high level of certainty. PP 66: Water, sanitation and hygiene (WASH) among school children in a conflict affected area MSK Wickrematilake, SM Arnold, K Pethiyagoda, AM Faizal Department of Community Medicine, Faculty of Medicine, University of Peradeniya Introduction: The UNICEF state that 1,299 out of 9,662 schools do not have functional sanitation facilities. Due to the war, the WASH facilities in the North and East was underdeveloped and it is important that water sanitation and hygiene are given high priority. Aims: To assess the knowledge, attitudes and practices on water sanitation and hygiene of the school children. Methods: A descriptive cross sectional study was carried out in the Kiran MOH area in the Batticaloa district. A total of 153 students in year 7 and 8 participated. Self administered questionnaire and an observational checklist were used as study instruments. Results: Majority of students knew that boiling water kills germs, and that water storage containers should be cleaned and covered (97.4%), and hand washing with soap removes germs (73.9%). However knowledge was not satisfactory about water contaminate caused by open defecation (22.9%), spread of infections through unclean nails (26.1%) and use of toilets as a measure of preventing diarrhoea (13.1%). Mean attitude score on water and sanitation was only 56.08. Only 71.9% cleaned their teeth using a toothbrush and toothpaste. 38.6% indicated they go to a nearby shrub for defecation. In schools only 54.1% had access to a clean toilet and 51% had access to a safe drinking water source. Conclusions: The knowledge and attitudes about important areas of sanitation was not satisfactory. Schools lacked adequate water and sanitary facilities. The communities including schools should be provided with adequate water and sanitary facilities which would improve WASH practices of school children. PP 67: The Sri Lankan Twin Registry (SLTR) A Sumathipala, S Siribaddana, C Siriwardana, K Jayaweera, A Adikari Institute for Research & Development Introduction and Aims: Twin research helps to determine the degree to which traits and disorders are heritable. Most such studies use volunteer registers and are from North America, Europe and Australasia. Population based registers are rare even in the West. SLTR is the first of its kind in a low and middle income country (LAMIC). Page 136 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Methods: It was proposed by the first author and founded in 1997, and launched at the 110th annual scientific sessions of the SLMA, initially as an island-wide volunteer cohort through media publicity. It was later extended to a population based cohort (Colombo district) with a strategic collaboration between Institute for Research and Development and Institute of Psychiatry, King’s College, London, with competitive charitable funding from the West. Results: The volunteer cohort comprises of 14130 twins (7065 pairs) and population cohort 19,040 (9520 pairs). Feasibility studies (which resulted in five publications), were followed by The Colombo Twin and Singleton Study (CoTaSS 1) exploring the prevalence and heritability of a range of psychiatric disorders and gene-environment interplay (seven publications) and establishment of a genetic laboratory. Second wave follow-up (CoTaSS 2) on depression and metabolic syndrome explores the prevalence and interrelationship of a number of key cardiovascular and metabolic risk markers and establishment of a Bio-bank (DNA and serum). Conclusions: In the context of scarcity of research capacity in LAMIC, SLTR has showcased how successful North-South partnerships can overcome barriers to minimize 10/90 divide leading to influential high quality research and publications in high impact journals. PP 68: Knowledge, attitude and skills of leadership among final year medical students MUD Yapa, DWN Dissanayake, UP Nanayakkara Department of Physiology, Faculty of Medicine, University of Colombo Introduction and Objectives: Medical curriculum should focus on developing strong leadership skills which will enable medical graduates to become future leaders. Objective of the study was to identify skills, knowledge and attitude on leadership among medical students. Methods: Self and rater versions of the Authentic Leadership Questionnaire (ALQ) and a questionnaire based on Medical Leadership Competency Framework (MLCF) were distributed among 120 final year students of Faculty of Medicine, Colombo. Scores calculated for each of the 4 components, Transparency (TR), Ethical skills (ES), Balanced processing (BP), Self-awareness (SA) of ALQ, is the average of the items scored from 1 to 4 (<3 indicates poor leadership skills). Knowledge was assessed using the questionnaire (≥4 indicates good knowledge). Results: Among students who completed all four sections of the ALQ (n=95; females=52, males=43) 61.1% had poor leadership skills (2.86 ±0.44). The students demonstrated low leadership skills in each of the components. TR (n=118); 2.92 ±0.52; ES, (n=110); 2.83 ±0.58; BP (n=105); 2.92 ±0.55; SA, (n=112); 2.77 ±0.65). There was a significant difference between all components of leadership skills among self and assessment of their leaders (rater) (TR, n=111; 2.56 ±0.62, p=0.001; ES; n=111; 2.6±0.66, p=0.005; BP; n=109; 2.68 ±0.73, p=0.011; SA; n=110; 2.61 ±1.33, p=0.024). Among 111 completed MLCF 87 (79.1%) had good knowledge (4.384 ±0.69). Majority 72 (62.39%) rated themselves as good or very good leaders. Seventy three (76.5%) wanted to undergo leadership training. Conclusions: Majority of students have poor leadership skills despite good knowledge and a discrepancy exists between actual skills and their views as leaders. The leaders have been rated lower than self. It is important to determine factors contributing to poor leadership skills and address them during training. PP 69: Lapses on pre disaster education: a study in a suburban community in Sri Lanka frequently affected by floods MAC Lakmal, PCI Wijesinghe, I Karunathilake Faculty of Medicine, University of Colombo Introduction: Flooding is the most common natural disaster in Sri Lanka and a considerable amount of the national budget is spent on immediate crisis response. The objective was to evaluate the knowledge regarding pre-flood preparedness and post-flood health hazard prevention in a community repeatedly affected by floods. Methods: A qualitative research was conducted in a community of 103 families in Kolonnawa using a semi structured script involving four focus group discussions. Participants representing all levels of the community hierarchy were selected from those who volunteered. Results: Fifty two (male= 28) participated. Study group was aware that a few days of rain could cause flooding in their area. They were not informed about safe evacuation centers and unaware of the importance and the contents of a two day emergency kit. Community stakeholders were aware of the contacts for emergency rescue, but in medical emergencies, the patient had to be transported to a local medical center. Knowledge of first aid was minimal. Formal Page 137 of 142

ABSTRACTS OF POSTER PRESENTATIONS

education at school about basic hygiene, and what should and should not be done during flooding was poor. Many young adults were affected by injuries which could have been prevented. Basic hygienic practices regarding water, cooking and sanitation were maintained. Knowledge on infectious disease transmission and early symptoms was minimal, especially among the elderly. Basic knowledge on post flood cleanup was poor. Conclusions: Knowledge about preparedness and health hazards of floods were minimal in the study group. Educational programs with drills at schools could improve response to floods.

PP 70: Sri Lankan research output in the global context: where do we stand? AMNL de Silva, P Wijetunga, S Rajapakse Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction and Objectives: There is little data on the contribution to global research by Sri Lankan researchers. We studied the research output by Sri Lankan researchers with the objectives of describing publication patterns, principle subject areas, key research institutions and international collaborations. We also assessed the research trend and number of citations. Methods: We searched several key databases for publications with Sri Lankan authors from 2003 to 2012. Retrieved data were categorised as peer-reviewed journal papers and conference presentations. They were analysed according to document type, subject area, institution, journal, international collaborations, and citation details. Results: Total research output by Sri Lankan researchers were as follows; 4777 in Web of Science (WOS), 6546 in Scopus, 2212 in EMBASE, 1684 in Medline and 462 in IEEEXplore. From 2003 to 2012, the number of peer reviewed journal papers have gradually increased, while the number of conference abstracts has declined. The Universities of Peradeniya (WOS-26.8%, Scopus-23.53%), Colombo (WOS-18.3%, Scopus-20.7%), and Kelaniya (WOS-8.5%, Scopus- 8.53%) had the highest output. Highest number of publications was in the field of technology. Highest numbers of international collaborations were with USA in WOS (13.7%) and UK in Scopus (13.94%). Hindex for journal papers in WOS was 61 with an average citation rate of 7.37. Conclusions: Publications by Sri Lankan authors in peer-reviewed journals are increasing, but the contribution to global research remains low. Policy makers should support academic institutions to enhance the quality, relevance and output of research by Sri Lankan researchers, and researchers should focus on obtaining high quality publications. PP 71: Association between academic performance and emotional intelligence among medical students Jennifer Perera, PHU Cooray, AN Hettiarachchi Faculty of Medicine, University of Colombo Introduction and Aims: Emotional intelligence (EI) is reported to influence academic and work achievements more than the traditional intelligence quotient (IQ). Evidence on the impact of emotional intelligence on academic performance of university students is sparse. Objective of the study was to study the association between EI and academic performance (AP). Methods: A validated questionnaire on EI was used to assess self reported EI among two batches of medical students (n=294). The AP was assessed using results of introductory basic sciences (IBS) end of course (first barrier exam) examination conducted at the end of first year. Scores for the sub categories of EI (Social skills, self management, self awareness and social awareness) were compared with examination results. Results: Among the participants, majority had higher scores for self awareness and self management components (63.6%, 58.2% respectively) while majority had lower scores for social awareness and social skills (68.7%, 51.4% respectively). Females scored significantly better than males in self awareness. Social skills were significantly associated with IBS examination scores where as self management, self awareness and social awareness were not associated with IBS examination scores. Conclusions: EI as a total score is not a good predictor of AP among first year medical students. It is recommended that further research should examine the effect of EI on clinical diagnostic ability. PP 72: A study on knowledge and attitudes towards end-of-life decisions of medical and non medical professionals and clergymen Page 138 of 142

ABSTRACTS OF POSTER PRESENTATIONS

V Pinto, MVG Pinto, PVR Kumarasiri, WMABW Eriyawa, SDK Weerasinghe, TMRP Senasinghe Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya Introduction: Withdrawal of life supporting care is an issue that is much debated. Advance Directive (AD) and Do Not Resuscitate orders (DNR) are legal documents which respect the right of patients. These have not been legalized in Sri Lanka. Objective was to asses the knowledge and attitude about AD and DNR among medical and non medical professionals and clergymen belonging to different religions. Methods: A cross sectional study carried out among in medical and non medical professionals and clergymen belonging to different religions. Results: Of the sample 79.6% doctors and 31.5% non medical professionals had heard of AD and DNR but could not explain their meaning. 82.6% of doctors and 37% of non medical professionals felt that DNR could be implemented in Sri Lanka. Buddhist clergy agreed with AD and DNR if the intention was to save another personâ&#x20AC;&#x2122;s life. Muslim clergy felt that according to holy writings, there are no provisions for AD and DNR. The Catholic clergy felt AD and DNR were only acceptable if the patient was terminally ill. Hindu clergy expressed that destiny has been decided by God and man has no power over it. Conclusions: Knowledge about end of life decisions are inadequate. Religions beliefs influence decisions made about such issues. PP 73: Evaluation of drug related problems in patients admitted to a medical unit of a tertiary care institute in Sri Lanka. LGT Shanika, TS Guruge, S Jayamanne, N Wijekoon, A De Silva, D Perera, , J Coombes, I Coombes, F Mohamed, A Dawson South Asian Clinical Toxicology Research Collaboration Introduction and Objectives: Scientific evaluation of drug related problems in Sri Lankan patients has not been carried out. It is important to identify the scale of drug related problems and the place for pharmacist centred intervention for patient management. The study was done to identify drug related problems and opportunities for intervention in a tertiary care hospital, using a validated tool. Methods: Total of 478 patients admitted to the University Medical Unit, Colombo North Teaching Hospital, over a period of 18 weeks, were interviewed on the day of discharge by a pharmacist. PCNE classification system for drug related problems and Medication Appropriateness Index (MAI) were used to evaluate the appropriateness, safety and efficacy of the medications prescribed on discharge. A post-discharge survey was conducted on patients who gave consent, to assess the knowledge of essential medication related information. Results: The pharmacist identified 1274 opportunities for drug therapy optimisation (an average of 2.7 opportunities/patient). Of them 212 (16.6%) were self-resolved. At least one opportunity for drug therapy optimisation was identified in 97 % of patients. The MAI score per patient was 2.7. In 41% of surveyed patients there had been no prescriber-patient communication regarding medications and the changes made to prescription. Conclusions: A significant number of drug related problems that need intervention were identified. Effectiveness of introduction of clinical pharmacy services in minimising drug related problems in hospitals should be formally evaluated. PP74: Factors affecting patient safety culture in a tertiary care hospital MT Amarapathy, S. Sritharan, MALR Perera Sri Jayawardenapura General Hospital Introduction and Objectives: Patient safety is an important component of quality health care. As health care organizations improve their quality of care, establishing patient safety culture becomes important. According to WHO, rate of adverse incidents in the healthcare system is very high in developing countries. In Sri Lanka, a developing country, adverse events in healthcare system can occur due to lack of infrastructure and equipment, quality and supply of drugs, poor performance of healthcare staff and inadequate financial investment. Methods: This cross-sectional descriptive study was carried out to assess the current patient safety culture in a tertiary care hospital in Sri Lanka. This study was carried out using a self administered questionnaire with eleven dimensions of patient safety culture. Sample consisted of 389 respondents, which included administrative and clinical staff.

Page 139 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Results: Two components, assessment of the patient safety culture in the tertiary care hospital and perception of patient safety culture by hospital staff, were analysed. The percentages of positive responses for variables across the hospital were analyzed. The dimension of patient safety culture with highest positive responses was team work within units (84.8%). Dimensions with lower positive responses were, workload and staff (15.7%), frequency of events reported as they occur (36.3%), non-punitive response to errors (39.4%), communication openness and feedback (62.1%), and team work across the hospital units (65.9%). Correlation between overall patient safety and other variables were found to be significant. Conclusions: According to the results of this study, patient safety culture in this tertiary care hospital is still in preliminary stage. That is a reactive stage but, with strong blame culture. PP 75: Students views on learning anatomy: using cadaveric dissections and computer assisted learning EAST Edirisinghe, SG Yasawardene Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenapura Introduction and Objectives: There is ongoing debate regarding teaching and learning anatomy in the medical curricula. This study evaluates the opinions and views of medical students regarding teaching and learning anatomy at Faculty of Medical Sciences, University of Sri Jayewardenepura. Methods: Total of 285 students of 2006/2007 and 2009/2010 A/L intakes, completed a self administered questionnaire regarding anatomy teaching and learning. Results: The 2006/2007A/L intake, trained in the newly introduced integrated systems-based curriculum were compared with the 2009/2010 intake also trained in the same curriculum. Majority of students (69.8%) felt that anatomy teaching was adequate and useful [65.2% (88/135) of 2006/2007 A/L and 74% (111/150) of 2009/2010]. Sixty seven (24.3%) [26.7% of 2006/2007 A/L and 20.7% of 2009/2010] found it overloaded but useful. Total of 243 (85.3%) students considered cadaver dissections as the most favoured method of learning anatomy. Learning from text books 229 (80.4%), learning at tutorials 221 (77.5%), pre-dissected specimen demonstrations 219 (76.8%) and learning using skeletons 216 (75.8%) were the other useful methods of learning anatomy. One hundred and fifty (52.3%) students preferred the internet and 174 (61.1 %) used interactive anatomy CD or DVDs. Use of the internet for learning anatomy was more among the 2009/2010 (54%) in compared to the 2006/2007 intake (51.1%). There was similar increase from 57.0% to 64.7% in usage of interactive anatomy CD/DVDs Conclusions: Cadaver dissections are the most favoured method of teaching and learning anatomy with an upward trend in computer assisted methods. Majority of students consider anatomy taught at medical school to be adequate and useful. PP 76: Emotional reactions of medical students to cadaver dissections EAST Edirisinghe, SG Yasawardene Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenapura Introductions and objectives: Human cadaver dissection is central in medical teaching and learning in initial years of medical undergraduates. A variety of emotional reactions are experienced when exposed to human cadavers. Adverse physical and psychological effects to human dissection have been reported particularly with European, American and Canadian students with 25.2% experiencing depression and nightmares. Objective of the study was to assess the emotions experienced by medical students at cadaver dissection. Methods: Two hundred and eighty-five students of Faculty of Medical Sciences, University of Sri Jayawardenapura from two intakes 2006/2007 and 2009/2010, completed a simple self administered questionnaire regarding emotions experienced at cadaver dissections. Results: Majority 181 (63.5%) of students was apprehensive about handling or dissecting cadavers when they entered the dissecting hall for the first time. One hundred and forty nine (52.3%) considered cadaveric dissections stimulating and 184 (64.6%) challenging, 144 (50.5%) enjoyable and 165 (57.8%) as informative. Female medical students were 3.3 times more worried than male students when entering the dissecting room for the first time. 156 (54.7%) students felt that interaction with anatomy department staff explaining and mentally preparing for dissections prior to entering the dissecting hall would lessen the emotional impact and reduce anxiety. 152 (53.3%) considered cadaver dissection based teaching as an important educational method, and 285 (83.5%) considered it to be helpful for future surgical skills.

Page 140 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Conclusions: Although the majority of medical students are initially apprehensive towards dissections they realize the value of dissections as an educational and surgical skills training method. The initial adverse emotional reactions to cadaver dissections are relatively less than that documented in Europe, America and Canada. PP 77: The use of inappropriate abbreviations in prescriptions NR Samaranayake, PRL Dabare, CA Wanigatunge, BMY Heung University of Sri Jayewardenepura Introduction and Objectives: Use of inappropriate abbreviations in prescriptions have led to medication errors. We investigated the use of inappropriate abbreviations in prescriptions. Methods: Prescriptions of outpatient and specialty clinics dispensed by the outdoor pharmacy of a teaching hospital in Sri Lanka were reviewed during a period of one month, and details of the abbreviations used were recorded. The lists of abbreviations of the Australian Commission on Safety and Quality in Healthcare and the Hong Kong Hospital Authority were used as a guideline to determine standard and error-prone abbreviations. Results: Total of 3370 drug items (989 prescriptions) were reviewed. The mean number of abbreviations per prescription was 5.9 (SD 3.5). The rate of error-prone abbreviations were, µg (microgram) 17.4%, mcg (microgram) 0.1%, u (units)1.9%, cc (cubic centimeter) 0.2%, OD (once a day) 0.2%, @ sign 4.9%, d (days/daily) 23.5%, m (morning) 4.4% and n (night), 15.8%. Among the 103 types of abbreviations observed, 71 were not standard acceptable abbreviations. Multiple abbreviations were used to indicate a single drug item or instruction (n = 7). The abbreviation “d” was used to denote “daily” as well as “days”. Conclusions: Error-prone abbreviations are used by prescribers. Many other unapproved abbreviations are also used frequently in the hospital. There is a need to eliminate the use of error-prone abbreviations, introduce a standard abbreviation list and educate health professionals on the importance of avoiding inappropriate abbreviations in prescriptions. PP 78: Elder abuse in a selected Medical Officer of Health area in the district of Colombo: prevalence of physical, emotional and financial abuse and neglect PC Samaraweera1, S Kathriarachchi2, S Sivayogan3, A Wijayasiri3 1 National Dengue Control Unit, Department of 2Psychiatry and 3Community Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura Introduction: Elder abuse is defined as physical, emotional, sexual or financial maltreatment or neglect of a person made vulnerable by advanced age. Prevalence of elder abuse has not been studied in detail in Sri Lanka Aims: The purpose of this study was to determine prevalence of physical, emotional or financial abuse or neglect among elderly aged ≥60 years in a selected MOH area in the district of Colombo. Methods: A descriptive cross sectional study was carried out in a MOH area in Colombo; involving 1500 elderly participants selected using a cluster sampling technique. Abuse among elders was assessed using Elderly Abuse Assessment Questionnaire [EAAQ] which was developed and validated by the authors. Results: The sensitivity for overall abuse in the EAAQ was 83.7% (95% CI 70.9-91.4) and specificity for overall abuse was 92.7% (95% CI 87.4-92.7). The reliability of the EAAQ was found to be satisfactory. The overall response rate was 96.5% .The prevalence of any type of abuse was 19.2% while the prevalence of physical abuse was 2.7% (95% CI 1.9-3.7) and the prevalence of financial abuse was 3.7% (95% CI 2.8-4.6). The prevalence of emotional abuse was 14.4% (95% CI 12.7-16.6) while prevalence of neglect was 15.1 (95% CI 13.3-17.0). Children were the main perpetrators of abuse followed by the daughters in law or sons-in-law. Conclusions: Study revealed that elder abuse exists to a considerable extent in Sri Lanka indicating the need for urgent intervention. Relevant authorities and also to the scientific community should be made aware of elder abuse. PP 79: Validation of Sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) and evaluation of health related quality of life among patients with cirrhosis in Sri Lanka JKND Miththinda, CK Ranawaka, A Pathmeswaran, AS Dassanayake, WRS de Alwis, MNF Mufeena, SM Senanayake, MA Niriella, AP de Silva, HJ de Silva Departments of Medicine, Faculty of Medicine, University of Kelaniya Aims: Our aim was to validate a Sinhala version of the CLDQ (sCLDQ) and to test its correlation with the degree of liver dysfunction in a cohort of Sri Lankan cirrhotics. Page 141 of 142

ABSTRACTS OF POSTER PRESENTATIONS

Methods: A standard method was used to translate the CLDQ to Sinhala. Pilot testing was done and relevant cultural and language adaptations made. The final version was self-administered to stable chronic liver disease (CLD) patients, together with the WHO Quality of Life-BREF (WHOQOL-BREF) validated Sinhala version, for comparison. The sCLDQ was re-administered 4 weeks later to test internal consistency and reliability. The validation was assessed using Cronabach’s alpha, intraclass correlation coefficient (ICC) and Pearson’s correlation coefficient. ANOVA and Pearson’s correlation were used to test correlation with the degree of liver dysfunction. Results: Validation was done with 48 subjects, mean age 55.6 (SD 10) years; male 79%. Item total correlations of sCLDQ varied from 0.30-0.82. Overall Cronabach’s alpha was 0.92. Re-administration of sCLDQ yielded an ICC of 0.54 (p=0.02). There was a significant correlation between sCLDQ and WHOQOL-BREF (r=0.34; p=0.03). Validated sCLDQ was administered to a different cohort of 202 cirrhotics with mean age of 55.3 years (SD 10.5); male 77%; mean duration of cirrhosis 2.7 years (SD 2.9) years. Higher Child class (F=0.000; p=0.017) and hyponatraemia (r=0.213; p=0.005) were associated with worse sCLDQ scores. There was no significant association between sCLDQ score and MELD (r=-0.128, p=0.072). Conclusions: The sCLDQ is a reliable and valid tool to assess QOL of Sri Lankan cirrhotics and it correlates with known indices of disease severity. PP 80: Liver functions; alpha fetoprotein levels and clinical features in patients with hepatoma NS Jayasinghe, RL Satarasinghe, PJ Rathnayake, IGI Dissanayake, R Wijesinghe Sri Jayewardenepura General Hospital Introduction and Objectives: Objective was to study liver function, the tumor marker alpha fetoprotein and associated co-morbid factors in a cohort of adult hepatoma patients admitted to medical units of a tertiary referral centre. Methods: Case notes of 42 consecutive hepatoma patients admitted to medical units at Sri Jayawardenepura General Hospital, Kotte, from January 2008 to January 2012 were retrospectively analyzed to obtain the required information. Results: Age range was 43-91 years; mean 65.5 years (SD11.1). Sex distribution male: female was 9:1. The results of the liver function tests were as follows. ALP mean 787.3 u/l (SD 661.3 range 158-3829); AST mean140.3 u/l (SD 82.9, range 35-365); ALT mean 75.5 u/l (SD 48.3, range 20-234); Albumin mean 2.88 g/dl (1.5-6.3) INR mean 1.27 (SD 0.3 range 0.9-3) The major co morbid conditions were diabetes mellitus (38.1%), hypertension (16.7%) and ischemic heart disease (11.9%). Alpha fetoprotein levels were <10, 10-350,>350 in 17.2%, 27.6%, 55.2% of the instances. Ascites 45.2%, hepatic encephalopathy 35.7%, upper gastro intestinal bleeding 16.7%, spontaneous bacterial peritonitis 9.5% were also present. Conclusions: In some patients liver function tests and alpha fetoprotein levels were not elevated. Major complications were those of chronic liver disease. Diabetes mellitus was the commonest co-morbidity. PP 81: Autoimmune hepatitis in Sri Lanka: How common are conventional serological markers? KRP Perera1, CK Ranawaka1, FHDS Silva1, JKND Miththinda1, AS Dassanayake1, MA Niriella2, AP de Silva2, HJ de Silva2 1 Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama 2 University Medical Unit, Colombo North Teaching Hospital, Ragama Introduction and Objectives: Autoimmune hepatitis (AIH) is an immune mediated chronic hepatitis of the liver of unknown etiology. AIH cannot be diagnosed by using a single diagnostic test. The diagnosis is made by different scoring systems based on combination of biochemical, autoimmune, and histological parameters, and exclusion of other liver diseases. Autoantibodies are a hallmark of autoimmune hepatitis and constitute an important part of the diagnostic work-up. We aim to study the serological profile of AIH in a Sri Lankan cohort. Methods: AIH database of gastroenterology clinic, Colombo North Teaching Hospital was analysed retrospectively. The Revised Original Scoring System of the International Autoimmune Hepatitis Group was applied to define the cases of (definite or probable) AIH. Results: Data of eighteen patients whose data was complete was analysed. 11/18 fulfilled the criteria for definite AIH and 7/18 fulfilled the criteria for probable AIH. Of 18 patients with AIH, mean age was 40.25 (SD 9.1) years and 14 (77.7%) were females. Among these 18 patients only 3 (28.3%) were positive for antinuclear antibodies (ANA), 2 (11.1%) had smooth muscle antibodies (SMA) but none of these patients were positive for antibodies to

Page 142 of 142

ABSTRACTS OF POSTER PRESENTATIONS

liver/kidney microsome type 1 (anti-LKM-1). All 18 patients were treated with prednisolone and azathioprine and 16 responded to treatment, but 2 patients did not respond to treatment and the condition progressed to cirrhosis. Conclusions: Autoimmune markers appear to be less common in this cohort of patients with probable or definite AIH. PP 82: Crohn’s disease with henoch schonlein purpura: first documented case in Sri Lanka NS Jayasinghe, RL Satarasinghe, R Wijesinghe, PJ Rathnayake, N Rasendran, Sri Jayewardenepura General Hospital Introduction: Henoch-Schonlein purpura is a syndrome characterized by cutaneous purpura, arthritis, nephritis, abdominal pain, and gastrointestinal bleeding. The clinical features of HSP are a consequence of widespread leukocytoclastic vasculitis caused by immunoglobulin (Ig)A deposition in vessel walls. The coexistence of HSP and inflammatory bowel disease has only been reported in pediatric age groups. The causes of HSP and Crohn’s disease are unknown. It is clear, however, that IgA plays a central role in the immunopathogenesis of HSP. Crohn’s disease appears to be a T-cell mediated disease, and there is little if any evidence that IgA or circulating immune complexes play any role in the pathogenesis of Crohn’s disease. Case report: A 31-year old patient presented with a vasculitic rash over lower limbs and buttocks, with associated multiple, large joint arthritis. He also had recurrent episodic abdominal pain with dyspepsia and frothy urine. The illness had started 8 months ago with similar vasculitic rash and frequent episodes of bloody diarrhea. He also had a history of renal stones. Endoscopy showed pangastritis and colonoscopy showed evidence of Crohn’s disease. Colonic biopsy confirmed Crohn’s disease. There were no features of gut henoch-schonlein purpura (HSP). Skin biopsy showed leucocytoclastic vasculitis. Urine full report showed significant microscopic hematuria with proteinuria. Twenty four hour urine collection had subnephrotic range proteinuria (935.26 mg/dl). Renal functions were normal. ANA, c-ANCA, p-ANCA were not detected. Dual pathology of Crohn’s disease with henochschonlein purpura (HSP) was confirmed. He was treated with prednisolone and azathioprine.

Page 143 of 142

PARTNERS AND SPONSORS Gold Sponsor

State Pharmaceuticals Corporation of Sri Lanka

Silver Sponsors

Brandix Lanka Limited Fortis Memorial Research Institute Global Hospitals Chennai National Science Foundation Reckitt Benckiser Unilever Sri Lanka Ltd World Health Organisation